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Getting Right with Patients and Families: One Florida Surgery Center Leverages IT to Improve Flow

June 7, 2017
by Mark Hagland
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Mike Madewell, Panama City Surgery Center’s administrator, explains how his organization improved patient flow and satisfaction, and operational efficiency

With its relatively high volume of approximately 900 cases a month, Panama City Surgery Center (PCSC) in Panama City, Florida is an outpatient clinic whose 84 staff members feel the need to be maximally efficient, especially maximally time-efficient. In that regard, the surgery center’s leaders have, like virtually all of their peers across the U.S. healthcare system, struggled historically to manage patient flow and patient traffic throughput, in a way that improves the patient experience and clinician and practice productivity.

Leaders at PCSC turned to the Panama City-based technology vendor Jellyfish Health for support in their efforts, making use of its Jellyfish Access platform in order to replace the  typically protracted wait in many high-volume facilities, with self-service check-in, shortened wait times, and real-time updates to family members on patient progress. As a result, PCSC has been able to reallocate the time of a full-time lobby receptionist to other needs, while reducing registration time by 68 percent. Positive feedback from patients and family members has been overwhelming, which portends well for the surgery center's patient satisfaction scores. In a related benefit, completed patient satisfaction surveys have increased by 28 percent now that patients can quickly fill them out from their mobile phone or computer as part of the Jellyfish solution.

Recently, Healthcare Informatics Editor-in-Chief Mark Hagland interviewed Mike Madewell, administrator of Panama City Surgery Center, regarding the organization’s initiative around improving patient flow, communication with patients and families, and efficiency improvement. Below are excerpts from that interview.

Your organization, Panama City Surgery Center, provides a broad range of surgical services, correct? Do you specialize in any particular areas?

Actually, we do everything but eyes. We don’t have ophthalmology, but urology, gynecology, orthopedics, gastroenterology, plastic surgery, general, surgery, pain management.

What was your baseline experience like, in terms of patient flow management and the clinician productivity related to patient flow? Why did you decide to engage a solutions provider?

As we got busier, we realized that we were having two problems. The first was at the registration desk itself. We operate with only two registrars; otherwise, we’d have someone busy in the mornings but without anything to do in the afternoons. But at peak patient traffic times, as we got so busy that that [having two registrars on duty] wasn’t enough, we had people waiting to get registered, or people waiting in the back. And we realized that pre-registering patients would help. There’s a software called OneMedicalPassport, which allows patients to complete a great deal of information via online pre-registration. With the help of that software, we call patients prior to surgery and ask them their medications and history, and that process is done by nurses. And that gives patients a log-in, and they can fill in their own information, so that nurses can review that information before calling the patient, so that speeds up that process.

And in our preoperative phone call process, the OneMedicalPassport solution helped streamline that process. It allowed us to not have to hire a third nurse to pursue that process. And we realized that we needed the same type of solution for front-desk registration, as it kept getting backed up. We needed patients to be able to check in without having to wait to check in. So if a patient were waiting to check in, they could check in with the Jellyfish process. So when I first started having this discussion with Jellyfish, and their design was designed for physician offices, I saw that it could work for us.

The other issue that we were having was a problem that Jellyfish could help resolve—once patients are checked in, and we have them checked in for surgery, and they have family members waiting in the lobby—and the biggest source of dissatisfaction is family members waiting for status updates. And there are all kinds of reasons why things don’t go as planned in surgery. And the challenge is communicating the updates, including delays, to family members in the lobby. And we used to have the kinds of pagers that restaurants have. But if they’re planning on waiting three hours, the range wasn’t broad enough; and there were privacy issues around phone calls. So we ended up having a full-time employee sitting in the lobby to manage that process, and that kind of helped, and patients appreciated that we were trying to communicate with family members.

And the thing is, moving forward, we will be paid partly based on patient satisfaction. It’s more than just making sure the surgery went well. And what we were finding is that most of the negative comments we were getting weren’t from patients, but from family members. And most of those comments related to wait times that were longer than expected, and they couldn’t get information; it was that whole information breakdown process.

