HIMSS: Patient engagement technologies necessary, but don’t solve people problems

New Orleans—"While technology is necessary to engage patients, provider behaviors and processes are much harder to change,” Edward Martinez, senior VP and CIO at Miami Children's Hospital, said during his March 4 lecture at the 2013 Healthcare Information and Management Systems Society (HIMSS) annual conference.

“There is more and more pressure to engage patients in a meaningful way,” said Martinez. “This process should be automated, but many providers have antiquated systems. As IT experts are beginning to help improve the care process, providers need to have a reality check about how care is delivered.  Implementing technology is the easy part, changing the way people think and their behaviors are much harder.”

Under the current engagement paradigm, a patient shows up to the waiting room just prior to an appointment and some information is gathered, explained Martinez. The patient is then seen in the exam room and sent home with instructions, but whether or not the patient follows or even understands the instructions is unknown. “As a provider, we have done our job with this process,” he said.

The use of technologies and process change allows for the delivery of a holistic experience that provides continuum of support and care for pediatric patients and a channel for parents, doctors and administrators, according to Martinez. For instance, before the patient arrives, Gaps in Care alerts, reminder services and pre-visit preparations are issued. “With the advent of smartphones, we don’t just have to use a patient portal to issue these services, but we have mobile phone options to engage these patients early on to ensure they arrive with the right information,” he said.

In the waiting room, there can be electronic check-in via a tablet, a medication adherence check, an electronic Gap in Care intervention and any other waiting room programs. “Oftentimes, the waiting room experience is boring, so if you can engage and educate your patients during this time, it’s a unique opportunity.”

In the exam room, in addition to the documented physician/patient discussions, there can be digital exam room programs and PracticeWire. During disposition or discharge, electronic check out, patient survey/consult, as well as digital medication adherence education. “These interactions with the patient allow for rare opportunities to do a better job in teaching the patient, and getting a better understanding of their unique circumstance to change the behaviors of our patients and in turn change the outcomes,” Martinez said.

Care coordination platform data are the foundation for understanding the complete view of the patient, including payer and pharmacy benefit management data, EHR data clinical history, demographics, as well as self-reported data.

Also necessary for this transition is the need for more focused care coordination from the personnel perspective. In the current model of healthcare, care coordinators lack:

• Time/capacity due to manual and inefficient processes that overburden the clinical staff;
• Data, which are often latent, and in silos so there is no simple way to understand what the patient requires; and
• Tools that can automate the coordination of care by facilitating patient engagement and empower the patient in his or her health.

“Currently, care coordinators are so busy following up with patients to ensure medicine is being taken or in acute situations, for instance, that they cannot focus on the people in the waiting room,” Martinez pointed  out. “We need to start making patients feel like customers, very valued customers.” He encouraged using mobile applications to improve the consumer relationship model.

In the care coordination workflow, when a health system finds a gap in care for a patient, the system automatically sends out an interactive voice response and patient or a patient’s guardian responds with ‘I wish to schedule’ or ‘patient has already completed it.’ Then, the staff tracks all patients who wish to set up appointments to close the gap and help schedule them. Finally, the patient comes in and gap is closed.

“It’s not about the technology, it’s about changing behavior,” said Martinez, who added that incentivizing healthcare professionals is effective, as the bonuses at Miami Children’s are tied in part to customer satisfaction scores.