NCQA: Health IT Can Be Tapped To Support Patient Engagement

Friday, April 25, 2014

Successful integration of patient engagement tools into health IT systems has "the potential to improve inefficient communication methods and change the dynamic of the relationship between the patient and health care system," according to a new report from the National Committee for Quality Assurance, EHR Intelligence reports. 

However, the report noted that there is not yet a complete framework for boosting patient engagement through health IT systems.

Details of Report

In a survey, the report authors identified six common themes of "opportunities and challenges" related to patient engagement through health IT:

• Patient engagement is an untapped opportunity with major potential, especially among marginalized groups;
• Health IT should adopt a user-based model that originates from the needs and preferences of patients;
• There is a dearth of evidence on the effectiveness of such tools;
• Patient-engagement tools should be integrated into overall health care IT systems;
• Patient and consumer trust needs to be fostered; and
• Leadership and collaboration among stakeholders are necessary to realize the full potential.

The report also detailed four activities that will help the industry identify and develop a cohesive strategy for patient engagement through health IT, including:

• Developing joint principles that will facilitate the design, creation and adoption of health IT tools that boost patient care, improve overall population health and lower health care costs;
• Creating and implementing an evaluation framework that focuses on investment and prioritizes consumer choice;
• Facilitating the creation of a unified health data integration strategy focused on patient engagement; and
• Demonstrating innovative ways to use IT tools for patient engagement.

Comments

In the report, the authors wrote that "[h]ealth IT tools for patient engagement are often disconnected from the health care system and in need of full integration across all opportunities for engagement." However, the report added that successful integration of patient engagement in health IT systems has "the potential to improve inefficient communication methods and change the dynamic of the relationship between the patient and health care system."

NCQA President Margaret O'Kane said the "core idea" of the report is that health IT "should be designed around the needs and preferences of patients." She added that "the question of how to link [health IT] and patient engagement is an area where a unified strategy is most needed" (Murphy,EHR Intelligence, 4/23).

http://www.ihealthbeat.org/articles/2014/4/25/ncqa-health-it-can-be-tapped-to-support-patient-engagement

How IT is Driving Changes in Community-Based Healthcare

 

By John DeGaspari

How is IT being used to transform healthcare delivery at the community level? At the annual meeting of the New York State Chapter of HIMSS, on April 23 in New York City, which was attended by Healthcare Informatics, Mary Ann Christopher, MSN, R.N., president and CEO of the Visiting Nurse Service of New York (VNSNY), gave an insightful presentation of IT-driven initiatives, which she said are crucial to transforming care delivery in her organization.

Christopher said that VNSNY, as the nation’s largest not-for-profit community-based healthcare system in the nation, occupies a unique place as it meets challenges inherent in healthcare delivery. It is both a payer and a provider organization, giving it “access to upstream dollars that allows it to innovate and deliver care in unique ways,” she told an audience of several hundred. It encompasses 50,000 providers, an inter-professional team of physician, nurses, rehab therapists, social workers, pastoral care, home health aides, and strong staff in IT, who deliver care to 70,000 patients in their communities. Information flow and continuity is critical to ensuring good care, she said.

“We are in a place in healthcare delivery that is cataclysmic, with the passage of the Affordable Care Act (ACA),” with both opportunities and challenges with the 30 million Americans having access to health insurance and care, Christopher said. “There are opportunities to come together as a health system that we didn’t have before.” Delivering care in a silo environment focused on discrete events and episodes is no longer acceptable. “Much of our intervention has been on the tertiary level of care, less on health promotion and disease prevention,” she said.

Christopher sees opportunities embedded in the financial pressures brought on by the ACA. “Value-based purchasing means we need to come together in more intentional ways to bring together the healthcare delivery system in ways that are aligned, both financially and in terms of their quality outcomes of patients and populations,” she said. Under the new healthcare scenario, caregivers need to consider what is happening to patients in the primary physician’s office; acute care, post-acute and sub-acute care settings; home and hospice care, as well as where patients live, she said. The challenge is transforming healthcare in a way that reaches all of those environments.

Consolidation among provider organizations and physician practices—either through acquisitions or virtually—is offering the opportunity to avert patient safety issues, as well as to get the cost structure in place to deal with declining reimbursements, she said. At the same time, policymakers are increasingly cognizant of the healthcare needs of marginalized people. Meeting that imperative means focusing on the needs of the most vulnerable populations, particularly the dual-eligible, who fall outside traditional treatment modalities in terms of quality outcomes, she said.