And what we found out is that, when you’re asking the patient o fill out a survey, a lot of the comments were based on their families’ experiences. We were finding out that the patient would get home, and they would start talking with their families. And if the family member had had a bad experience—they hadn’t been communicated with, etc.—then the survey results would come out somewhat negative. So getting a solution was really important.

So what did you do, as you began this process of innovation?

We talked to Jellyfish, and they said, well, our program was designed for physician offices, but we think it would work perfectly for you. So we looked at what they had, and modified it for our processes, and went live in February, and we added a second terminal. We have operating rooms and preop areas that a physician office doesn’t have. But a patient comes in, they get a unique identification number, and put their cell phone number into the system. So now we can send them a text. And if it’s going to be a long surgery, the family member can go shopping and come back. Or if we need to communicate anything else to them. And the screen in the lobby shows all the different areas in the surgery center. It’s like when you’re on an airline flight and the screen shows you where your plane is. So I can look and see where my family member is, by a number that identifies them. So I know where they are. And if there’s an update or delay, the program will say, “Patient 48 is in the operating room,” and when Patient 48 goes to recovery, that number pops up on the screen, from Recovery. And a little message will pop up saying that Patient 48—the family member can go talk to the doctor. So you’re not having to track people down.

And because of that, I’ve eliminated that full-time position of that person who sits out in the lobby. And the patients like it, because it’s real-time information, they don’t have to ask what’s going on anymore. Family members, from day one, have said, this is really awesome. I feel more comfortable now because I know where my family member is.

The thing is, we can have 40 people in the lobby at any given time. Having to have someone run back and forth is too difficult. My staff loves it because it’s easier. And I love it because I was able to repurpose that staff member. And the patients and family members love it.

And there are a number of dimensions to all this, correct?

Yes; there are other parts to the software that we’re rolling out soon. There’s a physician communication piece that’s next. If a physician has an app on his phone and start-time for a particular time—the system has an algorithm that can see that a room is delayed for an hour, and it notifies Dr. Jones. It automates that process, too, something that we were having to manually do.

So there’s a lot of time savings, and that translates into FTE savings. But the biggest thing for me is that patient satisfaction. We finally have a tool to use that really resolves that issue about communicating with family members in the lobby. All the other solutions we had tried were very labor-intensive, and didn’t really solve the problem. That’s the biggest thing that we like about it. And quite honestly, there are clinical studies out there that show that patients who are happy, heal faster. That mental state that they’re in has an effect on the healing process. On the other hand, if they go home stressed and their family members are stressed, they won’t heal as fast. So it’s not just about positive ratings, it’s about a healing experience.

What advice might you have for CIOs and other healthcare IT leaders, based on your experiences here?

I would share with them the same advice that I’d give around implementing any new software. There is a period of learning that will take place, and there’s a learning curve, and there’s a period of adjustment. And that learning curve isn’t very big with Jellyfish. But once you’ve gone through that, there’s no way you won’t be happy with the results.

We all have to use software to run parts of our businesses and lives, and the most frustrating thing is that when software is working fine, we’re happy with it, but when there’s a problem, how quickly does the vendor respond? Jellyfish has always been great and very immediate. We’re getting ready to change our base software that we run our surgery center off of, and when I went to Jellyfish and told them we needed an interface, and their response was, no problem, we’ll interface with anybody. And you’re always going to have hiccups and glitches, but their response was great.

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AMIA, AHIMA Call for HIPAA Modernization to Support Patient Access

December 7, 2018
by Heather Landi, Associate Editor
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Modernization of the 22-year-old Health Insurance Portability and Accountability Act (HIPAA) would improve patients’ access to their health information and protect their health data in a burgeoning app ecosystem, according to two leading health IT industry groups.

During a briefing on Capitol Hill Wednesday, leaders with the American Medical Informatics Association (AMIA) and the American Health Information Management Association (AHIMA), health informatics and health information management experts discussing how federal policies are impacting patients’ ability to access and leverage their health data.

While other industries have advanced forward with digital technology and have improved individual’s access to information, and the ability to integrate and use information, such as booking travel and finding information about prices and products, healthcare has lagged. Healthcare has not been able to create a comparable patient-centric system, AMIA and AHIMA leaders attested.

