Patient Estimates Enable Price Transparency for Medical Services

The Centers for Medicare and Medicaid Services (CMS) issued a ruling, in January 2021, to improve price and quality transparency for “shoppable” healthcare services, such as an imaging study, laboratory service, or elective medical procedure. The legislation was enacted to enable patients to shop for the most effective, lowest-cost health care available. The regulation required hospitals to provide an online computer-friendly tool, displaying at least 300 services in a standardized format, to assist patients when shopping for a routine test or elective procedure.

Penn Medicine implemented the self-service estimates module in the EHR, allowing people to visit a userfriendly web-based price transparency tool. There, they could create an estimate informing them of payment expectations prior to the scheduled service or procedure. The module was built to provide patients with ‘out of pocket’ expenses that they may incur based on Penn Medicine’s verification of their current insurance benefits. Prior to implementing this feature, patients were directed to contact a Penn Medicine financial advocate to estimate pricing for an upcoming service or procedure. The financial advocate transcribed the patient’s information over the phone, generated the estimate in the EHR and then called the patient back with the estimated amount. By using the self-serve estimate module, patients could receive a personal, automated real-time estimate immediately after entering their information.

This functionality has improved the patient experience by offering patients clear, accessible, and easy to understand estimates and financial obligations. Patients have been empowered to make more informed decisions about their care and render payments in advance of services.

Penn Medicine Patient Experience Survey Expands to Lancaster General Hospital

The Penn Medicine Patient Experience team created a real time patient satisfaction survey platform (PMX Survey) to reach patients through text messages after having an ambulatory visit. This new survey tool resulted in much higher patient engagement with response rates of nearly 25%. Further, by receiving patient comments in near real time after a visit, the care team was enabled to receive immediate and targeted feedback as well as identify service improvement opportunities.

To fully achieve integrated access, a mechanism was developed to extract data from the PMX survey database that connected to both the LGH data warehouse and Penn Data Store. This enabled the consumers of the data at LGH to benefit from and incorporate survey feedback into care delivery. Previously, Lancaster General Hospital’s data warehouse did not have access to the PMX survey database, which prevented the entity from accessing patient experience reports and dashboards.

Penn E-lert Intensive Care Monitoring Program Expands Enterprise-wide

One of the most essential technical components of the intensive care unit (ICU), is the continuous monitoring of patients’ vital parameters which has been shown to improve patient safety by reducing ventilator days, decreasing mortality, and reducing length of stay. Remote monitoring in the ICU is a viable option that provides the care team with unlimited access to critically ill patients across the ICUs (Intensive Care Unit) at Penn Medicine hospitals. This service allows for proactive identification of impending or evolving patient problems to effectively manage their care.

The Penn E-lert® electronic intensive care unit (eICU) monitoring system consists of real time clinical decision-making support and telemedicine technology to continuously monitor patients. The installation of the Penn E-lert® monitoring system is now available at all intensive care units, enterprise wide. The system offers 24/7 critical care monitoring and uses a fixed camera technology to monitor ICU patients remotely and document within the EHR. Penn E-lert® eICU is a state-of-the-art electronic intensive care system that provides an additional layer of expert medical and nursing support for critically ill patients. A primary benefit of the system is the clinical team’s immediate access to telemedicine specialty care consultants to assist in their clinical decision making based on an individual patient’s needs.

The Center for Connective Care manages this remote monitoring program, employing critical care registered nurses who perform consultations 24 hours a day, 7 days a week and critical care intensivists who perform consultations from 7:00pm-7:00am daily. Clinicians on the Penn E-lert® team are board certified Intensivists from the departments of trauma, anesthesia, pulmonary, neuro critical care, or emergency medicine.

Home Health Care Program Integrates Vitals Data into PennChart EHR

As part of Penn Medicine at Home’s telehealth program, patients have been using a monitoring device to measure their vitals so that essential information is reported and monitored by their caregivers. Previously, vitals data were manually entered by the caregiver during the home care visit on the remote home health web portal. Now, data is electronically captured and integrated from the patient’s device right into the electronic health record.

Information Services improved both the patient and caregiver experience by implementing an interface to send these patient demographics electronically between the system capturing the vitals and our PennChart EHR. The technology team implemented a results interface to communicate with our EHR. Print groups were configured to display patient and device reported vitals in the EHR remote client. Reports were also created to trend patient vitals information in the remote client so that the data could be viewed offline.

