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Nemours Children’s Health: Deploying Technology to Meet Consumers Where They Are

July 21, 2018
by Mark Hagland
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Nemours’ Gina Altieri offered HIT Summit-Denver attendees her perspectives on her organization’s bold journey around consumer engagement

How does a pediatric health system engage families more fully and improve service and loyalty? The leaders at the Wilmington, Delaware-based Nemours Children’s Health System have been on a multi-year journey around those goals, Gina Altieri told her audience gathered at the Grand Hyatt Hotel in downtown Denver, during the Health IT Summit in Denver, sponsored by Healthcare Informatics.

On Friday, July 13, Altieri, the senior vice president, corporate services, at Nemours, spoke on the topic “Developing a Technology Strategy to Increase Patient Engagement, Improve Satisfaction, and Deliver Better Care,” tracing her organization’s journey forward in working to enhance consumer loyalty through technology-facilitated improvement of care delivery and service quality.

Nemours Children’s Health System, which is anchored by the Nemours/Alfred I. duPont Hospital for Children in Wilmington, and by the Nemours Children’s Hospital in Orlando, treats 410,000 children every year, for a total of 1.7 million annual encounters, across 90 pediatric care locations in five states. All of its physicians are employed. And the health system sponsors more than 300 active research projects and clinical trials within its Nemours Research Centers for Excellence division. Furthermore, Nemours achieved Stage 7 status on both its inpatient and outpatient sides, in 2017, recognizing its high level of electronic health record (EHR) development, by the Chicago-based Health Information & Management Systems Society (HIMSS), and in February 2011, received the HIMSS Davies Organizational Award of Excellence for 2010, for its effective use of health information technology to improve the safety and quality of patient care.

Foundations first

Recapping a history of “two decades of IT evolution,” Altieri noted that “We decided a long time ago to eliminate all the separate clinical and business systems we had. In 1999, we quickly installed Cerner for inpatient, and then started to install our outpatient EMR. Several years later, we decided to have the revenue cycle management and all business systems put on two high-end platforms, and then decided to have all our applications on one platform, and replaced Cerner with Epic. And then we decided to dabble in telehealth, and we were building our Nemours Children’s Hospital in Orlando. And that really was all of the technical infrastructure we needed, in order to do what we’re doing now, as well as to build the team we needed, to leverage all that technology.”

Gina Altieri speaking at the Health IT Summit in Denver on July 13

Further, Altieri recounted, “When I first started, we had paper charts, and a lot of equipment we didn’t realize, and no sense of organization. And you really cannot function like that it today’s world; it’s just too expensive and inefficient. And the information security aspects are pretty important right now; so we really did need to invest information security; the government’s demanding it, but so are consumers. The other thing we’re doing,” she said, “is that because we had these systems for 20 years—the lifetime of a child—we had a lot of very valuable data. So we had been using the data behind the scenes, and we’ve been providing it to the frontline in an easy self-service way, so that the physicians have access to the data, the executives do, so that more and more people actually understand what the data’s been telling them. That’s been effective.”

Innovation for a purpose

A lot of different technology-facilitated innovations are taking place right now at Nemours, Altieri reported. For one thing, the health system’s leaders decided to go ahead and post ratings for all physicians, including consumer comments, on the organization’s website. “That wasn’t an easy task, because we posted them all, good and bad,” and there was some physician alarm at the prospect. “But we’re helping them to know what’s happening in real time. So when they see a Press Ganey result, for example, they can understand what’s going on in the consumers’ minds. And it’s been very helpful.”

Meanwhile, she added, “At Nemours, we have one integrated radiology department, so all the radiologists read all the studies. In fact, we have a 13-minute turnaround for all the [digital images], which is pretty remarkable.”

Further, Nemours has been successful with a remote-monitoring system in which trained paramedics monitor patients in their patient rooms 24/7. Up to 400 patients are monitored continuously at any time, in both the Wilmington and Orlando facilities, from a single location at the Orlando hospital. Nemours was the first pediatric hospital system in the world to install such a system, and, Altieri noted, parents have been strongly in favor of the capability.

On the softer side, she mentioned, “We also bring Santa from the North Pole to patients in the child life area or to the bedside. The elves are actually executives from some of the vendor companies. And the North Pole is actually next door to my office. The children are enchanted by this.”

Then, speaking of the journey forward in “listening to the consumer,” Altieri framed the bigger picture around consumer engagement. “One misconception about companies like Amazon and Lyft,” she said, “is that it was the technology that changed everything” in terms of those companies’ abilities to disrupt their business sectors. “But it wasn’t the technology alone that was a disruptor. It was that they met the consumer where they were. And if we don’t provide the consumer with what they want, they’ll go elsewhere.” Historically, she noted, “We’ve been OK in healthcare with forcing patients to call during the hours of 9 to 5, to schedule appointments. But what we’ve learned is that most people are scheduling online in off hours. In primary care, that can work OK; but in specialty care, we do demand a lot of information prior to the visit,” and that can pose challenges in terms of the ability to gather all the relevant information online. “The concern among providers is continuity of care; but the concern of the consumer is that they want to be seen. So we’re working through that. We clearly need to engage the millennials,” she said, “and that means meeting where they are. They’re ready for telehealth; they’re willing to pay for convenience; they look to the research and what others are saying about providers, before they make a decision. So a social media presence is very important. So then we hone down to the Nemours parent, and find out what’s important to us. They value quality, respect, and environment of care over cost. And they will choose hospitals based on internet searches.”