“Congress has long prioritized patients’ right to access their data as a key lever to improve care, enable research, and empower patients to live healthy lifestyles,” AMIA president and CEO Douglas B. Fridsma, M.D., Ph.D., said in a statement. “But enacting these policies into regulations and translating these regulations to practice has proven more difficult than Congress imagined.”

“AHIMA’s members are most aware of patient challenges in accessing their data as they operationalize the process for access across the healthcare landscape,” AHIMA CEO Wylecia Wiggs Harris, Ph.D. said. “The language in HIPAA complicates these efforts in an electronic world.”

AMIA and AHIMA recommend that policymakers modernize HIPAA by either establishing a new term, “Health Data Set,” which includes all clinical, biomedical, and claims data maintained by a Covered Entity or Business Associate, or by revising the existing HIPAA “Designated Record Set” definition and require Certified Health IT to provide the amended DRS to patients electronically in a way that enables them to use and reuse their data.

According to AMIA and AHIMA, a new definition for “Health Data Set” would support individual HIPAA right of access and guide the future development of ONC’s Certification Program so individuals could view, download, or transmit to a third party this information electronically and access this information via application programming interface. Alternatively, a revision of the current DRS definition would provide greater clarity and predictability for providers and patients.

The groups also noted that a growing number of mHealth and health social media applications that generate, store, and use health data require attention as part of a broader conversation regarding consumer data privacy.

Congress should “extend the HIPAA individual right of access and amendment to non-HIPAA Covered Entities that manage individual health data, such as mHealth and health social media applications, the two groups said. The goal is uniformity of data access policy, regardless of covered entity, business associate, or other commercial status, the group leaders said.

Beyond HIPAA, during the briefing Wednesday, panelists discussed the success of efforts to share clinical notes with patients during visits, including the successful OpenNotes initiative, and recommended that federal officials look for ways to encourage more providers to share notes with patients through federal policies, such as Medicare and Medicaid payment programs.

“More than two decades after Congress declared access a right guaranteed by law, patients continue to face barriers,” Thomas Payne, M.D., Medical Director, IT Services, UW Medicine, said in a statement. “We need a focused look at both the technical as well as social barriers.”

What’s more, AMIA and AHIMA recommended federal regulators clarify existing regulatory guidance related to third-party legal requests, such as those by attorneys that seek information without appropriate patient-direction.

“HIM professionals continue to struggle with the existing Office for Civil Rights guidance that enables third-party attorneys to request a patient’s PHI,” Harris stated. “We recognize there are necessary circumstances in which a patient has the right and need to direct their health information to an attorney. However, AHIMA members increasingly face instances in which an attorney forwards a request for PHI on behalf of the patient but lacks the information required to validate the identity of the patient. As a result, the HIM professional is challenged as to whether to treat it as an authorization or patient access request, which has HIPAA enforcement implications

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Health Systems Work with Epic on Electronic Patient-Reported Outcomes for Oncology

November 18, 2018
by David Raths, Contributing Editor
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With eSyM app, patients will provide feedback to their cancer care team via the EHR

Six U.S. healthcare systems are sharing a $9 million grant to research introducing electronic patient-reported outcomes (ePROs) into the routine practice of oncology providers to improve symptom management and to decrease hospitalizations.

The National Cancer Institute, in association with the Beau Biden Cancer Moonshot Initiative, recently announced the funding of the collaboration, the SIMPRO (Symptom Management IMplementation of Patient Reported Outcomes in Oncology) Research Center. The SIMPRO team will work with Epic, the EHR system used by all six participating institutions, which are New Hampshire-based Dartmouth-Hitchcock, Dana-Farber/Brigham and Women’s Cancer Center in Boston, Baptist Memorial Medical Center in Memphis, Lifespan Cancer Institute in Rhode Island, West Virginia University Cancer Institute, and Maine Medical Center in Portland.

SIMPRO will develop, implement, and evaluate an ePRO reporting and management system through an app called eSyM. Patients’ smart devices will enable a secure connection to their cancer care team via the EHR, and facilitate symptom tracking following cancer surgery or chemotherapy. The study will test whether monitoring the symptoms patients experience and providing coaching on how to manage them can decrease the need for hospitalizations and emergency room visits.

