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At the Health IT Summit in Denver, a Look at What Can Be Accomplished Under the Banner of Patient Engagement

July 12, 2018
by Mark Hagland
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Debe Gash of Saint Luke’s Health System shared her organization’s story of patient engagement progress

Even as the term “patient engagement” has become hotter than ever, the reality is that the leaders of most U.S. patient care organizations haven’t yet figured out how to execute on the concept. But Debe Gash, senior vice president and chief digital officer at the Kansas City, Mo.-based Saint Luke’s Health System, offered attendees a lot to consider, as she shared the innovations taking place in her organization, on Thursday morning, at the Health IT Summit in Denver, sponsored by Healthcare Informatics.

Speaking on the topic “Using Mobile Apps to Increase Patient Engagement,” Gash told the audience gathered at the Grand Hyatt in downtown Denver that patient engagement has to be a strategy, not just a wish. That’s especially true at any large integrated health system such as St. Luke’s she noted. St. Luke’s encompasses 10 hospitals with a total of 1,100 beds, with 1,500 providers, 750 of them employed, and 1.5 million clinic visits. It also encompasses 17 retail clinics, and four micro hospitals, with eight beds each.

Indeed, Gash told her audience, St. Luke’s Health Systems’ overall strategy encompasses mobile apps, patient engagement, and various strategies around patient/consumer convenience and service, all of them interrelated.

Debe Gash speaks at the HIT Summit-Denver

“Our growth has primarily been in the ambulatory space; we heard from our customers that they wanted more access to care in their neighborhood.,” Gash said. “So we’ve been deploying our clinics, our big boxes, and have embarked on this initiative to build micro-hospitals in our area. A micro-hospital,” she explained, is a small facility of eight beds, anchored by an ED. And if we need to perform a procedure or they need more complicated care, we transfer them to larger facilities. We’ve opened four of seven so far. In fact, our fourth micro-hospital opened just this week. These are exciting times for us.” Further, she reported, “We’ve gotten into the retail space. So far, we’ve created 17 clinics, and they’ve served us well.”

Among the guiding principles in this journey has been the articulation on the part of patients of what they want in terms of service, convenience, and interactions with providers.

Gash cited a recent survey that found that millennials’ demands for digitally facilitated healthcare are accelerating. Among other survey results: 71 percent of millennials want to book appointments with mobile apps; 74 percent would prefer to see a doctor virtually; and 75 percent look at online reviews before selecting a physician. What’s more, one-third downloaded a health app in the last 30 days; and 42 percent have used synchronous video telemedicine.

But the idea that interest in the digital facilitation of healthcare delivery and service is limited to younger people is deeply mistaken, Gash told her audience. “It’s a myth that older people don’t use technology,” she said. “My mother is 76, and she had problems using a flip phone; but I got her a smart phone, and she uses her smart phone more than I do. I see that with the elderly community; it’s an interesting dynamic. But even more interestingly, the millennial generation really want to use digital features in their use of healthcare.”

A new world—of consumer demands

The reality, Gash told her audience, is that the old, provider-centric world is falling away quickly now, and is rapidly being replaced by a world in which provider organizations will have to compete strongly with one another for patient loyalty and engagement. Indeed, she said, “For a growing number of people we serve as providers, companies that fail to offer a friction-free digital connection are just not going to be acceptable anymore. And when consumers have a choice, and more do now, it’s going to be critical that we provide friction-free digital services. Kaufman Hall found in a recent report,” she said, “that only 14 percent of hospitals offer digital tools for consumer engagement, and only 23 percent offer some form of telemedicine—and that is primarily inpatient consults, but not direct-to-consumer-type solutions. Only 20 percent of healthcare consumers have digital access to pricing. It’s not something that you can go out and search on your own. And only 43 percent provide messaging between patients and providers. And I personally believe that that figure is that high only because of the meaningful use program.”

