As it turns out, when the leaders of patient care organizations strive for patient engagement, a host of issues becomes triggered. That certainly has been the case at the organizations represented by discussants in a panel held Oct. 7 during the Health IT Summit in Chicago, held at the Intercontinental Hotel in downtown Chicago this week, and sponsored by the Institute for Health Technology Transformation (iHT2, a sister organization to Healthcare Informatics, under our corporate umbrella, the Vendome Group LLC).
The discussion session, entitled “Tools and Strategies to Engage Your Patient Population,” covered a wide range of issues, from how to fully activate patients, to connecting patients to meaningful care management and other processes.
The panel was moderated by Cynthia Burghard, research director at the Framington, Mass.-based IDC Insights. She was joined by Krishna Ramachandran, chief administrative officer at the DuPage Medical Group, a 500-physician, 70-location multispecialty group based in the Chicago suburb of Downers Grove; Tom Scaletta, M.D., chair of Emergency Medicine at Edward Hospital, in the Chicago suburb of Naperville; and David Kaelber, M.D., Ph.D., M.P.H., chief medical informatics officer at MetroHealth System, Cleveland.
Burghard noted that, “Historically, we have said, if we build health information exchange, they will come. But is that theory really going to apply here? In fact,” she said, “The paradigm is shifting to go to where the patients are.”
Kaelber stated, “The more we can go to where the consumer is, the more effective we will be. There are so many people who can benefit from the interaction, and how do you focus on what they need?” He recounted the story of an actual patient being cared for by a MetroHealth primary care physician. “This was a male patient who had not been compliant in taking his medications,” Kaelber noted. “They tried everything, and finally they ended up having a physician call this patient every morning at 9 a.m. to see whether he had taken his medication. That worked. They asked him why and he said, ‘Well, Henry calls every morning, and I can’t disappoint him!’ So what do we mean by patient engagement?” Kaelber asked. “It’s one of those questions where you ask five people, you get 10 different answers.”
Scaletta said, “I’d like to also differentiate patient experience from patient engagement. Patient experience is a sort of end-to-end thing. Every way in which we interact with patients is shaped by the culture of your organization, and affects the relationship with the patient. Engagement to me is about relationships; and the end goal is to get the patient activated, so that they’re motivated to learn and become active in their health.”
At DuPage Medical Group, “We also see the experience and the engagement as separate,” Ramachandran said. “Engagement, we slice into three buckets: we have the healthy patients; we just need make sure they’re OK and healthy; we have the rising-risk patients; and the high-utilizing patients. And we need to apply a high-touch form of engagement with them.”
“Patient engagement becomes very tactical, and happens in five or ten different places in an organization,” Burghard noted. “In other industries, there are chief customer [experience] officers, but they are different from healthcare. Is your organization thinking about this?” she asked her fellow panelists.
“We’re interested in both patient experience and patient engagement,” Kaelber offered. “This is something that the healthcare system needs to move into. We’re trying to take a very strategic approach; but there are not a lot of models out there for us to follow. It’s one thing to ask, don’t we want to engage patients more? And everyone says yes,” he said. “But then you have to figure out how to make it happen tactically, and so we have this big vision, but it’s being executed in little tactical pockets. On the technology side, we have our personal health record portal and direct patient messaging,” he noted. “And then we have the people side of this. And you only want to throw resource-intensive operations and programs at patients who are already resource-intensive.”
“And you certainly have a specific population, with some rather frail patients,” Burghard said, referring to the demographics of MetroHealth’s market in Cleveland. “And so everyone has to make it work in their own market. And who’s responsible for patient engagement? Is it the care managers in the physician office, the office staff, the physicians? Or everyone?” she asked.
“Strategy without tactics doesn’t go anywhere, either,” Ramachandran asserted. “So we have a director of patient experience who pulls the program together, with support from the board and CEO, but then with tactics to make sure we’re operationalizing this within our workflow. And we have MyChart within Epic, and our CEO made it a goal to get patients active on MyChart, and a whole bunch of tactics came out of that. And about 50 percent of our patients are active on MyChart now. So that’s an example of how tactics formed out of strategy are operationalized in the organization.”
Scaletta noted that “We were talking about risk stratification, and as patients become older and sicker, the intensity of interventions around them rises, as a result of aging, primarily. And we want to backfill with younger patients in high-deductible plans. They want to spend their money wisely. And they’re at the center of patient engagement, in my view. So we’ve done a few things, but the current thing will be tied to our new brand, HealthEDriven, a new service standard that outlines our expectations and how we engage with patients. And when you come to our facilities, which extend out now, there are all sorts of examples in other industries, like Starbucks and JiffyLube, but it remains lacking [in execution] in healthcare.”
“Creating key performance indicators around patient engagement seems to be an important step forward. What kinds of metrics are you all using?” Burghard asked the panel.
“We do look at the number of patients who sign up for the portal, but that’s more a process than an outcomes measure,” Kaelber said. “And a healthy patient isn’t going to check their portal every day. And we try to measure useful things, for example, the number of times patients looked at test results or immunizations. And we see each one of those as sort of a “mini-save”—and if they log on at 2 in the morning, we wouldn’t be responsive to them at that time in any case. And one of the killer apps we’ve seen in terms of patient engagement, is self-scheduling. I literally see people smiling when they find out they can schedule for themselves online. We do allow people to enter things like blood pressure, blood sugar and weight—and yet somehow, those are things we get very poor adoption for, in terms of adding that data in themselves. We just went live with bill-paying online, but we still haven’t found clinical killer apps in that area.”
“We have a survey that goes out, in order to find out if a patient had a great experience with a particular provider,” Scaletta reported. “And the score goes out, and we actually have created a certain threshold around this.”
“A lot of the patient surveys have to do with elements like, were the restrooms clean, was the waiting room attractive and quiet, and so on,” Burghard said. “But really, if you’re talking about accountability, you really have to make sure that patients are having good experiences with their physicians and other providers.”
“There are lots of indicators there,” Ramachandran said. “And yes, we have a physician dashboard” to help physicians understand what’s going on with their patients and patient panels.
“Patients are motivated to do this, but we’re trying to incent the physicians around this, too,” Scaletta noted.
Ramachandran reported that “We look at lots of elements, such as active e-visits, active messaging, active online bill-paying, and so on. So there’s an operational aspect to this, with a lot of features around convenience for patients.”
“David, I’m interested to learn a little bit more about the use of the personal health record as a vehicle for communication between patients and physicians,” Burghard said.
“One of our strategies was that when we turned on the PHR, that every physician, not just primary care physicians—was messageable,” Kaelber said. “And in the same way that most people can’t call their physicians directly, they go to a team—usually the physician’s office staff. And If a doctor responds or initiates a message, they can set the flag for the patient to respond directly to the doctor, or to their care team. And we see this as good, because it’s asynchronous communication, and that patient and doctor can respond as they can.”