“The opportunity to partner directly with Epic and their resources, to build these tools into our electronic health record, means in the short-term the research is more likely to bear fruit “and in the long-term that successful strategies can be disseminated around the country.” said Dartmouth-Hitchcock Chief Health Information Officer Peter Solberg, M.D., in a prepared statement,

After development and pilot testing, eSyM will be fully integrated into the EHR at each participating center, allowing for direct communication and real-time updates for clinicians who will have access to a dashboard of patients’ symptoms to prioritize outreach efforts and coaching.

The SIMPRO investigators will conduct a randomized trial to evaluate implementation of eSyM from a patient, clinician and health system perspective. Across all study phases, the implementation, adoption, acceptance, and adaptation of the ePRO system will be critically evaluated to promote better delivery of cancer care.



Related Insights For: Patient Engagement


UnitedHealthcare to Award Members with Apple Watches for Meeting Daily Walking Goals

November 16, 2018
by Rajiv Leventhal, Managing Editor
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UnitedHealthcare Motion, an employer-sponsored wellness program, is telling its participants they can get a free Apple Watch if they meet the insurer’s daily walking goals over a six-month period.

Participants can start receiving and using the Apple Watch (initially paying only tax and shipping) and then apply program earnings toward the purchase price of the device. Participants may be able to own, with a zero balance, an Apple Watch after approximately six months of meeting daily walking goals, the insurer announced this week. If members already own an Apple Watch, they can use the one they have.

UnitedHealthcare Motion, since 2015, has been providing eligible plan participants access to wearables that may help them earn over $1,000 per year by meeting certain daily walking goals. Since the program’s inception, participants have collectively walked more than 235 billion steps and earned nearly $38 million in rewards, according to officials.

Program participants can now use the Apple Watch to see how they are tracking against the program’s three daily goals—frequency, intensity, and tenacity—helping integrate physical activity and engagement with their health plan.

Indeed, UnitedHealthcare Motion is available to employers with self-funded and fully insured health plans across the country. The program may enable employees to earn up to $4 per day in financial incentives based on achieving FIT goals:

  • Frequency: complete 500 steps within seven minutes six times per day, at least an hour apart;
  • Intensity: complete 3,000 steps within 30 minutes; and
  • Tenacity: complete 10,000 total steps each day.

“This program is part of UnitedHealthcare’s broader effort to provide people with wearables, digital resources and financial incentives that help them take charge of their health, better manage chronic conditions and make care more affordable,” officials noted.

Indeed, these efforts build on UnitedHealthcare’s existing consumer offerings, powered by Rally, which have enabled people to earn more than $1 billion in health-related financial incentives since 2016, the insurer stated.

Among all eligible UnitedHealthcare Motion participants, more than 45 percent participated in the program—compared to some other employer-sponsored disease-management programs that report 5 percent engagement rates.

Among people who registered their device, 59 percent stayed active for at least six months, a rate higher than gym memberships (29 percent). Current program participants walk an average of nearly 12,000 steps, or more than twice the approximately 5,200 steps logged by the average American adult, officials said.

The program has been particularly appealing to eligible participants with chronic conditions. People with such a diagnosis are 20 percent more likely to participate, and people who have diabetes are 40 percent more likely to participate than those who do not, according to the insurer.

As CNBC’s Christina Farr speculated in a story that broke the day before the UnitedHealthcare announcement, “The integration with UnitedHealthcare, which is the largest U.S. healthcare company, could mean a boost in sales of the Apple Watch as more people are able to buy it at an affordable price.”

It was reported last year that another major health insurer, Aetna, which already offers the Apple Watch to its employees as part of a wellness program, has also been in talks with Apple about pushing the wearable device to the health insurer’s members, according to a report in CNBC.

About a month ago, UnitedHealth Group’s CEO said on an earnings call that the insurer would be unveiling a “fully integrated and fully portable individual health record” by the end of next year, with the Rally digital platform serving as the base for development. 

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