Emerging Tools and Technology for Consumer Engagement in Health Care Speakers: Matt McGeorge, Senior Consultant, Jean Glossa M.D., Principal, October 15, 2015 HealthManagement.com
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How is the doctor-patient relationship changing? It s going electronic. - Washington Post Headline April 27, 2015 5
Learning Objectives Recognize the importance of information technology in driving consumer engagement in healthcare. Understand the meaningful use guidelines related to consumer engagement. Exposure to some of the tools and technology helping consumers navigate the healthcare system, manage their health and wellness, and evaluate care options. Appreciate the role patients play in helping to keep electronic health records and information up-to-date and correct. Insight into the implications for clinicians as consumers more actively utilize electronic tools and technology 6
Matt McGeorge, Senior Consultant FACTORS MEANINGFUL USE TOOLS 7
Factors Driving the Use of Technology to Engage Patients Personal Access to Technology Payment Reform Patient Centered Care EHR Incentive programs 8
Patient Centered Care Gives patients the ability to communicate effectively and immediately with their providers Provides patients access to information that is important and useful to them, when they need it Allows providers to look holistically at an individual and treat them through the coordination with other providers Personal Access to Technology Empowering the Patient Patient Centered Care Payment Reform EHR Incentive programs 9
Payment Reform Increased expectations for patients/consumers Cost sharing Availability of information Choice and access Engaged patients/consumers will: Understand more about their health and the care provided to them Participate in developing a treatment plan and strive to meet treatment goals Demand higher quality for the care they receive Results of engaged patients/consumers: Increased transparency in care and cost Focus on patient centered care Personal Access to Technology Patient Centered Care Payment Reform EHR Incentive programs 10
Personal Access to Technology Personal Access to Technology Patient Centered Care Payment Reform EHR Incentive programs http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/pi_2015-04-01_smartphones_05/ 11
Personal Access to Technology Pew Research Center http://www.pewinternet.org/data-trend/internet-use/internet-use-over-time/ 12
Personal Access to Technology Pew Research Center http://www.pewinternet.org/data-trend/mobile/device-ownership/ 13
Lever: Meaningful Use (MU) Eligible professionals, eligible hospitals, and critical access hospitals are in the best position to encourage patients to use health IT to better understand and participate in their own health care. - Robert Tagalicod, Director, Office of E- Health Standards and Services Personal Access to Technology Payment Reform Patient Centered Care EHR Incentive programs https://www.cms.gov/ehealth/listserv_stage2_engagingpatients.html 14
Lever: Meaningful Use (MU) MU is intended to facilitate the movement of American healthcare and health IT toward delivering patient centered care Implementing MU requires a balanced approach: If measures too difficult, providers would not participate in program If too easy to meet, then healthcare outcomes would not significantly improve When providers adjust workflow for some patients, they will likely do it for all 15
Steps for MU Implementation for Health Information Technology (HIT) The MU criteria are being implemented in three stages Stage 1 Data Capture and Information Sharing 2011-2013 Stage 2 Advanced Clinical Practices (Clinical Decision Support) 2014-2016 Stage 3 Improved Outcomes 2017 16
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Meaningful Use Patient Engagement Measures (Evolution of Measures) Clinical Summaries of Care Patient Reminders Stage 1 Stage 2 2015-2017 Stage 3 Patient Specific Education Resources Patient Access to Health Information (electronic access from 2014 on) Electronic Access Menu Measure Prior to 2014 Combined Combined Electronic Messaging 19
Patient Specific Education Resources Stage Stage 1 Stage 2 Measure Menu: More than10% of patients are provided patient specific education resources Patient-specific education resources identified by CEHRT are provided to patients for more than 10% of all patients with office visits seen by EP 2015-2017 Patient-specific education resources identified by CEHRT are provided to patients for more than 10% of all patients with office visits seen by EP Stage 3 Combined with Electronic Access Measure (see next slide) * Measure objectives summarized for illustration, exclusions may apply 20
