B r o u g h t t o y o u b y:
Whitepaper
Using
Technology to
Improve
Patient Engagement and Outcomes
A
By Steph Weber
n idea that’s gained prominence through its inclusion in the Meaningful Use initiative of the Medicare and Medicaid EHR Incentive Programs, patient engagement is the concept of provider organizations offering healthcare resources and information to patients in order to improve their participation in care, shared decision-making efforts between the two sides, and outcomes, as well as lower costs of care. Patient engagement has become a central theme for healthcare provider organizations, and
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as such, physicians are under pressure to present patients with even more opportunities while also maintaining profitability, especially with the implementation of Medicare Access and CHIP Reauthorization Act (MACRA) and value-based reimbursement payment models on the horizon. “As healthcare shifts from quantity of care to quality of care, it is more essential now than ever for physicians to make efforts to engage their patients as partners in their health and care,” says Lana Moriarty, director of consumer eHealth at the Office of the National Coordinator for Health Infor-
mation Technology (ONC). “More engaged patients have the skills, knowledge, and ability to manage their health and act on providers’ recommendations that can lead to improved health outcomes and lower utilization of health services.” For their own part, patients are seeking more engaged healthcare relationships as well. A 2016 study from Accenture, a Chicago-based consulting firm, found that 92 percent of consumers believe patients should have full EHR access. Fifty-seven percent of Americans believe gaining access to online medical records would result in increased
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proactivity and engagement on their end, according to a 2014 study from Norwalk, Conn.based tech company, Xerox. Beyond the physician-patient relationship, engagement must envelop the entire care team. While the physician and patient may establish healthcare goals collaboratively, it is imperative that each care team member — from office staff to nurses to technicians — understand the objectives and proceeds in a way that supports those goals, experts say. “When the entire team engages and clearly communicates with the patient, it shows that they are all on the same page and [earns] the patient’s trust. It becomes clear to the patient that they are getting the best and cohesive care and they are more likely to act on recommendations given to them by the team,” says Moriarty. The development of new technology, like patient portals, have paved initial inroads toward facilitating communication between care teams and patients. However, since early portal technology traditionally offered somewhat limited functionality and lacked in user-friendliness, many physicians may assume this is the best the portal has to offer. However, experts say, patient portals and other digital health technology have evolved significantly, both in terms of aesthetics and capabilities. Yet these devices remain largely underutilized today, according to experts. True and lasting engagement cannot occur unless and until all parties are receptive. For physicians and care teams, this means providing frequent opportunities for patients to take a more proactive role in their health as well as offering support and the tools with which to do so when they are fully ready. For those patients who are seeking
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deeper engagement, physicians can influence patient outcomes and profitability by utilizing three emerging forms of health technology: smartphones and mobile apps; sensors and activity trackers; and patient portal optimization. Going Mobile
The proliferation of smartphone usage among physicians, nurses, and patients can provide a jumping off point for strengthening engagement. According to a 2015 Sources & Interactions study, 84 percent of physicians use smartphones in the workplace — and up to 93 percent own a device for personal use. As for nurses, 95 percent own a smartphone, with 69 percent using them professionally. Moreover, a 2016 survey by Harris Poll found that 59 percent of insured patients and 70 percent of millennials, born from 1981 to 1997, would select a primarycare physician who utilizes a patient mobile app over one who does not. Steven Wilson, a board-certified family medicine physician in Redlands, Calif., has seen this demand from patients in his practice. “A lot of times, [patients] actually want you to be engaged in their app,” he says. “I have patients who have blood pressure or glucose machines that go directly into their smartphone and they then send me that information [to review] before their appointment or even ask me a question about it.” This widespread smartphone adoption by physicians and nurses, coupled with the increasing demand for mobile access from patients creates an ideal environment for engagement. With more than 165,000 mobile health apps on the market, per a 2015 IMS Institute for Healthcare Informatics report, physicians can likely find an app suitable for virtually any
