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At Geisinger, the Path is Paved to Patient Empowerment

September 17, 2014
by Rajiv Leventhal
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In 2012, Leonard Kish, a health IT strategy consultant made the claim that if patient engagement were a drug, it would be the “blockbuster drug of the century.” When patients were actively engaged in their health, clinical care would improve, Kish said.

On September 16, at the Institute for Health Technology Transformation (iHT2) Health IT Summit in New York City, Gregory Moore, M.D., Ph.D., chief emerging technology and informatics officer at the Danville, Pa.-based Geisinger Health System, brought up Kish’s quote as a precursor to outlining the innovative and transformative things that are taking place at Geisinger, an integrated health system that now serves more than 3.5 million people. (Since December 2013, Healthcare Informatics has been in partnership with iHT2, through its parent company, the Vendome Group, LLC.)

Moore began his presentation by naming the six main drivers of high healthcare costs and poor quality of care: mistakes, unjustified variation; fragmented care; perverse payment incentives; supply-demand mismatch; and the patient being too passive a recipient of his or her care. “Many people would say that it’s the doctor’s responsibility for the patient to be less passive,” Moore said about the last driver. But people might not realize that for a family practitioner to take on that responsibility might be an 18-21 hour-per-day commitment, he said.

As such, the health system has recently established the Geisinger Institute for Advanced Application (GIAA), comprised of three components, directed by Moore: The Center for Reengineering Healthcare; The Center for Emerging Technology and Informatics; and the Center for Clinical Innovation. The broad goal of these three centers, said Moore, is to reduce costs and improve the quality of care. “That will be done by addressing issues head on,” he noted.

 For instance, The Center for Clinical Innovation is studying the care of large populations, patient and family engagement, and healthcare systems technology. In terms of patient engagement, Geisinger has three main objectives for each patient in its system: understand my health; manage my visit; and control my condition. To that end, Moore stressed the use of technology to enhance patient engagement, referencing that only one percent of a person’s life is spent with healthcare professionals, and that to activate patients, you have to meet them where they are. “Patients have multiple gaps in their care, and nurses and providers are overwhelmed within an office encounter,” Moore said. “You need to move work out of the office.”

Gaps in care are about moving data into action, he said, noting that Geisinger analyzes approximately 550,000 patients per day in an effort to close those gaps. A key to that process is identifying the gaps in care two weeks before a patient visit. This way, all lab work and procedures that need to be performed can be taken care of in advance of the visit. This level of anticipatory management has led physicians to make comments such as “Patients are definitely more prepared for their visit,” and “It takes the stress off of me.”

As a result, from 2010-2013, Moore said that Geisinger closed 250,000 gaps in care, leading to more than $30 million in fee-for-service revenue collected. “This approach is very patient centric, and quite frankly, it’s right for healthcare,” he said.

What’s more, the health system’s MyGeisinger online health management tool has 11,000 daily log-ins, 77,000 users per month, and 6,000 mobile app users. And while the majority of portal users are in the 35-54 age group, plenty of elderly patients use it as well, said Moore. Moore gave an example of how the tool can be used to assess risk for a certain disease and make a care management plan based on the patient’s preferences. For cardiovascular disease, Geisinger’s data might generate that a certain patient has a 26 percent chance of getting a heart attack in the next 10 years. “We provide that information to the patient and give them choices to lower that risk. Each thing they choose can decrease that risk even more until they reach their goal. We’ll cater it to their wants and ask what action (diet, exercise) they would like to start with first,” Moore explained.

Another big area where Geisinger is working to improve patient engagement is medication reconciliation, Moore noted, as medication adherence is a $290 billion problem in the U.S.  At Geisinger, 2,500 patients have been enrolled in its medication adherence program since 2011. Almost half of patients aren’t taking at least one medication listen in the electronic health record (EHR), while a quarter are taking a medication not on the list, Moore said. “This is a target area for us,” he said, adding that if the patient fills out the data at home, it allows the pharmacist to review it before the next visit. “Patient-reported data gives patients a voice in the measurement of their care. It will tell us if healthcare helps patients feel better and live their lives better,” he said.

Lastly, Moore mentioned the health system’s participation in the OpenNotes initiative, a project that brought together 105 primary care doctors and more than 19,000 of their patients to evaluate the impact on both patients and physicians of sharing doctors’ notes after each patient encounter. Led by Tom Delbanco, M.D., and Jan Walker, R.N. of Boston’s Beth Israel Deaconess Medical Center (BIDMC), the study included 24 primary care physicians and 8,700 patients at Geisinger and additional patients and physicians from BIDMC and Seattle-based Harborview Medical Center.

These notes are different from regular visit summaries, which give patients more limited snapshots of their visits. Conversely, a note contains a detailed account of the visit, including the history, exam, relevant lab or study findings, and the clinician’s assessment and plan of care. Moore said the project has had overwhelmingly successful results: 90 percent of patients better understand their health and medical conditions; 84 percent of patients take better care of themselves; and 91 percent feel more in control of their healthcare after viewing their notes.

And while physicians who took part in the project had plenty of concerns in the beginning—such as longer patient visits, more time addressing patient questions outside of the office, more time writing notes, and less candid documentation—the level of concern went down significantly after the program took off. Comments from physicians included “I think patients believe something I write in the chart more completely than when verbally communicated,” Moore noted. One year in, Moore said that 99 percent of patients wanted to continue to see their notes online, and that 370,000 patients have been impacted by the initiative.

Moore concluded by encouraging direct data sharing with patients, but urged that sharing information must be done properly. “Data and analytics have the potential to overwhelm patients, so it must be done in a meaningful way,” he said.

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