Is Your Organization Getting the Right Facilitators for Patient Engagement Out There? Piercing the Fog on the Way Forward | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

Is Your Organization Getting the Right Facilitators for Patient Engagement Out There? Piercing the Fog on the Way Forward

July 15, 2016
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An instant audience poll uncovered some of the challenges facing patient engagement efforts

The results of an instant audience poll on Wednesday of the audience at the Health IT Summit in Denver, sponsored by the Institute for Health Technology Transformation (iHT2, a sister organization to Healthcare Informatics under the Vendome Group umbrella), were revealing.

During the panel discussion, “Developing a Path to Patient & Consumer Engagement,” panelists asked the audience the following question: “Who is engaged in patient engagement at your organization?” Thanks to smartphone technology, audience members were able to participate in that instant poll, with the following results: 18 percent said, “Marketing”; 6 percent said, “Nursing Services”; 24 percent said, “Information Services”; and 53 percent responded, “Unique Collaboration” (meaning, a more customized approach that didn’t fit into the other categories).

Now, of course, the question could have been interpreted a few different ways, as is typical in polling situations. But how I interpreted it was this: who from your patient care organization is strategizing around patient engagement, and who is executing that strategy? (And that interpretation itself could reflect different levels of activity, and different understandings of what patient engagement looks like, of course.)

The results I’ve just referenced reflect what appears to me to be a broad set of issues and challenges in the U.S. healthcare system right now. On the one hand, the concept of patient engagement is one that’s being talked about more than ever, and indeed, a very large plurality, at least, of patient care organizations nationwide are trying to do something in this important area. And that is very good. On the other hand, in the absence of any practical, applied definition of “patient engagement,” as well as a lack of templates for action, things to be very clouded indeed. Is it patient engagement when a physician’s office tries to intensify its patient education on the individual patient level? Is it patient engagement when patients are encouraged to participate in their patient health records (PHRs)? Is it patient engagement when patients are encouraged to join social support networks, either online or in person?

And, per the instant poll conducted during the patient engagement session on Wednesday in Denver, who should be developing and executing such activities? The results of that instant poll speak to one of the core challenges, it seems: that there is no obvious, automatic locus for the strategizing, direction, or execution of patient engagement activities, either in medical groups, or at the hospital or health system level. Is patient engagement work the responsibility of the individual physician office? Of the case management nurses in the inpatient hospital? Of the marketing department? IT? One can easily see how the capabilities and involvement needed to execute on this important concept are ones that are difficult to bring together across the heavily balkanized operational silos of patient care organizations.

Ideally, as the leaders of patient care organizations move forward in developing accountable care organizations (ACOs), population health management, and care management strategies, that they will find in each organization the right locus for strategy, development, and execution around patient engagement.

One of the core problems that members of the patient engagement panel mentioned is one that should be underscored here. As Heather Haugen, Ph.D., health information technology director at the Denver-based UCHealth, put it, “We [as an industry] tend to think tactically about patient engagement, but we really need to think about it strategically.” That is particularly true in the context of another statement she made during the panel discussion Wednesday, which was that “The reason we do patient engagement is that we want to help patients, but we also want certain outcomes.”

Haugen’s point was further amplified during the discussion by fellow panelist Wayne Arvizu, telemedicine administrator in the Evans Army Community Hospital (Fort Carson, Colo.) informatics department, a facility within the Colorado Springs Military Health System. “We want the freedom to empower clinicians and the entire care team,” Arvizu said. “With regard to the clinics within our hospital, there’s been a lower level of satisfaction on the part of patients and higher acuity; but when we look at the office, and the way we empower the staff to communicate and the way families are able to access care in those communities, leads to a dramatic improvement in patient satisfaction within a couple of months. And that happens when we put full communication and a full team into this.”

What’s more, noted Colonel Kathy K. Prue-Owens, chief nursing officer at Evans Army Community Hospital, “Convenience improves both patient satisfaction and military readiness, so that the soldier doesn’t have to go so far” for care, and therefore is in a better position in terms of readiness. What’s more, she notes, “The fact is that our patients are younger people,” and therefore healthcare consumers who need a different kind of connection with their providers.

All of these comments made during Wednesday’s panel discussion—led skillfully by Al Villarin, M.D., CMIO and associate CIO at Staten Island University Hospital, a member of the NorthShore-LIJ Health System—underscored the odd combination of opportunities and challenges facing the leaders of patient care organizations when it comes to patient engagement.

On the one hand, the opportunities to create and/or enhance patient engagement are everywhere. On the other hand, it is precisely the kind of activity that patient engagement is, that falls into the cracks in between a very broad range of operational capabilities and activities in medical groups, hospitals, and health systems. Just like the personal health record (PHR), patient engagement belongs both to everyone and yet formally and explicitly, to no one. Is it care management? Well, kind of. Is it patient-physician communications? Sort of. Is it marketing? Well, it’s not marketing, exactly, but there definitely is a marketing element to it.

What is clear is that the most progressive medical groups, in particular, and especially those involved in accountable care and population health management, are pushing forward to figure out how to “do” patient engagement. There really are no templates for this, yet. But as odd and amorphous as patient engagement is as a phenomenon in healthcare, it is also something that is quite real, both as a need and as a potentiality.

Ultimately, money and policy issues will push all this forward, as employers who foot the bill for their employees’ healthcare continue to push more and more people into high-deductible health plans, and as those people begin to look more closely at what they themselves are paying more for, in their healthcare; and as the federal government and private payers push providers more and more to connect on a deeper level with their patients, finally bringing them into the care team, as has so often been talked about.

Right now, the leaders of patient care organizations are finding themselves to be extremely early in their development of functioning, successful patient engagement efforts; indeed, if one were to apply the infancy-to-old-age conceptual metaphor to the journey, one would have to say that patient care organizations are still in their infancy in this arena.

But things are beginning to happen. And over time, patient care organization leaders, at the medical group, hospital, and health system levels, are going to make progress in this important area. The light will dawn, functional templates that others can emulate, will begin to appear, and the confusion over who should do what and in what context, will eventually lift, like a morning fog. In the meantime, patient care leaders will remain eager to hear from the progress of their peers, as things move forward.

 

 

 

 

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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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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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