patient or condition. Since many patients are already familiar with and using health apps— 58 percent of smartphone users had downloaded at least one health-related app according to a study conducted by the New York University School of Medicine in 2015 — physicians may use that as a starting point. “What I find is that I like to ask the patient, ‘What kind of apps are you [already] using,’” says Wilson. “It gives me a sense of what kinds of things they’re concerned about and I can become involved with that.” Due to the sheer number of patients living with chronic disease, mobile apps may be well-suited for improving treatment compliance and, ultimately, outcomes. According to 2013 research by Pew Internet Project, 45 percent of U.S. adults have at least one chronic health condition. Those with two or more chronic health conditions frequently experience high blood pressure and diabetes, at rates of 78 percent and 45 percent respectively. “Patients with chronic disease are [more] likely to track health indicators,” says Moriarty. “Tracking makes patients feel more accountable and in control of their health and also prompt[s] a patient to quickly contact their provider when something appears to be urgent.” Disease management apps may also provide texting options, offering a convenient and inexpensive way to connect with patients between appointments. A 2016 study published in the Journal of the American Medical Association (JAMA) found that text messaging increased the rate of medication adherence for chronically ill patients from 50 percent to nearly 68 percent. A 2015 pilot study found that 30-day readmission rates were reduced by 10 percent — and 40 percent over the established
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baseline — by sending appointment reminders via email and text messaging to patients with chronic health failure. Wilson has witnessed the benefits of connecting with patients via digital communication. In addition to appointment reminders and educational support, his practice utilizes the technology to ensure medication and treatment plan adherence. “This type of technology [provides] the patient a rather quick way to communicate about concerns. If we have started them on some new medication or treatment, it’s an easy way for them to communicate any problems, side effects, or questions,” says Wilson. “It really allows them to be more engaged, and because of that, you see more adherence to the regimen and [progression] through the therapy they need.” For patients who are already active, wellness apps may be a perfect supplement to encourage ongoing activity. “Health conscious patients are looking for ways to track progress and help them with setting goals,” says Dara Barrera, manager of practice management and health information technology for Michigan State Medical Society. “These tools can be very helpful for a patient who is already engaged in their health and looking to make improvements. The key is finding an app that will fit the specific need of the patient.” Patients can often find one targeted toward their unique interests, whether it’s running, yoga or triathlon training. Apps provide a way for patients to track their current exercise and use the data to establish further activity goals with their care team. Wellness apps can also complement the healthcare goals of patients who require additional motivation. Whether patients are interested in increasing their
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activity level or improving their diet, several apps exist that can be customized to the needs of the patient. Apps can also send reminders to let the patient know that they haven’t worked out yet today or that their food log needs updated. Some apps have the option of working directly with a coach, while others incorporate points systems and have established communities that can be another source of support and encouragement. Patients who are going through certain health experiences may benefit from app usage as well. For instance, the people who subscribe to one or more mobile apps, 47 percent of them use a pregnancy-related app, according to a 2013 report by ByteMobile. Pregnancy apps can track the development of the fetus, provide advice for each stage of pregnancy, and remind patients of key appointments. Following the birth, childcare apps can provide a community of parents — both new and experienced — to provide childrearing support and advice. Informational content about developmental milestones, feeding, and childhood illnesses can also be easily shared and digested by users. This year alone, the American Cancer Society estimates that there will be more than 1.6 million people diagnosed with cancer in the United States. Apps related to cancer care can provide patients with a central location to document related medical information including treatments and medications. Other apps help patients develop a list of questions for their physician based on diagnosis as well as digitally record physician responses for future reference. A number of specialty care apps exist as well. For patients recovering from a stroke, there are apps to explain the recovery process
and treatment methods. Additional apps may offer support and educational content for patients with multiple sclerosis, Alzheimer’s, epilepsy or other diseases. Increasing adoption of mobile apps among patients has several benefits. Patients can take a more proactive role in their care and recovery as they learn about their health condition and gain access to highly targeted care. Physicians and the care team can communicate with the patient between appointments, thereby improving patient satisfaction and deepening engagement while also potentially preventing further complications or unnecessary readmissions. “There’s such widespread use of smartphones now [that] most [patients] are very familiar with [apps]. Apps have now become part of people’s lifestyles,” says Wilson. “And we should embrace that in medicine also.” Sensors and Activity Trackers
