5 ways Cleveland Clinic improved its patient engagement strategies

Some healthcare initiatives underway these days are easier to explain in succinct terms than others. Take ICD-10 and meaningful use, for example. One can be summed up as an updated coding system; the other is an effort to encourage healthcare providers to switch from paper to electronic health records.

Now take a term like "patient engagement." Yes, it's safe to call it an effort to get patients to take more responsibility for their health information. But when you try to think in more specific terms it becomes clear that those specifics vary significantly from provider to provider.

On an operational level, what this means is that providers who want to improve their "patient engagement" need to determine both what that looks like presently within their own practices, and what steps they need to take to move forward.

According to David Levin, MD, chief medical information officer at the Cleveland Clinic, a few years ago the organization's leadership took a comprehensive look at how patients engaged the its services, focusing primarily on the impacts the overall patient experience had on care outcomes.

"The result," he said, "was a series of initiatives that helped define what we wanted to do (with patient experience), as well as how to measure the impact of the changes."

Together with Lori Posk, MD, Cleveland Clinic's medical director for its MyChart personal health record, Levin recently pointed to five key changes in how patients interact with the organization, changes which, he said, have led to dramatic improvements in the patients' experience.

• Open access scheduling. According to Levin, one of the earliest and biggest changes came when the decision was made to make it easier for patients to get in and see their doctors. Now, at all of Cleveland Clinic's family health centers, patients can log on through the patient portal, view their provider's entire schedule and make their own appointments.
• Patient education. A key part of ensuring both patient satisfaction and ongoing engagement, Levin said, is "being sure that patients understand what's going on with them, as well as what's supposed to happen next." To that end, Cleveland Clinic creates appropriate patient educational materials, which can also be accessed online, that runs the gamut from follow-up information following individual visits to continuing care information for chronic conditions.
• Open medical records policy. According to Posk, Cleveland Clinic has had an open records policy for years, but now everything is getting put online in personal health records. Moreover, since October of 2012 the organization has been rolling out increasing access to electronic patient information, beginning first with lab results,. From January to September of this year, Posk noted, 3.5 million lab results and images had been made available to patients electronically. Soon, she said, patients will also be able to review their physicians' notes online after a visit, in addition to being able to schedule follow-up appointments.
• Two--way messaging via patient portal. The telephone has long been the indispensable tool for communications between doctors and patients, but now communication has been significantly expanded, as well as made considerably more convenient, with email and other electronic formats made available on the Clinic's patient portal. Levin pointed to the ease with which a variety of information can be shared in this manner, noting also that "in a world defined by healthcare reform, we see a big role for this kind of communication in coaching patients and eliminating unnecessary office visits."
• Patient reported outcomes. Taking patient engagement up yet another notch, Levin said the organization has begun a series of pilot projects in which patients can enter data into their own records. This information, he said, then becomes part of the clinical workflow, enabling doctors to track their patients' progress, and potentially modify their care, between visits.

Of course, Levin and Posk noted that none of these changes would have taken place without an overall plan.

"Some of the initiatives began as experiments," Levin said, "but they're all part of a very deliberate strategy. It seems very clear to us that part of how we're going to get to better outcomes is through this kind of collaboration with patients."

http://m.healthcareitnews.com/news/5-ways-cleveland-clinic-improved-its-patient-engagement-strategies

High-tech monitors will help patients and their caregivers

TVs in your hospital room are so yesterday.

In the near future, flat-screen terminals mounted on the wall or near your bedside might offer a lot more than entertainment. Patients will be able to surf the Internet, order their meals, communicate with nurses and view their latest X-rays — all through interactive patient-care systems.

Educational videos on managing medical conditions, prescription orders and medical records can be flashed on the same screen where patients view dozens of television channels and just-released movies.

“The nice thing is it really puts the patient in the driver’s seat,” said Gary Harper, a registered nurse specializing in information management and communication at the West Palm Beach (Fla.) VA Medical Center in Riviera Beach, Fla., where 259 high-tech terminals should arrive by year’s end. “And it will help the nurses give even better care.”

West Palm Beach VA is one of six veterans hospitals in Florida scheduled to have systems installed in the next year, according to GetWellNetwork Inc., the Maryland technology company handling the project.

Hospital technology experts predict interactive systems, which have been around for more than a decade, will start taking off for one simple reason: They make patients happier. And that could make a big difference to a hospital’s bottom line.

Medicare now collects patient satisfaction data and cuts reimbursements for facilities performing poorly, said Nathan Larmore, a principle-and-practice leader at Sparling, a Seattle-based technology consulting firm advising the health care industry.

And using interactive tools to get patients more involved in their care should reduce hospital readmissions, Larmore said, which is another factor affecting reimbursements.

“In the past, hospitals looked at bedside technologies that improved a patient’s experiences as luxuries. But once they were mandated to focus on patient satisfaction, there was renewed interest,” Larmore said. “Hospitals being built in the last eight years are starting to look more like hotels, which is the industry where some of this technology has come from.”

Larmore estimates that about 10 to 15 percent of acute-care hospitals nationwide have interactive patient terminals. Costs have held many of them back, he said, as systems can run “several hundred dollars to a couple thousand dollars” per room.

“Project managers are used to spending millions of dollars on a fancy lobby, but not several hundred dollars on a television system,” Larmore said.

