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Is Your Health System Prepared for Consumerism?

July 27, 2017
by Heather Landi
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While the terms “consumerism” and “patient engagement” are often used interchangeably, many thought leaders say the concepts are not the same, and strategies for engaging consumers are quite different from strategies to engage patients.

“Patient engagement is about connecting with pa­tients, so that we can influence them to be interested in and involved in their own care, and there’s ben­efits to us and them, such as increased compliance and maybe better communication that leads to bet­ter care for the patient. But, consumerism is such a huge topic and obviously it has an effect on patient engagement as well. If I, as a health system, have a relationship with the patient, then the kind of engage­ment that I can have is quite a bit different than trying to force a conversation on a patient that they are not interested in having,” Doug Thompson, senior direc­tor, research at the Washington, D.C.-based Advisory Board Company, says.

Effectively developing consumer insights and applying those insights to healthcare service design will require robust data and analytics, many healthcare thought leaders say, and that, in turn, will require the expertise and leadership of CIOs.

A Kaufman Hall report on the state of consumerism in healthcare, which was based on an online survey of more than 100 hospital and health system executives, found that 70 percent of leaders said consumer-related insights is an above-average priority, but less than one-quarter said they have advanced capabilities in place, referring to the capabil­ity to apply consumer insights to healthcare service design. And, those same leaders also reported that actions aren’t always integrated with organizational strategy. Only 10 percent said consumer­ism is a high priority with a number of advanced capa­bilities in place, but also said that there is a long way to go compared with other industries.

What’s more, the Kaufman Hall survey findings indi­cate that gaps exist in each of four critical elements of consumerism—patient experience, use of consumer in­sights, patient access and strategic pricing. For exam­ple, 79 percent of respondents said there is a pressing need to understand and enhance patient experience, but only 18 percent have employed advanced means to do so. Additionally, 68 percent of respondents said strategic consumer insights are a high priority but only 16 percent ranked themselves as having advanced ca­pabilities in that area. Further, only 29 percent of re­spondents consider strategic pricing a high priority, and only nine percent have advanced pricing strate­gies in place.

“The influence of consumerism cannot be underesti­mated in patient engagement strategies as the industry drives toward personalization,” Hal Wolf, director, infor­mation and digital health strategy at the Chicago-based The Chartis Group consulting firm, says, and further ex­plains, “Patients wear three hats: citizen, consumer and patient. The citizen has expectations of what a health system should be able to do, they have consumer ex­pectations of service based on other industries, and they have deep needs as a patient that they want solved. In the end, healthcare is a service and will judged as such, so all three hats need to be taken into consideration for the right patient engagement to meet the growing de­mands of today’s consumer.”

In that Kaufman Hall report, a key theme from emerg­ing healthcare leaders is that consumerism is not a pro­gram or a problem to be solved, but a key to growth. “Under value-based care, success requires ‘engaging the consumer…figuring out what they value,’ said one survey respondent,” the report authors wrote. In that same report, health system and hospital leaders iden­tified a number of barriers to action on consumer-re­lated insights, including resistance to change, lack of urgency, competing priorities, lack of clarity and lack of data and analytics.

What’s more, the survey respondents noted that capa­bilities to address consumerism require action in four key areas—organizational alignment, content (consumer-relat­ed data and research), capability (skills to develop and use consumer insights) and data/IT, according to the report.

The Advisory Board’s Thomp­son notes that most healthcare organizations do not currently have the right aligned mindset with consumerism. “You can’t make a cultural leap all in one step, even if the CEO wants to do it. I think education is part of it, trying to expose the lead­ers of the organization to some best practices.”

The Kaufman Hall research­ers, in their report, highlighted the steps taken by one unnamed health system to ad­dress the rise in consumerism in healthcare. The health system’s board established the priority of getting bet­ter consumer insights and the system launched two specific actions to gain additional data about patient behavior, expectations and attitudes—consumer focus groups to frame the business goals, and a 50-question local-market consumer survey. The survey responses, which provided insights into topics such as access, use of services, price sensitivity, health system preference and technology use, combined with demographic and utilization information, has allowed the health system to group local consumers into segments sharing similar characteristics related to healthcare attitudes and use of healthcare services, the report authors wrote. Those five consumer segments were “at-risk evaders,” “eager and engaged,” “unengaged utilizers,” “healthy hesitants,” and “price shoppers.”

Further, with the insights, the health system devel­oped segment-specific approaches. For example, for the “price shoppers” consumer segment, the health system delivered online messaging about affordable and convenient health system walk-in clinics, for the “engaged and eager,” the health system has begun de­veloping virtual visit offerings.