There has been a rising interest in sensors and activity trackers in the last few years, frequently referred to as wearable technology. A 2016 survey by Accenture revealed that 78 percent of consumers would use these devices to track fitness and vital signs and 90 percent would readily grant access of any generated data to physicians. Practices can capitalize on this growing acceptance and availability of wearable technology to provide a higher level of patient-centered care. As EHR capabilities expand, integration of wearable data with traditional clinical data becomes a more viable option. “An increasing amount of EHRs have the ability to integrate patient-generated health data into their systems and some rely on this data for remote monitoring,” says Moriarty. “Since this tracking is longitudi-
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nal, this helps physicians and the rest of the care team get a better idea of the health of the patient.” Wilson has been using wearables with his patients for almost four years. “These types of devices can be helpful tools in patient care and should be tailored to the individual patient’s established health goals,” says Wilson. For his patients interested in making healthier food choices, Wilson recommends an activity tracker that can scan food package barcodes, quickly calculating the nutritional content and seamlessly logging it directly into the patient’s food diary. For others needing to improve their fitness or sleep cycles, activity trackers and wearable devices can illuminate necessary changes. “If the goal is to sleep better, a wearable device can [help] patients establish their own sleep patterns and see objectively any changes that occur with lifestyle changes, supplements, or medications,” says Wilson. Patients utilizing tracking devices tend to take a more proactive stance when it comes to their health, perhaps in large part because the data is customized to their situation. “Monitoring their weight, sleep, activity, heart rate, calories, and fluid intake on a daily basis allows patients to have regular feedback that is specific to them,” says Wilson. When the care team and patient come together to review the data or the data is shared through the portal, a conversation begins. “[Patients] share that data with me and I provide suggestions and appropriate advice based on their personal health goals and [take] into account chronic conditions like hypertension and diabetes,” says Wilson. “I’ve seen patients become more engaged and invested in improv-
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ing their health when they use these devices.” Enhancing the Portal
Patient portals may provide another opportunity to strengthen relationships among the care team and patients. While the services offered by the current generation of portals — typically bill pay, scheduling, access to test results, and messaging with providers — are a significant advancement, the portal remains an underutilized asset for influencing engagement and outcomes. “Patient portals have had a surge in use in the last few years because of the Meaningful Use incentive program,” says Barrera. “As use of portals
increases in practices, you will begin to see greater capabilities that can be offered.” An example of a capability that has rapidly evolved as of late is telemedicine, specifically virtual consultations through the portal. A 2015 Harris Poll found that 64 percent of adults would choose a telehealth visit at least some of the time if given the option. “Virtual consultations have many benefits. Physicians are able to see patients [who] cannot [attend a traditional] appointment. This prevents admission to the hospital and allows for medication compliance monitoring,” says Padam Bhatia, a board-certified psychiatrist in Miami, Fla. “In my
Patient-Generated Health Data In addition to fostering deeper patient involvement and better outcomes, engagement technology can lead to higher revenues as well. “Increased patient portal use can lead to financial incentives through the Medicare Access and CHIP Reauthorization Act (MACRA),” says Lana Moriarty, director of consumer eHealth at the Office of the National Coordinator for Health Information Technology (ONC). “Additionally practices that leverage health IT tools — such as patient portals, telemedicine, and health tracking devices — can also see cost savings [related to] lower utilization of health services, reduced call volume, increased productivity, improved practice workflow, and savings that result from moving away from a paper-based system.” For practices interested in incorporating more patient-generated health data into their daily workflows, Moriarty offers these suggestions: • Discuss with practice staff how patient-generated health data can improve care and efficiency. • Determine the data you’re already collecting and decide what additional tracking would be most beneficial. • Develop written policies and procedures regarding the handling of data, such as when data will be accepted as well as who will review it. • Educate patients and caretakers about the value of patientgenerated data and how it will impact care. • Start small and make changes as needed. For example, consider launching a pilot program to collect symptoms for patients managing a chronic disease.