Children leading the way

Many of the early adopters have been children’s hospitals, he said, “because kids focus on their environment and adapt to the technology.”

Joe DiMaggio Children’s Hospital in Hollywood, Fla., has replaced televisions with interactive monitors. The GetWell Town system, a pediatric product from GetWellNetwork, was part of the new Joe DiMaggio building construction in 2011, then was expanded into the original hospital.

“When we were doing the new building, we talked to the kids about what they wanted, and they said a computer in their room,” said Michelle Barone, director of patient and family centered care for Joe DiMaggio and Memorial Regional Hospital, also in south Florida. “They wanted to be able to get on the Internet and watch movies without waiting for a volunteer to bring them a DVD.”

GetWell Town does all that — plus medical education videos, a hospital-wide game show, and an interface that lets young patients bring in their own Xbox or Wii games.

Barone said Memorial has discussed bringing interactive systems to the adult hospitals, “but right now, it’s all about the numbers,” she said. “When kids are in the hospital, we go above and beyond to cheer them up. We forget that when you’re an adult, you want to be coddled a little, too.”

Officials with the VA, which has its own federal health care funding, say the monitoring systems will greatly improve life for veterans residing in their Community Living Centers, which will be the among the first units to get the terminals.

The Miami VA, the first Florida veterans’ hospital to receive its systems, started the $2.4 million project in June, installing 230 units in the living center and some inpatient rooms.

Chuck Rivenburgh III, 43, is one of four paralyzed vets in Miami’s living center who got a “sip and puff” adapter, allowing him to flip through 48 television channels and pick from among 30 recently released movies by blowing through what looks like a double-pronged straw. The monitor is mounted on a flexible arm attached to the wall, allowing it to be pulled close to Rivenburgh’s bedside.

Rivenburgh, who served in the Army during Desert Storm but was injured after returning home, has lived at the VA hospital for 14 years. Before the GetWell system, he said he was limited to 14 TV channels, none of which included NFL games.

He is thinking of adding a keyboard to his tray table so he can access the Internet through his bedside monitor rather than at the computer on the other side of his crowded room.

“My TV is on pretty much all day long, so all these functions are a huge improvement,” he said.

Louis Marcus, GetWell’s interactive patient care manager for the South Florida VA installations, said the system will be upgraded so that doctors and nurses can leave notes, check pain levels and allow patients to order meals. Such terminals will become even more valuable as medical records go electronic, Marcus said.

As for the veterans, “The feedback has been great,” Marcus said. “I had one family who was visiting sit down with me for half an hour and tell me how grateful they were.”

http://www.startribune.com/lifestyle/health/221410951.html

Wales' first cancer patient survey to be launched

• By Julia McWatt

The Welsh Government and Macmillan Cancer Support launch the first national survey allowing cancer patients to report back on the quality of their care

Cancer patients across Wales will be able to report back on the quality of services they have received after the launch of the first national patient experience survey today.

The survey, developed by the Welsh Government and Macmillan Cancer Support, aims to look at patient experience and drive up standards for cancer services across the country.

It comes just days after campaigners voiced their disappointment that vital cancer targets set by the Welsh Government were missed again.

Figures showed that just 83.6% of people needing urgent treatment for cancer were seen within the two-month target.

The Welsh Government target is for 95% of patients to begin treatment within 62 days of diagnosis, and has not been met since 2008.

Targets for 98% of non-urgent cases to start treatment within 31 days were also missed, with 97.4% of cases being seen in that timeframe.

The publication of the survey, which will be sent to patients in the next month, is part of the Welsh Government’s Commitment to improve care for cancer patients as part of its Cancer Delivery Plan for Wales.

The survey will be issued to patients who had a hospital stay between June 2012 and March 2013.

Health Minister Mark Drakeford said:“The best people to ask about how cancer services are being delivered in Wales are the patients themselves. They have a raft of experience and are experts in their own lives. There is a great deal to learn from what they have to say.

“When a patient hears a doctor deliver a diagnosis of cancer, it is a life-changing moment. How the doctor delivers that diagnosis and the support the individual receives, not just for their medical care, can impact on the outcome for the individual.

“The cancer experience survey asks questions that cover each stage, from diagnosis to hospital care to home support. I would encourage all those who receive a survey to take the time to complete it. The information you provide can help improve services in the future.”

Susan Morris, general manager for Macmillan Cancer Support in Wales, said:“Macmillan is delighted that the Welsh Government is conducting an all-Wales cancer patient experience survey.

“It is the first time such a comprehensive survey of cancer patients’ experiences of care has been conducted in Wales and Macmillan is really pleased to be a partner in this important initiative.

“It is vitally important to measure survival rates and cancer waiting times targets, but it is equally important to find out what patients really think about the quality of the care they receive.

“Local health boards must take the survey’s results into consideration to inform planning for future cancer services to make sure these services meet people’s clinical and non-clinical needs and that they are truly person-centred.”

Fellow cancer charities welcomed the publication of the survey.

Dr Rachel Iredale, director of Tenovus’ cancer support Team, said: “We welcome any attempt to improve service delivery by asking patients about their experiences.

“We know from our own experience that feedback is vital. We recently surveyed over 1,600 people who use our services and we can clearly see certain issues emerging.

“These include the quality of care patients receive from the NHS, the need for their care to be closer to their home and that patients want to be viewed and cared for as a whole person, not just their cancer, with support for the whole family which continues beyond their treatment.”