Consumer focus groups are a key place to start, Thompson says. “I think engaging with consumers in a much more direct way is a good thing, whether it’s focus groups or senior executives of the health system talk­ing to consumers rather than talking to their own busi­ness people. Or, even engaging in some guided creative thinking, because every health system executive is also a consumer of healthcare. All you have to do is get a health executive to set aside their day job hat and say, ‘What was it like the last time I went to the hospital or the doctor’s office or my family member did?’ Immedi­ately, every person understands these issues. It most ef­ficiently starts at the top of the organization with getting exposed to a lot of different best practices.”

Overall, Thompson says health system CIOs and other senior executive leaders need to think on a strategic level, rather than a tactical level, about consumerism. “Health systems are attacking this problem in too tacti­cal a fashion, such as, ‘We need to reduce readmissions, so what do we do for that?’ Now, you can text those patients or send them brochures, but you don’t have an overall relationship with the patient. If a consumer feels that I have a great relationship with a health system then that health system has much more of an influence on the consumer,” he says.

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Who Isn’t Using Patient Portals? New Study Sheds Light on Portal Use

December 12, 2018
by Heather Landi, Associate Editor
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About two-thirds of adult patients did not use an online patient portal in 2017, and research indicates vulnerable and disadvantaged patients are less likely to use these technology tools, according to a study published in the November issue of Health Affairs.

Technologies such as online patient portals, which provide secure internet access to medical records and test results in addition to email communication with providers, can improve health care quality. And, evidence thus far shows that access to online portals increases patients’ engagement and adherence and may reduce unnecessary utilization and spending.

However, while the majority of adults in the United States believe that online access to personal health information is important, disparities in portal access exist.

“Findings from multiple studies that analyzed different population groups, including nationally representative samples, consistently show that members of racial and ethnic minority groups, older patients, and people of lower socioeconomic status are less likely than others to access an online portal,” the study authors wrote. The study was led by Denise Anthony, professor of health management and policy and sociology in the Department of Health Management and Policy, University of Michigan School of Public Health. Anthony and her co-authors also note that “inequities in access to new and beneficial technologies can exacerbate existing disparities in health.”

One national study, a March 2017 by the U.S. Government Accountability Office (GAO), found that only about 15 to 30 percent of patients who were offered access to a portal used it, with lower use among people living in rural and high-poverty areas.

“To identify appropriate levers that can be used to address inequities in online portal access, policy makers and providers must have a clear understanding of who is and is not accessing portals, as well as the reasons for not accessing them,” the study authors said.

For the study, titled “Who Isn’t Using Patient Portals and Why? Evidence and Implications from a National Sample of U.S. Adults,” researchers analyzed information about 2,325 insured respondents to the nationally representative 2017 Health Information National Trends survey to examine characteristics of patients who do not use portals and the reasons why they don’t them. By identifying who is not using portals and why, the researchers sought to uncover barriers and reduce disparities.

The study indicates that about two-thirds (63 percent) of insured adults with a health care visit in the previous 12 months reported not using an online patient portal. The research indicates that nonusers are more likely to be male and age 65 or older, have less than a college degree, not be employed, live in a rural location, be on Medicaid, and not have a regular provider.

These factors, along with race, were also related to whether a patient reported receiving an offer to use a portal.

Relative to females, males had significantly higher odds of not being offered access to and not using a portal, the study indicates. Members of racial minority groups (specifically, non-Hispanic blacks and non-Hispanics of other races—including Asian Americans, Native Americans, Native Hawaiians, and Pacific Islanders) had significantly greater odds of not being offered a portal. Among only those who were offered a portal, these groups reported rates of using a portal comparable to the rate of non-Hispanic whites.

The study also found that people with only a high school diploma or less were significantly less likely than those with college degrees to have been offered access to a portal. Patients with Medicaid insurance were significantly more likely to report not having been offered access to a portal and not using one, compared to people with other insurance.

Patients who lacked a regular provider were significantly more likely to report not having been offered access and not using a portal.

When evaluating reasons why people did not use a portal, the researchers did not find evidence of disparities in technological barriers. The reasons patients gave for not using portals included the desire to speak directly to providers and privacy concerns, both of which require recognition of the important role of provider communication and patient-provider relationships, the study authors note.

The study authors conclude that healthcare providers will need to address patients’ privacy and security concerns to enhance provider-patient communication.

“Reducing disparities in portal use will require that providers, particularly those serving vulnerable populations, communicate with all patients about portal use and have the capacity to discuss these technologies with patients,” the study authors wrote.

“Health care providers and plans can increase patients’ use of portals and narrow disparities in that use through direct communication about the benefits of portals, while also addressing patient-specific needs and concerns. Such interventions will require recognition that providers’ communication with patients takes time—an extremely scarce resource in clinical practice today,” the study authors concluded, while also noting that careful monitoring of who is and who is not using new technologies, and why, and designing technologies to address patients’ needs, will help ensure that such innovations do not exacerbate disparities but rather lead to improvements for all.

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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.



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