Technology as an enabler of better care

In Christopher’s view, the only way to achieve those goals is to rely on the greater application of technology. She said that the healthcare industry has a “burning platform” to come together in ways that engage people where they live and put the patient and the community at the center of care. “More and more we see a system where we are called to function inter-professionally, where those who have clinical informatics expertise are as critical as the physicians and nurse in that team of care,” she said.
She said VNSNY has embraced its role as a virtual integrator, putting the information in the hands of the providers and VNSNY staff to make better decisions. She expressed a vision that information technology will enable better care. Among her examples: more treatment in place rather than moving a patient to an ED; less isolation from frailty as patients use web-based apps to engage them and participate in round tables with other patients; less diagnostic uncertainty by using home-based tests, with results that can be transmitted to providers in real time; and texting to provide motivational cueing to patients.

For example, VNSNY is using texting to provide motivational cueing to teenage mothers in its Nurse Family Partnership program. “They are not likely to pick up the phone when the visiting nurse comes, but they will respond to texting and cueing, and that’s a modality that we are using increasingly,” Christopher said.

In another initiative, VNSNY is using predictive analytics in its Outcome and Assessment Information Set (OASIS), a federally mandated tool to assess patients for home care. Using predictive models, it is able to identify, based on characteristics of those patients, what other services they might need beyond a traditional home care, she said. “For instance, we know that based on certain diagnostic characteristics, there are frailty indices. We are able to extrapolate that data and able to predict that that patient will benefit from an intensive rehab program to avert falls,” she said.
The OASIS assessment also predicts patients who would be more appropriately managed within a palliative care environment of hospice rather than traditional home care episode that is focused on acute intervention and then discharge. “This is an important set of analytics to make sure we are providing the appropriate care for the patient at the time they need it,” she said.

Christopher noted that VNSNY Center for Home Care Policy and Research has culled data to determine what other episodes might occur, creating alerts to the staff as they deliver care. “Our research center has culled through tens of thousands of patient records, and determined, for instance, that any medication change with a patient under our care potentially triggers a fall, which always triggers a re-hospitalization,” she said.

Predictive analytics are also used in VNSNY’s health plan to assess patients for receiving managed long-term care services. From that analysis it is able to identify the interventions that should be used to care for and coordinate the care for those patients. “It tells us, based on that risk acuity adjustment and that chronic disease burden, how much face-to-face intervention we need, what kind of telephonic intervention we should be using, should it be telehealth or should it be electronic,” she said. In a health scenario that no longer reimburses for the amount of face-time, it is critical for provider organizations to select the appropriate means to communicate with patients, she said.

Using technology to engage patients

The organization is also using technology to optimize patient and member engagement. Its goal is “to get patient and caregivers more comfortable and more literate with how the disease path physiology is impacted by the behaviors that they demonstrate on its hourly or daily basis,” she said. To do that, it has integrated telehealth significantly across the enterprise. 

For example, it is using biometrics with congestive heart failure (CHF) and diabetic patients who, using an application in the home, measure relevant physical data that is transmitted to a central station in real time. The data are used as cues for the provider to give guidance to the patient. “We have found that by using this with a community hospital, to reduce length of stay by 0.8 days for patients with the highest level of acuity of CHF and also to reduce that 30-day re-hospitalization below the national numbers,” she said.

In a separate application, it has used biometric technology to measure data on 410 diabetic patients, with the result that 80 percent of the patients have achieved better hemoglobin A1C control. Christopher added that VNSNY’s research has shown that those improvements have occurred because telehealth has raised the patients’ awareness of the link between their behavior and health risks, and they have modified their behavior for better outcomes.

Interactive voice response has proven to be another effective technology for its frailest patients. It is using interactive voice with members in its Medicare Advantage Health Plan, 85 percent of which are dual eligible, so are patients with the highest disease burden. The goal is to “Interrupt that cycle of non-medication adherence, one of the biggest factors of first 30-day all-cause readmission in the nation,” she said. These technologies have helped to reduce costs because people can be prompted through technological interventions.

Using a solution (supplied by Remedia LLC, Amherst, Mass.), it runs all of the pharmaceutical medications plans of care for its patients to screen for anything that would be inconsistent with best in class practice, and then drive the changes in that medication plan. It has implemented another solution (supplied by Eliza Corp., Danvers, Mass.) to deliver medication of voice alerts to patients about when they should be refilling their meds; if they have not, the patients’ case managers outreach to them to understand what is happening. 

Through VNSNY’s special needs program for 5,000 patients with AIDS and HIV, We also have a special needs program through we care for about 5,000 people with hiv and aids, VNSNY has started a text-messaging initiative (using a technology from New York-based RipRoad), to send patients reminders of medication refills and follow-up appointments with specialists. “Our goal is to help with the management of the disease and also, to reduce unnecessary reliance with EDs,” Christopher said.

