John Sharp, MSSA, PMP, FHIMSSSenior Manager Health Information SystemsHIMSS

June 6, 2014

Value of Patient Engagement Technologies

Take Aways

• Patient Engagement is key to Meaningful Use Stage 2

• Reaching the 5% participation threshold is a challenge

• Integration of patient engagement into a strategic initiative is the key

• There is growing evidence that patient engagement impacts medical outcomes

• This is our goal, is it happening now?Friend is being treated at two health systems, both have the same EHR, PHR• When he logged into the second PHR, it prompted him,

asking if he agreed to integrate his two medical records. He agreed.

• The next time he saw his specialist at the first facility, she noticed that his records from the other system had been integrated into his record

• Lessons: – Health information exchange works– Should be driven by the patient’s consent– Leads to a more engaged patient– This is what Meaningful Use is about

One Patient, One Record

Patient Engagement Defined

We define engagement as “actions individuals must take to obtain the greatest benefit from the healthcare services available to them”

This definition focuses on behaviors of individuals Relative to their healthcareThat are critical and proximal to health outcomesRather than the actions of professionals or policies

of institutionsCenter for Advancing Health 2010

OUTCOMES

Meaningful Use Stage 2

• Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP (for EPs only) More than 50% of all unique patients seen by the EP are provided timely online access to their health information

• Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge from the hospital (for Eligible Hospitals/CAHs only)

• Use secure electronic messaging to communicate with patients on relevant health information (for EPs only) More than 5% of all unique patients seen

View, Download, Transmit

Patient Activation is the First Step for Patients and Providers

• Believing the patient role is important• Having the confidence and knowledge necessary to take action

• Actually taking action to maintain and improve one’s health

• Staying the course even under stress• More likely to have a breast cancer screen or clinical indicators in the normal range (A1c, HDL, and triglycerides)

• http://link.springer.com/article/10.1007/s11606-011-1931-2

Activate

Unique aspect of this standard

• Requires patient participation • Incentivizes the provider or

hospital to engage and motivate the patient to participate in a portal and secure messaging

•  87 percent – say they want to control their health data. (Accenture)

Blue Button as a Tool

• One solution for View, Download, Transmit• Available for Medicare and VA patients now• Cerner just announced its participation

• Additional Resources– Blue Button Plus -Learn how to structure a

patient health record and how to transmit it to a patient’s location of choosing. 

– Blue Button Connector – select a source, search to see if that source uses Blue Button, ID yourself, download

Blue Button Plus

Blue

But

ton

Conn

ecto

r

Tools - Direct Trust

A simple and standards-based way for people to send and receive authenticated and encrypted health information over the Internet,

Why Patient Engagement

Blue Button Public Service Announcement

Patient Engagement Tools

• Patient Portal basics– Appointments– Prescriptions including refill

requests– Results – lab, radiology, etc.– Problem list

• Secure Messaging

Implementation of Patient Engagement• Module from EMR vendor or add on?• Must have the workflow in place to

manage these– Triage workflow – similar to phone

calls – who does prescription refills, appointment requests, when to escalate to the provider?

• What about proxy access?• Releasing labs – immediate or after

provider reviews?• What are the exceptions to release of

data? Mental health, genetic testing, HIV, cancer diagnosis, others?

Adoption Strategies

• Opt-in versus Opt-out? Opt out gets you there faster

• Educate at the point of care– Have patient/caregiver login day of or day

before discharge– Education in waiting rooms– Online how-to videos

• Educate patients about appropriate use of secure messaging

• Mobile

Viewing Patient Engagement as a Checkbox or Adopt as a Strategic Initiative?

