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Survey: Adoption of Health IT to Improve Care Coordination Remains Sluggish

June 17, 2016
by Heather Landi
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Despite the promise of health IT to improve care coordination, there has been sluggish progress in the use of health IT to connect doctors and patients, according to a new survey report from Nielsen Strategic Health Perspectives.

The survey, sponsored by the Council of Accountable Physician Practices (CAPP), polled 30,000 consumers and 626 physicians to monitor the progress of healthcare delivery reform and the movement toward accountability. The survey measured respondents’ experiences with the five patient benefits associated with effective accountable care: care team coordination, prevention, 24/7 access, evidence-based medicine, and patient and physician access to and use of robust information technology.

Overall, according to the survey report’s Patient Experience Report Card regarding coordinated, accountable care, some encouraging findings were that about half of patients have experienced coordinated care and about one third have physicians follow up, and most physicians report using evidence-based guidelines. However, with regard to 24/7 access to care, only about one-third of patients have 24/7 access to care outside of the emergency department. And, the use of health IT needs work, according to the survey, as the use is growing but still rare, and older patients are not interested in having access to it. With regard to preventive primary care, most patients do not get the message, if one is delivered, especially around weight management, the survey authors stated,

“Our survey found that while it is encouraging that the use of care teams and care coordination seem to be increasing, access and the effective use of technology still need improvement, and tactics that help to prevent illness are still woefully ineffective,” CAPP executive director Laura Fegraus said in a statement.

The survey found that only half of patients report that their physicians better know their history, primarily due to the ability to share information through electronic medical records, which indicates that half the time, patient information is not being shared across providers.

And, patients with multiple chronic conditions, who are the patients who could most benefit from better care coordination, report receiving only slightly more follow-ups and care management compared to healthier patients. Patients with chronic illnesses do not perceive more coordination of care, the survey authors stated. For instance, the survey indicates that 39 percent of chronically ill patients report that their primary care doctor’s office has a nurse or care manager to help the patient stay on track or comply with treatment instructions, compared with 37 percent of total patients.

The survey examined whether physicians are utilizing technology to improve care, and the survey findings indicate that access to electronic engagement is increasing but remains low. And, of those with access, the percentage of consumers actually using their access to digital tools also remains low. Of those surveyed, only 14 percent reported having access to and actually using a digital tool that enables online submission of questions to be answered by a medical professional. About 25 percent reported having access, whether they use the access or not, and that number grew from only 11 percent in 2015.

And, only 10 percent reporting having access to and actually using email reminders about taking medications or reminders about other health measurements. Nineteen percent reported having access to this type of electronic engagement, which increased from only 6 percent in 2015. More are reporting having access to and using text appointment reminders, 21 percent in 2016, and the percentage that now have access to that type of electronic engagement grew significantly, up to 32 percent from only 9 percent in 2015.

Roughly 44 percent report access to online information, such as appointment scheduling, obtaining lab test results, or viewing information via portals. According to the survey findings, about half to one-third of patients with online access don’t use it. For instance, 48 percent of patients now have access to an online portal to log on and see lab tests, imaging results or other information, up from 28 percent in 2015, but only 35 percent report having access and actually using it.

Patient perceptions about shared electronic medical record (EMR) information hasn’t changed from 2015. Forty-nine percent of patients say their doctors are now able to share information about their health and know their history before going to the appointment, and in 2015, 46 percent of patients reported that.

And, the survey found that patient-physician engagement around mobile apps remains low, as only 4 to 5 percent of patients reported that their primary care physicians recommended using a mobile app to track physical activity levels or monitor biometrics or recommended using a wearable health monitor.

With regard to the use of health IT, older Americans are less likely to want to use digital technology for healthcare, which presents a challenge in fully leveraging this technology to improve care delivery to this population. Only 20 percent of patients age 65 and older have access to and use online appointment scheduling, compared to 26 percent of patients age 18 to 64. And, in addition, 29 percent of seniors have access to online appointment scheduling, but don’t use it. Also, only 10 percent of seniors don’t have access to this digital tool, but want access, and a quarter of senior patients don’t want access to online appointment scheduling.

Text reminders are least appealing to older patients, with 57 percent reporting they don’t have access and don’t want access to text reminders for taking medications.

In general, the survey finds, physicians are moving towards high-tech patient engagement, but slowly. Of the physicians surveyed, 31 percent in 2015 report having email correspondence with patients about health, up from 28 percent in 2014. Half (50 percent) report offering an online portal for patients to see lab tests and other information, up from 41 percent in 2014.

In conclusion, CAPP recommended a number of policy levers to help close the gap and expedite performance in accountable care, including payment reform to support “system-ness” and better outcomes; more robust health information technologies to improve sharing of information among providers and easier access by consumers; and standardized quality measures in language consumers can understand.

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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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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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