And those deficiencies are a problem. “The lack of contemporary digital experience, I believe, is a major vulnerability for hospitals and health systems today,” Gash told her audience. “And that’s because we’re seeing [disruptive new] entrants into the healthcare industry that can pose a threat to our not-for-profit systems. Look at the merger of United Healthcare and Optum, and of CVS and Aetna,” she said. “What are they doing? They’re employing physicians and practices, acquiring practices, employing health management programs; and their goal is to basically do that primary care service. So they’re pulling assets out of the healthcare system, and they’re highly capitalized companies. So that’s the threat. And what are Apple and Amazon doing? Apple says, we can go directly to the consumer; they’re good at that. And what could Amazon do? They’re investigating healthcare, and they, too, are highly capitalized companies.”

So what should provider leaders do? “We need to think about that threat, and how we can continue to compete and differentiate ourselves and work with that potential down the road,” Gash told her audience. “So those are things that could disrupt our industry, and the real reasons why St. Luke’s is trying to deliver a better experience, so that we’ll be the choice of our consumers, and create that friction-free service, and make sure that we’re better at delivering that last mile of care. We’re known in the market as being the least convenient type of service provider. So we need to change that paradigm, and that’s critical.”

Among other actions, Gash and her colleagues “have been pursuing digital solutions for a while,” she noted. “We’ve deployed MyChart”—the personal health record embedded in the electronic health record product from the Verona, Wis.-based Epic Systems Corporation—“and we’ve mobile-enabled our website, Still,” she said, “there was a lot of friction in our service delivery model, which still relied on traditional forms of communication, including phone, letters, and face to face encounters. And yet we still had really good customer satisfaction scores. Our HCAHPS [Hospital Consumer Assessment of Providers and Systems] scores are great,” she noted.

“So our thought is that we need to continue pursuing the removal of friction in that last mile of delivery of care. How many of you have trouble scheduling an appointment with your doctor? I do. It takes two or three interactions to get one scheduled. That’s friction. Or I get discharged from my provider, and he says, I want you to go get a diagnostic test, and I have to call, and it can only be done between 7 and 4 on weekdays or whatever, and I have to take off work or whatever, and that’s friction. And we want to remove it.”

Pacing those efforts has been one strategic element involved. After deploying MyChart, Gash and her colleagues enabled “Saint Luke’s 24/7 Virtual Health visits, through our app. You can schedule an appointment, you can do it via video,” she explained. “That was deployed, and people were very excited about it. We pushed it with our employee health plan. But we were only getting about three visits a week. We partnered with ZocDoc to offer online scheduling. It was hard to convince doctors to allow us to do this,” she reported. “So I went back and did a lot of research, wanted to know if we were doing what our consumers wanted. Through focus groups and reading research papers,” she said, “I found that it’s really generational, what people want.”

Research shows that millennials—18 to 29—are “very digitally fluent, are the most socially connected, and are the most likely to read reviews, find prices, and seek for value,” Gash noted. “They are the most likely to shop for providers and write reviews online.” Meanwhile, “The 30-49-year-olds are often directing not only their care but their family members’. And they want care to fit into their busy lives, through non-traditional hours, etc., and virtual care delivery. The 50-64-year-olds are active, managing personal wellness, and managing multiple chronic illnesses, and they want timely access to care. Over 65s are traditionals. They don’t mind seeing the doctor, but traveling is hard for them. And they’re probably the most resistant to virtual care options.”

Doing that research was eye-opening for herself and her colleagues, Gash told her audience. “It helped us to understand what consumers were looking for, including access to after-hours care, weekend availability, etc. Value was a key factor; and what we heard was that convenience and service trump what is free. In other words, people are willing to pay for extra service. People are looking for cutting-edge technology and convenience of service,” she said. “We wanted something we could brand our own and could leverage that brand in our market, the perception of St. Luke’s, as a way to publish some of these capabilities. And we wanted to bring those digital features together as part of that brand, and simplify that access. So we started looking for features our customers asked for. They thought wayfinding would be great in these big facilities. Also, food service, and e-check-in. Those were all things we heard from our population. So we changed our approach, and expected we’d see increased utilization of e-services.”

And all of that was based on building a mobile application first. In that regard, Gash reported, “I did a lot of research in the market to see what’s out there and available. We do not have mobile application developers in our shop. We wanted something that we could purchase as a service. There really wasn’t anything in the HIT space that could meet our needs. So I have a friend, Andrew Burns, who works in our space and he said, ‘Hey, Debbie, I have a product.’ They primarily work in the entertainment industry, but what he explained was exactly what I needed—a mobile platform that would enable me to bring all these products together and drive engagement. So we partnered with them to develop the SaintLukesKC mobile app. It provides access to the medical record, and to online scheduling. It also facilitates virtual visits; and it provides directories of locations, as well as wayfinding information within facilities.”