New IT platform for care coordination

VNSNY is migrating to a new IT platform (GuidingCare, supplied by Altruista Health, Reston, Va.) that will bring together on a single screen clinical data that care coordinators use to manage the care, services and benefits around that particular patient, but also the claims data the person will have access to, as well as incoming and outbound customer service incoming calls.
She said the system will provide opportunities for patients to access the system any time on any device. “Our goal being that they will be able to control their own health, they will be able to indicate to the care coordinator, what their goal is for them themselves. They will be able to establish with the care coordinator a dashboard that is specific to them, which monitors their disease progress across industry standards in terms of metrics and benchmarks,” she said. She added that the portals VNSNY is implementing are user friendly and include visual cueing to promote better understanding and enhance health literacy.

At same time, it is moving to a new technology platform on the provider side to reduce the minimum data set at intake. This will help to ensure that that initial assessment will use predictive analytics for risk stratification that will then hardwire what the services within VNSNY should be, she said.
It also plans to centralize and automate the scheduling using evidence based guidelines. “We have estimated that this will take out $40 million in cost out of our system, important given the federal and state reimbursement reductions that have occurred within the provider and plan space over last two or three years,” she said.

Searching for health ‘hot spots’

VNSNY has also implemented a program to look at the characteristics of patients accessing the healthcare delivery system within certain neighborhood geographies. It identified the social determinants of health as they impacted the health of the population, such as immunization status; morbidity statistics in terms of diabetes, cardiovascular disease; and issues of crime, alcohol and substance abuse. Using that model and geo-mapping the community, it has identified “hot spots” that require a unique level of intervention, and deployed community wellness coaches, nurses and social workers, working with community-based coalitions in the area to address those needs.

“This is a program that is being followed by the Centers of Medicare and Medicaid Services, the Institute for Healthcare Improvement and the New York State Department of Health. Early results have shown that we are already impacting the number of folks accessing the emergency departments for ambulatory care and sensitive conditions, for which they are better served by primary care access,” Christopher said.

Source URL: http://www.healthcare-informatics.com/article/how-it-driving-changes-community-based-care

Gamification in healthcare isn't just about playing games

There are a number of pilot projects, technology startups and other developers who are playing around with gamification in healthcare. It's not yet clear whether this approach -- mixing self-monitoring and entertainment -- is yielding the type of traction and adoption that will ultimately lead to sustainable patient behavior modifications and improved health outcomes. Still, I suspect there will be significant growth in this area over the next several years as more patients adopt a consumer mentality about their health and wellness.

For example, people using the Pact mobile app by GymPact risk losing money if they don't follow through on their commitment to exercise. The app requires them to set a personal goal to eat right and exercise several times each week. The users also designate a financial amount that they are willing to lose if they don't follow through on their promise. Those who faithfully exercise earn money that gets paid by those who don't keep their "pact," creating an ecosystem where some users are paying others.

We have only seen the beginning of how gamification principles will help patients improve their health.

The Pact app and its approach to improving health has some parallels to online gambling. Some people simply enjoy the entertainment aspect of online gambling, while others may have an addiction or are highly motivated by the desire to earn money. Similarly, there are people who are compelled to exercise and lose weight, while others are casually exercising to maintain an average level of fitness.

The concepts and principles of gamification are all around us, whether we recognize them or not. Many people are naturally competitive and like to compare themselves to others. That is why companies like to host walking competitions and measure their employees' performance and progress by giving them wearable activity trackers like Fitbits. This desire to compete is also why television shows like The Biggest Loser are so popular. So, even if you are not the type of person to spend countless hours on playful games like Angry Birds or FarmVille, we are all wired in a way to enjoy and to be motivated by the core principles behind gamification.

Accenture reported there are seven key elements behind gamification: status, milestones, competition, rankings, social connectedness, immersion reality and personalization. As consumers become more engaged with their own health, they will take greater responsibility for managing their own condition. People who have diabetes will feel the need to learn more about their condition, their medications, and how they can improve their self-management.

Those who are healthy can stay that way by becoming more knowledgeable about disease prevention, age-appropriate screenings, and maintaining active lifestyles. As people gain more knowledge and insight about their conditions, they will want to set goals, measure their progress against those goals, reach milestones, and compare their performance against certain benchmarks. If patients take these steps to be actively engaged in staying healthy, they will apply gamification principles whether they realize it or not.