Patient Access to Health Information Stage Objective Measure * Stage 1 Stage 2 More than 50% of all patients who request an electronic copy are provided I within 3 business days Menu prior to 2014: More than 10% of all patients seen are provided electronic access within 4 business days after info available to EP More than 50% of all patients seen are provided online access to their health info within 4 business day after info available to EP; more than 5% of all patients view, download or transmit to a third party their health information 2015 2017 (2 measures) Stage 3 (optional 2017; required -2018 on) 2. measures) patients * Measure objectives summarized for illustration, exclusions may apply 1. More than 50% of all patients seen are provided online access view, download, and transmit to a third party their health information 2. in 2015 & 2016, at least 1 patient views, downloads or transmits his or her health info to a third party; in 2017 more than 5% of patients seen by EP views, downloads or transmits health info to third party 1.For more than 80% of patients, patient is provided timely access to view, download or transmit their health info or is given access of their choice that meet the API Specs in the provider s CEHRT 2. EP must use clinically relevant info from CEHRT to identify & provide electronic access for more than 35% of 21
Stage Stage 1 Stage 2 2015-2017 Stage 3 (optional 2017; required -2018 on) (EP must meet 2 of 3 measures) Electronic Messaging/Coordination of Care through Patient Engagement Not required Objective Measure* A secure message was sent using the electronic messaging function of CEHRT by more than 5% of patients In 2015, the capability for patients to send and receive a secure message with the EP was fully enabled during the EHR reporting period; in 2016, EP must send or respond to a secure message sent using CEHRT function; in 2017, EP must send or respond to messages from 5% of patients (or patent representative) using CEHRT function 1. In 2017, more than 5% of patients seen by EP actively engage with EHR provided by EP, in 2018, requirement applies to more than 10%; 2. In 2017, for more than 5% of patients seen a secure message was sent using messaging function of CEHRT or in response to message from patient, after 2017, the requirement rises to 25%; 3. Patient generated health data from non-clinical setting incorporated into CEHRT for more than 5% of patients seen * Measure objectives summarized for illustration, exclusions may apply 22
US Hospital Adoption of Patient Engagement Functionalities 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Identify and provide patientspecific education resources View, Download and Transmit information from their health/medical record online Request an amendment to change/update their health/medical record Schedule appointments online Request refills for prescriptions online Submit patientgenerated data (e.g., blood glucose, weight) 2012 2013 2014 Office of the National Coordinator for Health Information Technology. 'U.S. Hospital Adoption of Patient Engagement Functionalities,' Health IT Quick-Stat #24. dashboard.healthit.gov/quickstats/pages/fig-hospital-adoption-of-patient-engagement-functionalities.php. October 2015 23
Health IT Tools Personal Access to Technology Patient Centered Care Office of the National Coordinator for Health Information Technology. 'Trends in Individuals Use of Health IT: 2012-2014,' Health IT Quick-Stat #46. dashboard.healthit.gov/quickstats/pages/fig-individuals-health-it-use.php. June 2015 Payment Reform EHR Incentive programs 24
Patient portals Health IT Tools - A patient portal is a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet connection. Office of the National Coordinator for Health IT - Uses: - View discharge summaries, lab reports, medications - Request appointments and prescription refills - Challenges: - Having a portal does not equate to patient engagement - Patients with multiple providers have multiple sign-ons 25
Usefulness of information within online medical record reported by individuals who used their online medical record at least once within the past year, 2013-2014. Health IT Tools Reasons for not accessing online medical record cited by those who did not access their online medical record, 2013-2014 NOTE: *Significantly different from prior year (p<.05). Not useful includes not at all useful or not very useful; Useful includes somewhat or very useful. Number of respondents ranged from 384 (2013) to 474(2014). SOURCE: 2013-2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange Patel V., Barker W. & Siminerio E. (October 2015). Trends in Consumer Access and Use of Electronic Health. ONC Data Brief, no.30. Office of the National Coordinator for Health Information Technology: Washington DC 26
