Patient Engagement
WHATS YOUR DEFINITION OF PATIENT ENGAGEMENT
&
DOES TECHNOLOGY PLAY A ROLE?
PRESENTER:
LOU SEMRAD, BSN, MBA
DIRECTOR, CLINICAL SERVICES
HOMETOWN HEALTH
Patient Engagement
How does your organization define patient engagement?
Web based portals
continuity of care
Technology (HIT)
Expensive$$$
Patients dictating terms of care
Education
Patient what?
Patient Engagement
Some events that will shape your definition.
1.
2.
3.
4.
Meaningful Use – strong emphasis on patient engagement
Growth of social media and access to the internet
Focus on improving health among targeted population
a. Reducing unnecessary readmissions
b. Improving compliance
c. On-going healthcare needs – chronic conditions that need continual
contact with healthcare staff
Patient driven – as deductibles increase, patients may demand greater
access to their health information to help them with healthcare decisions
Patient Engagement
Overview
• To successfully participate in the government’s EHR incentive payment
program, it’s not sufficient to simply purchase a certified system and start
using it. CMS regards patient engagement as a key component of
meaningful use.
• It’s not about the technology; it’s about transforming health care delivery
for the benefit of patients and everybody else involved in their care.
Seidman, J. Guiding Principles for Stage 1 Meaningful Use Adjustments.
• Patient Engagement: Achieving Meaningful Use, by: Elizabeth W.
Woodcock, MBA, FCMPE, CPC
Patient Engagement
Stage 1
Patient Engagement: Achieving Meaningful Use
• 4 of the 25 criteria for Stage 1 focus on patient engagement.
•
•
Provide clinical summaries for patients for each visit
Provide patients with an electronic copy of their health information, upon
request
• Send reminders to patients, in the manner requested by patients (≥65 years
of age or ≤5 years of age)
• Provide patients with timely electronic access to their information (patient
portal)
For successful demonstration of “meaningful use”, physicians can get bonuses up
to $64,750.
Patient Engagement
What does certified mean?
Patient Engagement: Achieving Meaningful Use
To qualify as a certified EHR, the system must support the performance of
each of the meaningful-use criteria set forth by CMS and it must enable a
participating professional to report each of those objectives. The HITECH Act
empowers the Office of the National Coordinator for Health Information
Technology (ONC) to certify EHRs — complete systems and EHR modules — as
qualified. ONC has created a comprehensive list of systems that have been
tested and certified under its temporary certification program.
This list is continually updated, and can be viewed online at:
http://onc-chpl.force.com/ehrcer
Patient Engagement
Meaningful Use
Stage 2 Meaningful Use
• CMS released Stage 2 MU proposed criteria on February 23, 2012
• Published in the March 7th Federal Register
• Public comments due no later than May 7th
http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4443.pdf
Patient Engagement
Meaningful Use
Proposed Eligible Hospital/CAH Objective:
Provide patients the ability to view online, download, and transmit information
about a hospital admission.
We propose this as a core objective for hospitals in Stage 2 with the following information that must be
available as part of the objective:
• Admit and discharge date and location.
• Reason for hospitalization.
• Providers of care during hospitalization.
• Problem list maintained by the hospital on the patient.
• Relevant past diagnoses known by the hospital.
• Medication list maintained by the hospital on the patient (both current admission and historical).
• Medication allergy list maintained by the hospital on the patient (both current admission and historical).
• Vital signs at discharge.
• Laboratory test results (available at time of discharge).
• Care transition summary and plan for next provider of care (for transitions other than home).
• Discharge instructions for patient, and
• Demographics maintained by hospital (gender, race, ethnicity, date of birth, preferred language, smoking
status).
Patient Engagement
Meaningful Use
Proposed Eligible Hospital/CAH Objective:
There are 2 measures for this objective, both of which must be satisfied in order
to meet the objective.
1. More than 50 percent of all patients who are discharged from the inpatient or
emergency department (POS 21 or 23) of an eligible hospital or CAH have their
information available online within 36 hours of discharge.
2. More than 10 percent of all patients who are discharged from the inpatient or
emergency department (POS 21 or 23) of an eligible hospital or CAH view, download,
or transmit to a third party their information during the EHR reporting period.
Patient Engagement
Meaningful Use
Stage 2 MU:
The second measure represents a new concept for meaningful
use criteria, because it measures the hospital based upon the
actions of the patient.