We can't forget about those who enjoy smartphone games and spend many hours tapping on screens to play mind-numbing (but thoroughly entertaining) games. For these individuals, adding a gaming element to disease self-management could reduce their apprehension toward the medications and treatments associated with the condition. There are also examples of this targeted at children. Muppets Band-Aids incorporated a quick response code on the Band-Aids so a parent can scan the code with their smartphone to show an entertaining video to a toddler who just scraped his knee. When Kermit the Frog starts singing about feeling blue, will the child forget about his scraped knee? There is a more serious example of the Pain Squad iPhone app that is designed to help children dealing with cancer track their symptoms so their clinical care team can do a better job to manage their pain.

Simulation games such as PatientPartner are aimed at helping patients improve their medication adherence. By walking through a virtual role-playing game, patients can learn about the various clinical outcomes that may result if they fail to adequately manage their health conditions. Monster Manor is a game that engages young children with diabetes to be better at taking their insulin and to have fun while they are doing it.

We have only seen the beginning of how gamification principles will help patients improve their health. As healthcare providers, payers and innovators find successful ways to engage patients by applying gamification strategies to both children and adult patients, we will see a shift in population health that is driven by more engaged and motivated individuals. Gamification will motivate some patients to receive ongoing feedback, reminders and status updates about their progress in caring for their own health.

About the author:Joseph Kim is a physician technologist who has a passion for leveraging health IT to improve public health. Dr. Kim is the founder of NonClinicalJobs.com and is an active social media specialist. Let us know what you think about the story; email editor@searchhealthit.com or contact @SearchHealthIT on Twitter.

http://searchhealthit.techtarget.com/opinion/Gamification-in-healthcare-isnt-just-about-playing-games

The serious business of gamification

If you’re interested in changing behaviour in your workplace, helping employees or customers to develop new skills, or spurring innovation, you may want to consider the approach known as gamification. If that scares you – given that the word is ugly and sounds as if you would just be encouraging staff to play video games – Brian Burke, a vice-president at technology research firm Gartner Inc., says you should relax.

Gamification is actually not about playing games. Games are about entertainment. Gamification is serious stuff, using game mechanics such as badges and awards to digitally engage and motivate people to achieve their goals.

“It’s not entertainment. It’s motivation,” Mr. Burke said in an interview.

He points to the Boy Scouts, which has long used badges to motivate youngsters, and Weight Watchers, which uses a points system and social encouragement to nudge dieters. Both are examples of gamification from the days before the term was even coined. “It provides them with the encouragement, motivation, and clear path to achieve a goal,” he said.

Mr. Burke stresses that when using gamification, it is vital that the emphasis not be on organizational goals but on motivating people to achieve their own goals. When those personal objectives are aligned with the organizational goals, you can hit the gamification jackpot.

Behavioural change is the most common use for gamification. It comes in handy because new habits must be created to change behaviour, and gamification can excite us to adopt those practices.

In his book Gamify, Mr. Burke notes that Spanish bank BBVA used gamification to encourage customers to use its online services. The BBVA Game, which has 80,000 users, rewards players for completing challenges that educate them about Web banking, encouraging them to use the service. Points are awarded, which can lead to prizes. It has led to a 5-per-cent increase in BBVA’s Web-banking users, who spend 60 per cent more time on the site. Because online banking can be easier than going to a branch, the game is aligned with customers’ needs. But it’s also aligned with BBVA’s needs, because it reduces costs.

Samsung Electronics focused on customers with its social loyalty program, dubbed Samsung Nation. Customers are rewarded with points, levels and badges for watching product videos or commenting on Samsung products. The program has doubled the number of items placed in online shopping carts.

A key to success for behavioural change is to increase complexity over time. The BBVA Game starts by encouraging customers to watch instructional videos and then try simple operations such as checking an account balance. As users become more confident with the help of coaching, they move to more complex tasks such as paying bills.

Gamification can also help people to build their skills. Learning new skills often requires a repetitive process of lectures and practice, which gamification can handle. Or if the skill is best learned in an experiential way – such as being presented with a problem to solve – gamification can provide a vehicle for collaboration with others.

There have long been games that can teach new skills, such as Where in the World is Carmen Sandiego? (a series of video and computer games and TV shows designed to stimulate kids’ interest in geography, cultures and history). But Mr. Burke says those are games first, and skill-builders second. Gamification puts the skill-building first.

U.S. organizations such as Capital BlueCross are using it to educate members on the complexities of health care. The U.S. Department of Health and Human Services applied a gamified solution to educate health-care practitioners on best practices about privacy and security.