Patient Portals - Opportunities: Health IT Tools SOURCE: 2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange Patel V., Barker W. & Siminerio E. (October 2015). Trends in Consumer Access and Use of Electronic Health. ONC Data Brief, no.30. Office of the National Coordinator for Health Information Technology: Washington DC 27
Patient Portals - Opportunities: Health IT Tools Role of Health Information Exchange: - Provider Initiated - Patient Initiated Reinforces importance of interoperable systems SOURCE: 2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange Patel V., Barker W. & Siminerio E. (October 2015). Trends in Consumer Access and Use of Electronic Health. ONC Data Brief, no.30. Office of the National Coordinator for Health Information Technology: Washington DC 28
Health IT Tools Secure Messaging: Any electronic communication between a provider and patient that ensures only those parties can access the communication. Messaging is private, tamper resistant and authenticated Patients can send care related questions to providers and promotes their role in the relationship Providers can understand if there significant issues that need addressed, can improve patient satisfaction 29
Health IT Tools Secure Messaging Challenges: Expectations about responsiveness (from both patient and provider perspective) Is it really part of the work flow? Opportunities: Establishes communication channel to allow provider gain insight into patient health status outside of practice setting. Best Practices: Adopt active role in promoting, teach patients how to use and be willing to use 30
Health IT Tools Patient Generated Data Facilitation Patient-generated health data are healthrelated data created, recorded, or gathered by or from patients (or family members or other caregivers) to help address a health concern. - Office of the National Coordinator for Health IT Patients and/or caregivers can generate their own health information that would focus on health history, vital signs, symptoms 31
Health IT Tools Patient Generated Data Facilitation Challenges: Is the data good? Is it timely? How does it get appropriately incorporated into record? Opportunities: Gain insight into patient health status Develop capacity to take action more quickly 32
Health IT Tools State and Plan Perspective Using text messaging to support enrollment or other initiatives Portals and mobile applications to provide beneficiaries information Support for providers with implementation 33
Jean Glossa, MD, MBA, FACP PROVIDERS PERSPECTIVE- MANAGING INFORMATION 34
Providers Perspective 35
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Information overload for the physician Info coming in from multiple sources Info from sources that you need to go get Info may be repeated/redundant Info may be incomplete or wrong Leads to: Medical errors and omissions; poor quality care Low productivity, inefficiency or unfocused work Provider burnout Patient and provider low satisfaction and drop out 37
Surviving strategies Solutions: Transitioning to team based care Screening data before it gets to you- who else on the team can review and interpret this data? Transition to alternative payment modelswhere your reimbursement isn t all about volume and visit counts- but its about quality metrics and clinical outcomes 38
Traditional Model Case Mgr/Coord Specialty Care Nurse Medical Assistant PROVIDER PATIENT Admin Scheduler Lab/Rad 39
Provider Led Member Centric Care Medical Asst Care coordinator Provider Patient and family RN Home care Ancillary ER or hospita list 40
Patient and Provider Getting the unengaged provider involved Role of the provider in supporting patient engagement. physician patient technology 41
Getting providers engaged in the technology movement Team based model Show them the evidence that technology improves clinical outcomes 42
Strategies to keep your patients engaged- the role of the physician Recent survey -shows the influence of providers: 48.2% of respondents said they would use such a device if their physician provided one 44.2% said they would be more inclined to use one to attain better health care advice from their physician. 43
Stakeholder Role(s) Patients/Consumers User Data Generation Director Providers User Promoter Facilitator State Agencies User Distributer Convener Health Plans User Supporter Supplier 44
Q & A Matt McGeorge, Senior Consultant, mmcgeorge@healthmanagement.com Jean Glossa M.D., Principal, jglossa@healthmanagement.com Izanne Leonard-Haak, Managing Principal, ileonardhaak@healthmanagement.com October 15, 2015 HealthManagement.com