1 ENGAGING PATIENTS IN TRANSITIONS OF CARE: Laura Kreofsky, MHA, MBA Susan Woods, MD, MPH Nan Robertson, RPh
2 Presenters Laura Kreofsky, MHA, MBA Principal and leader of Impact Advisors Discovery and Development services email: laura.kreofsky@impact-advisors.com Susan Woods, MD, MPH Internist, Portland VA Medical Center Consumer informaticist and Associate Professor, Oregon Health and Science University, Departments of Medicine and Medical Informatics email: susan.woods@va.gov Nan Robertson, RPh Principal and Pharmacy Informatics Senior Consultant The Robertson Group LLC email: nan@therobertsongroup.org
3 Presentation Topics/Agenda Patient Engagement: A Common Understanding Transitions of Care: Costly, Complex and Critical Engaging Patients in Transitions of Care People Process Technology Case Study Q&A
4 Patient Engagement: A Common Understanding
5 Drivers of Patient Engagement Shifting from Volume to Value Increased Risk/Responsibility Longer Episodes of Care/Accountability Readmission penalties Share Savings Advancing Technologies Evolving delivery models Less bricks and mortar More clicks and mobile It s What Patients and Caregivers Want
6 and Where and How they Want It Patient Portals Biometric Sensors Remote Monitoring Mobile Devices Virtual Visits Prevention Ambulatory EHR Ambulatory Wellness Urgent Care / ED Inpatient EHR Social Media Home Healthcare Care Management Acute Care Inpatient HIE Analytics & CDS Long-term Care Sub-Acute Telemedicine Source: Impact Advisors, LLC Occupational Health
7 Transitions of Care: Costly, Complex and Critical
8 In the beginning.
9...signs of progress
10 and then, the government stepped in to help.
11 MU Stage 2: Patient Engagement Secure Messaging (Eligible Professionals only) View/Download and Transmit Health Information Providing summary care record for transitions of care/referrals Clinical summaries to patients (or reps) w/in 1 business day Using CEHRT to identify patient-specific education resources and provide those resources to patients Sending patient reminders Complying with Public Health Measures requiring opt-in/opt out
12 Why Focus of Transitions of Care? The locus of care (and cost is shifting) Treatment spending drops from 70% in 2007 to 50% of budgets by 2025 1 50% of cost for an episode of care is for post discharge 2 Providers and institutions are recognizing key transition activities such as Med Reconciliation and patients participation in them as high ROI Patient verification and clarification of their discharge medications using a secure web portal resulted in the discovery of 23 potential adverse drug reactions for 60 patients, 50% of which were classified as serious. 3 1. Circle Square/IBM/Frost and Sullivan, 2013 2. Advisory Board, 2013 3. Engaging patients in medication reconciliation via a patient portal following hospital discharge Heyworth et al., Journal of the American Medical Informatics Association, Sept 13, 2013
13 Today s Care Coordination Strategies Today, providers are coordinating care in manual, resourceintensive ways, with the patient at the periphery Care management coordinators 77% Disease registry Patient Centered Med Home Health coaches Care transition coordinator 60% 60% 52% 50% Wellness program 33% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Source: ACO 2012: The Train Has Left the Station, KLAS Research & Leavitt Partners, November 2012
14 Strategies for Engaging Patients during Transitions of Care
15 NeHC Patient Engagement Framework Source: National ehealth Collaborative Patient Engagement Framework (www.nationalehealth.org)
16 Patient Engagement Components People Patients and families Caregivers Process Workflows Communications Technology Portals/PHRs Mobile Social Health Meaningful Use Blue Button
17 Engaging Patients in Transitions of Care: People, Process and Technology Patient Growing dependency on digital technologies Expectation of real-time access to services Increasing clinical and financial responsibilities Proxy Enables sharing information Supports caregiver effectiveness Provider/Staff Foster understanding of what the patient wants Supports behavior change Get out of the way
18 Engaging Patients in Transitions of Care: People, Process and Technology Targeted Patients, Targeted Processes You ve got the data, now use it Focus on high risk / high cost populations and processes Patient Centric Processes Care Coordination @ Transitions of Care Meds Reconciliation Embrace the patient owns the chart mindset Staff Engagement Practice what you preach Help them be evangelists Communication/Activation Market tools and technologies available Activate early and often
19 Engaging Patients in Transitions of Care: People, Process and Technology PHR/Portal Blue Button Open Notes Mobile Apps In-home Technology Remote Monitoring Secure Messaging Telemedicine Video Visits Etc. Etc.
20 What Patients Want Notify me. Help me care for myself. Let me see all my health records. Help me manage my medications. Help me manage my appointments. Let me add to the record. Help me understand my information. Make it easy for me to send you information. Let me share my information outside VA. Help me connect with other Veterans. Source: The Voice of the Veteran, Department of Veterans Affairs, 2011
21 Looking online for health information Source: Pew Research Center s Internet & American Life Project, 2012 Survey. N = 3,014
22 71% Got information or care from a health professional for their last problem
23 MyGroupHealth Users and PHR Usage
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27 Views after one year % Agree Patients PCPs Takes better care of self 70 28 Better understand conditions 84 41 Remembers care plan better 84 44 More prepared for visits 73 36 More in control of care 84 49 Take medications better 60 31 Source: Inviting Patients to Read Their Doctors Notes: A Quasi-experimental Study and a Look Ahead. Ann Intern Med, October 2, 2012 157(7):461-470.
