Are patient care leaders failing to make a conceptual distinction that might really make a difference? That question was pondered by Joy Grosser, CIO at UW Medicine, the four-hospital University of Washington health system, in her opening keynote address on Monday morning at the Health IT Summit in Seattle, being held at the Grant Hyatt Hotel in downtown Seattle, and sponsored by Healthcare Informatics.
Speaking to an audience of healthcare leaders, Grosser, who joined UW Medicine as CIO just under a year ago, said that one key thing that patient care organization leaders need to ponder is the crucial difference between patient engagement and the patient experience, as an understanding of that distinction can really make a difference in how organizational leaders strategize forward to meet the needs of patients and communities.
Beginning her presentation, entitled “Patient Engagement: Can Digital Health Help Our Patients Become a Member of the Healthcare Team?” Grosser noted that she finds the terms “patient” and “provider” somewhat limiting and problematic, but also that terms like “consumer” can also be problematic, Grosser outlined some of the challenges and opportunities in enhancing both patient engagement and the patient experience
“When it comes to patient engagement, how are providers and patients—how are we working together to improve health?” Grosser asked her audience. “We all know that medication adherence is an issue. People do what physicians tell them to do, but how to we create greater engagement, which contributes to improved health outcomes? And how does information technology contribute? Even though my father was a physician, my parents were somewhat of the era in which you did what your doctor told you to do, without asking. Some years later, people began to research medical issues on their own. Now, my children’s generation has a completely different attitude. There is always the question of ‘why’ patients should do something in particular.”
Meanwhile, Grosser said, “I use the broader umbrella term ‘digital health’ to describe how we bring things to our patients.” Indeed, she said, “Oftentimes, ‘patient engagement’ and ‘the patient experience’ are described as interchangeable, but I find they’re very different things. The patient doesn’t have to be engaged to have an experience.” That said, “There is overlap, though. In fact, if you’ve had a bad patient experience, it’s going to be harder to engage as a patient.”
Meanwhile, Grosser told her audience that, while hosting a patient portal is just a beginning when it comes to engaging patients, website development is a necessary start. In fact, Grosser said, in a road trip the past weekend in which she went through several different large communities, she web-searched the websites of several different hospital organizations, and found that, among several of them, one could only scheduled appointments in a couple of or a few medical specialties, and that most appointment scheduling still had to be accomplished via telephone call.
So some of the limitations of patient portals include that, since the development of a patient portal was a requirement of the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical Health) Act, simply having one really is no longer a differentiator in the market; second, portals tend to be not strongly customized versions of EHR (electronic health record) brand templates; and the portals that have been created tend to be difficult to customize as “containers” for a variety of patient-facing tools.
Still, Grosser noted, “There’s that opportunity to be a container of patient information, rather than just one place that the EHR sits. We recognized that there were limitations, as we moved into an app world and wanted to link those apps,” she said, of the hospital industry’s movement forward in this area.
Meanwhile, as a practical matter, telehealth inevitably started small, Grosser said. “It started with physicians saying, ‘OK, put my picture online’” to create an initial presence. “We didn’t move there as an industry, we moved as individuals; so much so that all our EHR vendors have pulled in virtual care elements into their EHR solutions. Our physicians were often slow to respond, though.” In relation to that, she recalled, I worked in an organization in Southern California in which they began training physicians just out of residency” to specialize in telehealth, and “to learn how to interact from a screen. We actually worked with film industry people to train” those physicians how to interact more effectively through a screen. “There are literally physicians coming out of residency who are working online. People are calling them Uber doctors. They’re working for third-party vendors. We might want those physicians in our healthcare systems as well,” she noted.
More broadly, in terms of creating and expanding on a digital health presence, Grosser said that there really is a market growth opportunity there, but that so often, internal opposition will be a limiting factor. “Oftentimes,” she said, “your physician billing organization will say, ‘We can’t see a person virtually for the first time, because we can’t verify them as a real person. But there’s a real differentiator when teledoc companies said, I don’t care if I’ve seen you in person before or not.” So, she asked, “Are your physicians looking at this as an annoyance, an add-on, or a growth opportunity? I was at a conference about a year ago, and people were touting an online experience, except you got an appointment by calling first. They had linked the medical records, and visits, but not the scheduling for the visits. And are these visits recorded in your medical record as a visit? Or deemed as being an urgent clinic, where the documentation will have to be redone?” Numerous practical challenges remain.