Vital signs were now able to be validated more efficiently, especially since they were transmitted in real- time and contained timestamps. The automated process also saved nurses from writing vital signs on a piece of paper, then re-entering them in the EHR. The interface also helped eliminate transcription errors that occurred when manually typing vitals. It additionally allowed vitals to be captured during times when a clinician was not visiting a patient or documenting an encounter.

Penn Medicine OnDemand (PMOD) Program Transitions Video Platform

The PMOD department was originally set up to perform telemedicine services with a video platform that Penn Medicine selected to integrate with our EHR. Once telemedicine gained mainstream adoption in healthcare, our EHR vendor established their own platform to support their client healthcare systems and facilities. Our technology team decided to switch solutions and prepare our users to transition platform support. New workflows were designed to use the application and system peripherals were also integrated. The technical team also determined where the video platform servers would be hosted, established licensing, and mapped out a maintenance schedule for continuous upgrades.

Due to these efforts, coordinated with our operational counterparts, Penn Medicine now has a validated and reliable long-term EHR integrated telemedicine solution implemented across the health system. A much-improved patient experience has also resulted from the new telemedicine technology. Patients were enabled to complete pre-check-in steps and connect to their video visit right from their myPennMedicine app. They no longer needed to search for email and text messages to find and connect to their appointment. Using this solution also allowed Penn Medicine providers to have a single platform to document their encounters and connect to their video visits. Another significant benefit achieved was that the servers became hosted by our EHR partner, which minimized maintenance work and potential challenges with troubleshooting issues between different integrated vendors.

Lancaster General Health Enables Telestroke Neurology Service

Lancaster General Health (LGH) developed the use of telestroke services to connect off-site stroke service providers to support overnight acute stroke management. LGH providers were able to remotely monitor patients and provide updated eHealth EHR consultation notes, using the Caregility platform. Integrating documentation and resulting orders improved the speed at which stroke patients could start lifesaving care. This allowed clinicians to assess the patient faster and start thrombolytic therapies to remove clots and restore perfusion to the brain.

Developing this new offering allowed for orders to be placed for testing, based on a more specific patient evaluation instead of following general protocols. Telestroke services enabled higher-level procedures to be performed, which historically would have required an on-site provider to monitor the outcome in person, rather than via remote monitoring. This program provided expedited services for LGH stroke patients and increased their recovery rate.

Information Services implemented carted mobile devices so that a remote stroke assessment could be made by a provider in the patient room. Complex clinical workflows were developed for LGH providers to coordinate care for stroke patients using mobile carts. LGH has used the technology more than 244 times since May of 2021 and has been able to drop its door to needle time from 51 minutes to 37 minutes.

Tele-Stroke Expansion Lends Help to Patients in Need of Specialized Care

Stroke is a time sensitive medical emergency that requires prompt evaluation and treatment. The “golden hour” after the onset of stroke symptoms is critical. Penn Medicine’s Telestroke Program is designed to provide urgent consultation to stroke patients at partner hospitals who need neurovascular specialists at the Comprehensive Stroke Center to provide specialized clinical expertise for severe, life threatening, or limiting conditions. This program helps stroke patients receive timely and appropriate care, irrespective of their location.

The Telestroke Program began by partnering with Shore Memorial Hospital, and then Grandview Hospital to develop a business model and new technology for patient care workflows. The team created a new workflow in the PennChart electronic health record to quickly register non-Penn Medicine patients, built tools for neurovascular specialists to conduct urgent telemedicine consults, and configured telemedicine carts to enable remote patient evaluations.

A new VPN tunnel was set up along with a new rapid server to enable physicians to facilitate faster, more accurate triage or hospital transfer decisions using advanced imaging artificial intelligence. The team trained providers at each organization on the new workflows and developed new reports for tracking tele-stroke consults.

The Penn Medicine neurovascular specialists provided numerous virtual consults and urgent telemedicine visits for patients, offering their clinical expertise and diagnostic skills. The service was supported by a unique integration of diverse medical technologies that connected physicians with patients across the care continuum with interactive communication devices. They helped with treatment and also transfers to the Comprehensive Stroke Center at HUP. Additionally, remote patient/device monitoring helped to streamline care delivery in tandem with the most widely used imaging software among physicians for stroke patient care, research, and clinical trials.

The Telestroke Program created a framework for future expansions to other hospitals and helped extend specialized care and expertise to some of the sickest patients in need of care for stroke and neurology related conditions. The program is a testament to the power of technology and collaboration in healthcare and demonstrates how telemedicine can be used to bridge the gap in medical access and improve patient outcomes.