Patient Engagement
Meaningful Use
Stage 2 MU:
Stage 2 Timeline Delay
“Finally, we propose a minor delay of the implementation of the onset of Stage 2
criteria. In the Stage 1 final rule, we established that any provider who first attested to
Stage 1 criteria for Medicare in 2011 would begin using Stage 2 criteria in 2013. This
proposed rule delays the onset of those Stage 2 criteria until 2014, which we believe
provides the needed time for vendors to develop Certified EHR Technology.” CMS
Patient Engagement
Meaningful Use
Stage 3 MU:
We anticipate that Stage 3 meaningful use criteria will focus on: promoting
improvements in quality, safety and efficiency leading to improved health
outcomes; focusing on decision support for national high priority conditions;
patient access to self-management tools; access to comprehensive patient
data through robust, patient-centered health information exchange; and
improving population health.
http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/20124443.pdf
Patient Engagement
Technology
Increasing Access to High Speed Internet &
the Use of Mobile Platforms (mHealth)
2000
2012
5% of the population had access to high speed internet
>50% have access to high speed internet
Source: www.internetworldstats.com
Kaiser Permanente allows patients access to their EHRs on their mobile
devices and just launched an iphone app and has surpassed 3 million
users of its online personal health record.
Source: www.mobilehealthnews.com
Patient Engagement
Technology
Improving Health Among a Targeted Population
We anticipate that Stage 3 meaningful use criteria will focus on:
promoting improvements in quality, safety and efficiency leading
to improved health outcomes; focusing on decision support for
national high priority conditions; patient access to selfmanagement tools; access to comprehensive patient data
through robust, patient-centered health information exchange;
and improving population health.
Patient Engagement
Technology
Reducing Patient Readmissions: CHF Patient
218
216
Daily Weight
214
212
210
208
206
Hospitalization
Patient Engagement
Technology
Patients With On-going Care Needs
Depression
Compliance issues
Patient Engagement
Funding
$20,000,000,000
• The amount of funding made available in the HITECH Act for HIT.
Equivalent to 100,000 homes valued at $200,000 each
• Healthcare organizations that do not implement EHRs will face penalties.
Patient Engagement
Why do this
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Link Between Technology and Patients Involvement
CMS is a driving force with the industry following
ACO model rewards efficient, quality healthcare
Access through technology helps begin the conversation
between patient/family and care provider
A 2012 National eHealth Collaborative survey found 73% of
respondents felt “better care coordination” would be the
most important benefit of health info exchange
Patient Engagement
Why do this
Link Between Technology and Patients Involvement
4 federal programs will drive policy through incentives/penalties
that necessitate patients being involved (engaged) in their health
& well-being, improving their outcomes and their experiences:
1. VBP
2. Meaningful Use
3. Avoidable readmissions
4. ACO’s
Patient Engagement
Challenges
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Comprehension
Left behind – may not have insurance provider pushing them
Lack of physician leadership / provider adoption
Lack of motivation – personal and institutional
Access to high speed internet
Lack of recognition that they need to take command of their health
Funding
Interoperability standards
Patient Engagement
Why patients may drive it
Patients Asking for Access to Their Health Information
• Increasing deductibles
• Increased activity from insurance providers for their beneficiaries to
become involved (engaged) and be self-managers or active consumers of
healthcare (lower premiums are the carrot)
• Increasing use of mobile devices (Gen Y spends more time on the
computer than watching TV)
Patient Engagement
Key Success Factors
Components of an effective Engagement Strategy
1.
2.
3.
4.
5.
6.
7.
8.
Acknowledgement that your organization and patients are going to have to communicate in
new ways
Define not just the patients role, but the role of key healthcare members (case managers,
PCP)
Assessment of patients needs (comprehension level, communication ability, physical
limitations)
Tailor information to the individual (relevant information to a patients circumstances)
Flexibility and guidance to help reduce patient anxiety and increase dialogue about healthrelated issues
Ability of healthcare members to track patients engagement and comprehension (allows
team to adjust educational materials for example)
Support the care of the patient across all continuums of care (care transitions)
Patient access to information that meets their abilities (based on the assessment)
Patient Engagement
How does your organization define patient engagement?
“care that is respectful of and responsive to individual patient preferences,
needs, and values, and ensuring that patient values guide all clinical
decisions”. Joshua Seidman, PhD