In terms of results, Gash reported, “We have been promoting our app. We started with a soft launch, using it primarily without our own employee population, to get feedback, then… Our adoption is growing rapidly… 97,188 visits… we’re retaining our users. We have about 7,500 users using our mobile app right now, and that is growing exponentially. Our MyChart utilization is increasing as a result of the mobile app. We’re seeing many users leveraging the product, doing more messaging; and we’re seeing more patients participating in online payments.”

Lessons learned

In terms of lessons learned, Gash said, “You really need to find out what your customers want, because what you think may not be right. I really encourage you to do focus groups and talk to your customers and discover what they’re looking for. And our demographic is very different from children’s hospitals, ambulatory spaces, etc. You do need to check with the consumer. I think you need to define a strategy and execute it. And also talk to your business units about what would work for them. Also, don’t be afraid to try something new. Just because another system hasn’t done it, doesn’t mean you shouldn’t. Look outside our industry—we are way behind! Look outside the healthcare space for solutions. We are so far behind in digital—look outside healthcare and figure out how to apply what they’re doing, to healthcare.”

Two other key pieces of advice: “Make sure that people know what you have to offer. And that means, when it comes to patient engagement solutions, that you’ve got to include your marketing team” in the development process. The other key piece of advice: “Measure results. It’s so important to go back to the organization and say, here’s the success, here’s what we’re seeing. I encourage you to figure out what those measures of success might be. When I meet with the board, I’m sharing those kinds of results.”





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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.



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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. 

Related Insights For: Patient Engagement


N.Y. Hospital Conducts Digital Assessments of Patient Interactions

November 13, 2018
by David Raths, Contributing Editor
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Upstate University Hospital uses Vocera Rounds mobile app to gather data, provide feedback
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Physicians at Upstate University Hospital in Syracuse, N.Y., are using a mobile app to collect data about hospitalists’ behaviors during patient interactions in order to provide real-time feedback.

Amit Dhamoon, M.D., Ph.D., internist at Upstate University Hospital and associate professor of medicine at SUNY Upstate Medical University, said he was looking for a way to improve physician-patient communications.

“It is still unclear why some physicians really connect with patients and some just are not able to,” he said. “It is unclear why certain patients trust certain doctors more than others. We want to look at some basic behaviors.”

His team decided to do the digital assessment using a customized version of Vocera Rounds, a mobile application that enables clinicians to collaborate in responding to patient feedback and closing care gaps. “We needed a way to collect the data, relay it, and analyze it,” he said.

Fourth-year medical students who are going into internal medicine join the team of hospitalists on their rounds and serve as “silent shoppers,” Dhamoon said. They focus on the communication aspects of each interaction, and enter their observations into an iPad.  Residents and physicians also use the app to conduct a brief patient survey after the encounter. 

Among other things, they assess:

• how much time the provider was in the room;
• whether the provider introduced themselves;
• whether they sat down at eye level with patient; and
• At the end of conversation, did they ask if there were any questions?

Dhamoon said patients may pick up on body language or other things that physicians are not even cognizant of. “We are focusing on how to treat gall bladder disease or make their pneumonia better. We are focusing on the medicine,” he said. “We have to do that, but we also have to communicate what we are thinking.”

In an academic medical center, it is not unusual for teams of eight to nine doctors, residents and students enter a patient’s room. “Sometimes they don’t know what to do with their hands, so they stand with their arms crossed in front of them,” Dhamoon said. “For the patient, who is lying down with an ailment, it can almost feel like an inquisition.”

Dhamoon says hospital rooms are sometimes cramped and there is not a chair available. “I can say that it should be the gold standard that we are at eye level, so it doesn’t send a message to the patient that we have one foot out the door. But if we don’t have the basic tools in place, like a chair, then it is not going to work.”

Dhamoon and his colleagues are studying the effectiveness of this training approach and its impact on patient satisfaction measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.  “My colleagues are incredible people. I want our patients to see how incredible they are. We get in our own way sometimes.”



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