Meaningful Use Stage 1

• Many hospitals and providers were eager to receive incentives

• Hurry to meet the minimum requirements• Stage 2 – more emphasis on having an impact on quality of care

• Should not be another check

Patient Engagement fit with Strategy

New Payment Models•Patient Centered Medical Home•Accountable Care Organizations•To achieve these successfully, patient engagement essential

Strategic Alignment

•Moving from • Implementation of the EMR• to•Optimization•Then to•Transformation of care

Patient Engagement andOutcomes/Value

Six Examples of Value (1)

Patient Education + Telemedicine = lower blood pressureCombination of patient education and remote patient monitoring • Reduce the average systolic blood pressures for 34 patients by 20 points in week

• continuing to a 30-point drop in week five

Six Examples of Value (2)

How Outcomes are achieved through patient portals: a realist review• 15 of the 18 Randomized Clinical Trials

demonstrated significant positive effects on these outcomes

• No studies found serious adverse consequences of patient portal implementations

JAMIA 2014

Six Examples of Value (3)

Controlling asthma through appsPilot study from Geisinger Clinic•50 percent reduction in the number of people with uncontrolled asthma among users of the device and app. 

•App enables providers to check in more often with their patients and may help avoid asthma-related emergency department visits or hospitalizations.

Six Examples of Value (4)

Mayo Clinic has started testing a mobile Cardiac Rehab app•Led to a 40 percent reduction in admissions

•only 20 percent of participants were admitted to the ER within 90 days

• In the control group, 60 percent of participants were readmitted in the same timeframe

Six Examples of Value (5)

Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study and a Look Ahead• 11,797 of 13,564 Patients accessed visit notes

frequently• a large majority reported clinically relevant benefits

and minimal concerns• virtually all patients wanted the practice to continue• With doctors experiencing no more than a modest

effect on their work lives, open notes seem worthy of widespread adoption.

• Annals of Internal Medicine 2012

Six Examples of Value (6)• Blue Button VA Users reported that:

– For 73% helps them understand their health history better because it is all in one place

– For 72% helps them monitor their laboratory results better

– 68% reporting that it makes it easier for them to give others important information about their health.

– Use of the Blue Button for care coordination was most likely in patients with diabetes or lung disease, individuals who rated their computer ability higher, and those who had a system for organizing their health information.

– High rates of satisfaction– Future work on the demonstrable impact of the Blue

Button on health behavior and outcomes

More Examples

And a Few More…Engaging patients in medication reconciliation via a patient portal following hospital discharge – JAMIA 2014Out of 60 patients

– 108 discrepancies were seen – 23 potential adverse drug events

Randomized controlled study of web-based patient education in first time colonoscopy patients

18% less sedation medication14% decrease in procedure time11% more knowledgeable

Challenges of Measuring Value

Mayo Clinic – difficult to measure changes in healthcare utilization•  Conclusions: No significant change in face-to-

face visit frequency was observed following implementation of portal messaging.

• Secure messaging and e-visits through a patient portal may not result in a change of adult primary care face-to-face visits.

• Functionality of patient portal may change – enhancements, upgrades

• Improved workflow may improve utilization

ROI

Healthcare’s new entrants: Who will be the industry’s Amazon.com?PwC : http://www.pwc.com/us/en/health-industries/healthcare-new-entrants/index.jhtml

The Future of Patient Engagement

•Patient demand•Patient as Partner

•Incentives•MU2, HCAP, readmits

•Technology•Mobile, remote monitoring

The Future of Patient Engagement

Social Media

Online Communities

Texting for Health

The Future of Patient Engagement

PATIENT GENERATED HEALTH DATA

Take Aways

• Patient Engagement is key to Meaningful Use Stage 2

• Reaching the 5% participation threshold is a challenge

• Integration of patient engagement into a strategic initiative is the key

• There is growing evidence that patient engagement impacts medical outcomes

• HIMSS Patient Engagement Resource Library http://www.himss.org/library/patient-engagement-toolkit

• HIMSS Connected Patient Communityhttp://www.himss.org/connectedpatient

• Blog post on Five Models of Patient Engagement Demonstrate Value http://blog.himss.org/2014/04/11/five-models-of-patient-engagement-demonstrate-value/

• HIMSS Value Suite http://www.himss.org/ValueSuite

DIG DEEPER

Questions?

Contactjsharp@himss.org@johnsharpLinkedIn.com/in/JohnSharp