As a result of the research that she and her colleagues conducted, Altieri reported that “We came up with Nemours Anytime, Anywhere. We want to be that trusted advisor” for consumer medical information. “Our aim is to expand a more accessible continuum of care within our communities to be a more proactive partner in guiding and empowering parents throughout their children’s development. We’re trying to tie everything together, so that their experience is a seamless one and they only have to go to one place, and we remove all the friction that exists today. So we created the Center for Health Delivery Innovation. We have editors, data scientists, developers, design thinking experts. We use agile methodologies to work with patients and families and providers every step of the way.”

In short, Altieri said, success in all these areas requires developing an entire “ecosystem” of technology infrastructure to support consumer engagement. She cited Nemours KidsHealth; Nemours Prevention & Population Health; the health system’s HIMSS Stage 7-level core IT infrastructure; and telehealth capabilities, as composing that constellation of supports. What’s more, she said, in all this, “You can’t just pull solutions off the shelf; you’ll no engagement with providers and patients/families.”

A consumer insights and digital strategy

“We also created a consumer insights and digital strategy, to analyze our consumers’ digital footprint and optimize leveraging of out digital assets,” Altieri continued. And in that regard, “We’ve been able to track what parents are doing when they go to our site, and we’re trying to direct them to schedule an appointment or have a video chat and get more connection to Nemours. And what’s the click-through rate? Why did they stop at a particular point in the process?”

A lot of learnings have been absorbed along the way, Altieri noted. “Originally,” she said, “the patient portal was a little clunky, people we’re really using it. But we’ve embedded our kids’ health content, our patient instructions, and have automated the onboarding of the patient portal to make it easier. Everything has to be made easier.”

Further, she said, “We’ve been doing telehealth for five years, We call it Nemours CareConnect. We have partner facilities. They want to retain patients. And we want to transfer only the really complex cases to our children’s hospitals. And we’ve turned it to direct-to-consumers. 24/7, a Nemours board-certified physician can provide telephonic care. In addition, 400 specialists have also been trained to do consults from the hospital. We’re also in schools. Right now, they’re in special-needs schools. But eventually, they’ll be in general mainstream schools. We’re also on cruise ships.”

Meanwhile, Altieri reported, “The Center for Health Delivery tied all these separate assets together,” and created an app for asthma management that “touches the entire continuum of care, and works not only for the provider, but also for the patient and family.” In developing the app, she said, “We asked the providers, what problem can we help you solve? And they were saying, most of the problems have to do with gaps—what’s happening in the home and other things that might be triggering this?” And she showed the audience a video involving actors that walked through what a mother and her daughter experienced as they were guided through telehealth and in-person encounters around the daughter’s asthma, with caring, empathetic interactions with physicians and other clinicians, and successful follow-up around questions and concerns. What the video depicted was a thorough and comprehensive approach to helping parents with children with chronic illnesses to have their children’s medical issues handled successfully, with caring and convenience. One particularly exciting element of the use of the consumer app as part of that continuum of care is that the parent can make notes on exercise, activities, symptoms, etc., that are relevant to their child’s condition, and those are then incorporated in the information that the clinicians caring for the child have at their disposal.

“We’ve launched that proof of concept, it’s on the app store. And we had our first telehealth visit through the app last week,” Altieri noted, after showing the video of that care delivery and management process. “Now, we’re working on an app for cardiac care, and then we’ll move on to add one for diabetes, and then for WellChild care, which will be the umbrella for all of this.”

In the end, she noted, it’s all about listening to consumers and finding out what they want and need, and figuring out how to deploy technologies that facilitate improved care delivery and management, and support consumer convenience and wants. Nemours leaders, she emphasized, will continue to listen and to act accordingly.






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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. 

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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.”



Related Insights For: Patient Engagement


GetWellNetwork Acquires HealthLoop

November 9, 2018
by David Raths, Contributing Editor
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Company seeks to provide comprehensive digital patient and family engagement platform

GetWellNetwork, a Bethesda, Md.-based company offering a platform for improving patient engagement, has acquired Silicon Valley startup HealthLoop.

The acquisition expands 280-employee GetWellNetwork’s reach into nearly 700 healthcare providers. Mountain View-Calif.-based HealthLoop’s platform enables care teams to engage patients before and after admission through automated, daily check-ins. Customers include Advocate Aurora Health, UCSF Health and LifeBridge

GetWellNetwork said it is combining its nearly two decades of experience implementing patient engagement solutions with 30-employee HealthLoop’s expertise in mobile technologies and digital care management. The move is designed to catalyze growth in the ambulatory space and signals its plans for more investment in cross-continuum tools to connect patients, families and providers.

GetWellNetwork was named one of Healthcare Informatics’ “Up and Comer” companies back in 2014. In an interview then, CEO Michael O’Neil described how the company uses the TV set in a hospital room to enhance patient engagement. To deal with pain management, GetWellNetwork has a workflow called the pain assessment pathway. If a patient is on a morphine pill, the system interrupts the TV show every hour to ask the patient to rate their pain on a scale. "If I report a certain threshold or below, it is simply going to document that in Epic, Cerner or Allscripts," O'Neil said. "If I report a five or above, it will document but also, through a Vocera badge, signal a nurse to go to the room. That is one pathway we help deploy, where pain management is a service or quality metric that a particular organization is trying to move the needle on. We are working with healthcare systems with the courage to take the 'patient-centered mission' off the poster in their office and bring it to the point of care."

In a prepared statement about the most recent acquisition, O’Neil said:  “Adding HealthLoop to our portfolio advances our strategy to provide the most comprehensive, end-to-end digital patient and family engagement platform. The changing nature of the how and where care is delivered requires dynamic solutions to meet modern engagement challenges. With HealthLoop as part of the GetWell portfolio, we’re excited to help health care organizations rethink and accelerate their digital strategies.”




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