One area of real opportunity, Grosser said, involves live chat with patients. “I’ve looked through many surveys” of healthcare consumers, to determine what it is that consumers say they want. Fundamentally, she said, patients want three things: access, communication, and knowledge. “But maybe how they want those will evolve, as the IT side evolves as well. They want mobile, including chat. And honestly,” she said, creating “chat is so easy. It’s an incredibly important part of that mobile industry as well.” And, she said, patients want a voice experience—in some cases, via technology like Alexa. That opportunity will be particularly strong on the mental health side of the industry.
In fact, Grosser said, healthcare consumers “want the same experience they get when booking airfares. They want to do that here in Seattle with hospitals and clinics,” to find out which patient care organizations will offer what types of physician visit availability, and eventually, even to compare specific moment-to-moment comparative availability. “And how do they get a Kayak-type experience, where they describe the kind of physician they want, and a mechanism can help them?”
Beyond scheduling ease, Grosser noted, “Patients want communication with their healthcare team. And they want knowledge,” including trusted, customized knowledge. That is where some type of Alexa experience, involving artificial intelligence, could prove quite appealing to patients in the near future.
Meanwhile, engagement could also apply along another dimension, Grosser told her audience. And that would be in the area of wearables and other consumer-facing devices that could appropriately communicate specific types of patient data to clinicians, as needed. For example, she said, “If I’m in orthopedics, I might not want to know how much you walk every day, but I might want to know you walked after your hip or knee replacement, or that you went for your physical therapy. AI [artificial intelligence] can help me filter the information I need as a health system.”
Ultimately, Grosser said, when it comes to innovation, “We are moving towards a mobile health maturity model. We’re looking for patient-generated data, generated in a meaningful way. We have to understand that that kind of information is meaningful.”
Meanwhile, Grosser asked, “How do we get to those empathetic health and healthcare tools? This is where I think the market for engagement will take us a long way. Patients will want to connect with non-threatening people to help them take the next steps. How do we make sure that they’re taking the right steps? That we want them to go off particular medication? How do we classify the right apps for them? Work together with their clinicians on the best apps for them?”
There are vast opportunities to create new forms and channels for the engagement of healthcare consumers, Grosser emphasized. But patient care organization leaders need to be very aware of the emergence of a broad range of disruptors, from technology and retail companies like Microsoft and Amazon, but also from such business combinations as CVS as Aetna, as any of those entities might easily rush in to fill voids that patient care organizations have not yet figured out how to fill.
“I think disruptors are good things to the industry,” Grosser told her audience. “If we look at Amazon-related headlines—at Amazon, they’re looking for data scientists, and have been talking about tackling healthcare for some time. My adult children were born before Amazon was created,” she noted. “I asked my children this weekend what they thought about doctors being on Amazon. They said, oh, that’s a great idea! And ended up being engaged in a great conversation. They don’t look at healthcare as a continuum of care. They look at it as offering options” to consumers. And in that context, she said, it's important to note that “The book industry was a test for where else Amazon wanted to go.” And after several years focused primarily on selling books, the executives at Amazon figured out how to succeed in selling a vast range of consumer goods via the same model. Could Amazon disrupt the retail pharmacy industry? Could the CVS-Aetna merger end up strongly disrupting the patient care delivered in medical clinics? What about the announcement last week on the part of Walgreens, which will be partnering with the 14-hospital, Grand Blanc, Michigan-based McLaren Health Care, to expand pharmacy and healthcare services across that state?
Meanwhile, employers represent another potential disruptor in this area. And auto manufacturers, who face the reality that one-quarter of the cost of producing a car, is eaten up by employee and family healthcare costs, are contracting directly with organizations like Cleveland Clinic, in order to cost-effectively manage their employees’ and employees’ family members’ costs for high-volume procedures like total joint replacement. Patient care organization leaders also need to look at the venture capital funders in healthcare to see where VC companies are investing their money into the future.
In the end, Grosser told her audience, the potential for patient care organization leaders to move proactively to engage their patients and improve their experiences, is great; but the potential for outside organizations to come into healthcare as disruptors, is also significant.
Patton concluded her presentation by sharing a quote from General George S. Patton: “Never tell people how to do things. Tell them what to do and they will surprise you with their ingenuity.”