28 Views after one year % Agree Patients PCPs Felt offended 2 8 More confusing than helpful 3 21 Worries more 7 42 Concerned about privacy 32 -- Source: Inviting Patients to Read Their Doctors Notes: A Quasi-experimental Study and a Look Ahead. Ann Intern Med, October 2, 2012 157(7):461-470.
29 Communication I can go in and ask more intelligent questions and we don t have to spend as much time with them explaining everything to me. Source: Patient Experiences with Full Electronic Access to Health Records and Clinical Notes Through the My HealtheVet Personal Health Record Pilot: Qualitative Study. Susan S. Woods, Schwartz E et. al., Journal of Medical Internet Research 2013;15(3):e65
30 Knowledge Doctors aren t real gabby and never tell you everything. Even if you questions, they ll sort of slide around them. They don t have time. I found stuff out that I was just truly amazed at about myself. Source: Patient Experiences with Full Electronic Access to Health Records and Clinical Notes Through the My HealtheVet Personal Health Record Pilot: Qualitative Study. Susan S. Woods, Schwartz E et. al., Journal of Medical Internet Research 2013;15(3):e65
31 Self-Care Made me feel more responsible for myself, like there s no excuses. You know, it s right there, you know. You can t use the doctor didn t tell you. You could pop over to Google or the library, and see what it s saying instead of sitting there sweating it out trying to figure out what it is.
32 Quality An ultrasound on my liver said. Re-do in 6 months. Six months came, nothing happened. So I called the doctor. He says, Yeah, they did say that. So, if I hadn t reminded him, I wouldn t have got it.
Talk to Patients. They Know Cool Stuff You Don t. 33
34 Patient Engagement Case Study
35 Meet Doug 60-year old historically healthy male Rarely used a computer or the Internet Rarely discussed his condition with others Never made his own appointments or ordered his own prescriptions
36 Doug s Journey through the Healthcare Maze Diagnosed with multiple difficult conditions over a 7 year period Managed by 12 physicians across 8 departments in a coordinated care health care system
37 Doug s Approach: Power to the People! The challenge: Coordinating care across Urology Cardiology IM Interventional Radiology GI Surgery Oncology Infectious Disease Hospitalists The Toolkit: Secure messaging On-line care plan for selfinitiated actions based on lab results On-line appointing Medication management Medication requests Prescription refills Medication list clean-up Internet support groups Patient Education Resources
38 Medication Management: What Transition? Medication Antibiotics for recurrent infection Patient Action Monitor lab results and message provider to act Chemotherapy side-effect treatment Secure message symptoms; adjust dosing as recommended by oncology pharmacist Anticoagulation Therapy Monitor lab results (INR) and secure message anticoagulation RN for dose changes
39 Today Doug pilots his own health care Established collaborative e- relationship with his care team Trusted use of online tools He feels empowered and connected
40 Engaging Patient in Medication Management 1. Print current medication list for patient review launch the conversation of shared accountability Print and review discharge medications Print and review current medication list before the office visit 2. Implement secure messaging and encourage patients to send a message to their doctor/health care team when they have medication questions or see inaccuracies 3. Display the patient s current meds on-line and provide them with a path to communicate discrepancies, requests, and inquiries
41 Action Steps/Take Aways Develop Your Patient Engagement Plan, Now! Focused on high impact areas: Transitions of Care Meds Management Other NEHI framework for progressive advancement Be Holistic in Planning Approach People: Patient, Provider and Staff Engagement Process: Front-to-back evolution Technology: It s at your fingertips (literally) Enable Patients Innovation Identify patient populations based on their needs, limitations and abilities The Patient works for Free
42 Contact Us Laura Kreofsky, MHA, MBA Principal and leader of Impact Advisors Discovery and Development services email: laura.kreofsky@impact-advisors.com Susan Woods, MD, MPH Internist, Portland VA Medical Center Consumer informaticist and Associate Professor, Oregon Health and Science University, Departments of Medicine and Medical Informatics email: susan.woods@va.gov Nan Robertson, RPh Principal and Pharmacy Informatics Senior Consultant The Robertson Group LLC email: nan@therobertsongroup.org
43 APPENDIX
44 Selected Resources on Patient Engagement Engage! Transforming Healthcare Through Digital Patient Engagement Edited by Jan Oldenburg, Dave Chase, Kate T. Christensen, MD, and Brad Tritle, CIPP; HIMSS, 2013 http://www.amazon.com/transforming-healthcare-through-digital-engagement/dp/1938904389 Journal of Health Affairs, New Era of Health Engagement issue, February 2013 AHRQ Guide to Patient and Family Engagement in Hospital Quality and Safety http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/patfamilyengageguide/index.html The 7 Habits of Highly Patient Centric Providers www.forbes.com/sites/davechase/2013/02/18/ Is there a business case for engaging patients? www.forbes.com/sites/davechase/2012/10/21 National ehealth Collaborative Patient Engagement Framework www.nationalehealth.org/patient-engagement-framework
45 A Patient Engagement Roadmap Source: http://www.nationalehealth.org/patient-engagement-framework