A key element of design is to create theory-practice loops. Players are provided with instruction, a challenge, and feedback on their efforts. “Gamification breaks the learning process into small, achievable steps and provides constant feedback and encouragement throughout the process,” Mr. Burke writes in his book.

To spur innovation, gamification can encourage people to submit innovative ideas, evaluate proposals and then collaborate to refine the idea into reality. Quirky, a crowdsourcing product-development company that has more than 6,000 inventors as members and has launched more than 400 new products since 2009, uses gamification in this way.

Mr. Burke says the process can be captivating. During his research he found himself hooked as he submitted a name for an anti-theft rucksack – one of 1,400 possible choices – and watched his suggestion bounce up and down in the Quirky rankings.

While he is an enthusiast, Mr. Burke warns that the biggest challenge facing companies is to understand the limitations as well as the opportunities of gamification. “A lot of organizations are pursuing opportunities that are unlikely to be successful with gamification,” he said. Faced with a problem, they throw some points at it and hope a solution will materialize. But you need to figure out how a point system might work, how to employ collaboration, and whether what you are designing can hold for the long term as well as short term.

But if you get it right, he believes you can harness the power of game design to great benefit for your organization.

Harvey Schachter is a Battersea, Ont.-based writer specializing in management issues. He writes Monday Morning Manager and management book reviews for the print edition of Report on Business and an online work-life column Balance. E-mail Harvey Schachter

http://www.theglobeandmail.com/report-on-business/careers/management/the-serious-business-of-gamification/article18020562/

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Nearly 9 out 10 Adults May Lack the Skills Needed to Manage their Health and Prevent Disease

What is health literacy?

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.¹

Health literacy is dependent on individual and systemic factors:

• Communication skills of lay persons and professionals
• Lay and professional knowledge of health topics
• Culture
• Demands of the healthcare and public health systems
• Demands of the situation/context

Health literacy affects people's ability to:

• Navigate the healthcare system, including filling out complex forms and locating providers and services
• Share personal information, such as health history, with providers
• Engage in self-care and chronic-disease management
• Understand mathematical concepts such as probability and risk

Health literacy includes numeracy skills. For example, calculating cholesterol and blood sugar levels, measuring medications, and understanding nutrition labels all require math skills. Choosing between health plans or comparing prescription drug coverage requires calculating premiums, copays, and deductibles.

In addition to basic literacy skills, health literacy requires knowledge of health topics. People with limited health literacy often lack knowledge or have misinformation about the body as well as the nature and causes of disease. Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes.

Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated or forgotten, or it is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained.

Why is health literacy important?

Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy.  In other words, nearly nine out of ten adults may lack the skills needed to manage their health and prevent disease.  Fourteen percent of adults (30 million people) have Below Basic health literacy.  These adults were more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with Proficient health literacy.⁶

Low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services (see Fact Sheet: Health Literacy and Health Outcomes). Both of these outcomes are associated with higher healthcare costs.

Key research study findings on the relationship between health literacy and health outcomes:

http://www.health.gov/communication/literacy/quickguide/factsliteracy.htm

Use of preventive services

According to research studies, persons with limited health literacy skills are more likely to skip important preventive measures such as mammograms, Pap smears, and flu shots.¹ When compared to those with adequate health literacy skills, studies have shown that patients with limited health literacy skills enter the healthcare system when they are sicker.²

Knowledge about medical conditions and treatment

Persons with limited health literacy skills are more likely to have chronic conditions and are less able to manage them effectively. Studies have found that patients with high blood pressure,³ diabetes,^3-5 asthma,⁶ or HIV/AIDS^7-9who have limited health literacy skills have less knowledge of their illness and its management.

Rates of hospitalization

Limited health literacy skills are associated with an increase in preventable hospital visits and admissions.^10-13 Studies have demonstrated a higher rate of hospitalization and use of emergency services among patients with limited literacy skills.¹²

Health status

Studies demonstrate that persons with limited health literacy skills are significantly more likely than persons with adequate health literacy skills to report their health as poor.^10, 12 14

Healthcare costs

Persons with limited health literacy skills make greater use of services designed to treat complications of disease and less use of services designed to prevent complications.^1, 11-13 Studies demonstrate a higher rate of hospitalization and use of emergency services among patients with limited health literacy skills.^10-13 This higher use is associated with higher healthcare costs.^15 16,

Stigma and shame

Low health literacy may also have negative psychological effects. One study found that those with limited health literacy skills reported a sense of shame about their skill level.¹⁷ As a result, they may hide reading or vocabulary difficulties to maintain their dignity.¹⁸

Partner with mHealth Games to promote health literacy and begin improving health outcomes today!