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private practice, I am able to see patients who are too busy, too far [away], or too anxious to come into the office for a more traditional assessment.” With more insurance companies offering reimbursement for telehealth services and a rising demand for it from patients, physicians may find offering this service a way to boost engagement as well as the bottom line. A 2015 Tractica report estimated that telehealth video consultations will grow from 19.7 million per year in 2014 to almost 160 million by 2020. According to the National Conference of State Legislatures, 48 states plus the District of Columbia provide some reimbursement for telehealth services under the Medicaid program. Private payers in 32 states as well as the District of Columbia provide similar reimbursement models. “While this has been slow to take hold nationwide, insurance companies are reimbursing for telemedicine visits [at a rate] similar to what a practitioner would see from a traditional office visit,” says Bhatia. Offering the service doesn’t have to be costly either. A number of cloudbased, HIPAA-compliant platforms exist — some standalone applications while others utilize the practice’s existing patient portal. “Depending on the telemedicine platform used, virtual consultations can be very cheap to implement, [often requiring] only access to a phone, tablet, or computer with audio/video capabilities and an internet connection,” says Bhatia. While quick access to physicians underlies the demand for virtual consultations, instantaneous access to research and healthcare information may explain the overwhelming popularity of sites like WebMD. A Rock Health study from 2015 found that 71
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percent of respondents had looked online for health information. The 2015 WebMD Patient Engagement Survey noted generational differences in the online searches though. Millennials were likely to seek healthcare information from multiple sources including the internet — many times classifying a physician’s written instructions as equal to those found online. Because of this, it’s important that patients are referred to trusted online resources. In this sense, targeted educational literature and videos may be shared via the patient portal as well, offering another reference tool for patients. While portal capabilities vary per vendor, more are providing integrated patient education materials that correspond to labs, procedures, and health conditions contained in the patient record. Access to clinical summaries as well as preventative care recommendations can assist patients interested in taking a more active role in their health, especially since the information is catered to their unique situation and needs. “Increased portal use can improve patient likelihood to follow through on preventative care recommendations and improvements in disease management for patients with chronic diseases,” says Moriarty. Lastly, the portal provides an excellent mechanism for which to track patient goals as well and foster communication between the patient and care team. For example, Wilson’s patients send him their food diaries though the portal, and in turn, he provides feedback, guidance, and encouragement that will help steer the patient toward their goal. Both the patient and care team can focus their efforts on the primary health goal, many of which may be preventative in nature and eliminate ongoing risk factors.
Conclusion
Thanks to a number of technological advances, there are more methods and tools with which to engage patients than ever before. However, don’t underestimate the original online techniques — your practice website and social media channels. Both still hold tremendous value and can be used to not only attract new patients, but offer ways to continuously educate and interact with existing patients. “While newer technologies have an expanding role in healthcare, there is no replacement for the personalized touch of the written or spoken word,” says Bhatia. “Patients are less skeptical of newer technologies and more willing overall with treatment options if they feel like they know the personality of their physician, [which] is why more traditional patient outreach efforts, such as websites, videos, and blogs, have an entrenched role in educating patients.” Besides having more ways to access patients, there is also much more incentive for practices to do so. Physicians and the care team can use technology to better meet the needs of patients and offer support outside of traditional methods as well as between office visits. This deeper level of engagement can lead to improved patient outcomes, which can increase revenues under MACRA and value-based reimbursement payment models. Physicians may attain a distinct advantage by incorporating patient-generated data from mobile apps and activity trackers into clinical care, while also maximizing the portal’s functionalities to include targeted healthcare education, video content, and interactive goal tracking. Steph Weber is a healthcare freelance writer hailing from the Midwest.
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