Alistair Erskine, MD, chief clinical informatics officer at Geisinger Health System in Danville, Pa., oversees how the health system uses clinical information to leverage evidence-based practices across the care continuum. Part of his role involves working to make clinical data available and actionable for clinicians, as well as patients.
As Geisinger and other health systems across the country work to improve population health, ensuring patients receive evidence-based interventions is critical. Getting data to physicians in near real-time helps to facilitate this. Geisinger believes this data should also be shared with patients, whose engagement is critical to the ultimate success or failure of preventive and disease management efforts. As a result, the health system recently launched two innovative programs to educate and engage patients about their care, which Dr. Erskine discussed at the Healthcare Leadership Forum conference held in Chicago this week.
OpenNotes
Last summer, the health system gave more than 100,000 of its patients access to their entire clinical note through the MyGeisinger online patient portal. The program was an extension of the Robert Wood Johnson Foundation's OpenNotes pilot, which Geisinger participated in.
Today, the portal gets 11,000 hits a day and is used by 35 percent of patients, said Dr. Erskine.
Initially, some physicians were resistant to making the notes so open. For example, a patient would be able to see if a physician noted he or she was 'noncompliant.' However, most physicians have come around to appreciate the move, and many have reported patients asking questions that they may not have in the past, based on information they read in their record.
The opening up of patient records has also forced physicians to be more descriptive in their notes, which benefits both the patient and other caregivers who may reference the note. "What we're really expected to produce is a clinical receipt, not a clinical note," he said, describing the approach to notes most physicians had prior to OpenNotes. Now, physicians have more incentive to create a true clinical note.
Patient education with iPads
Geisinger has also brought a technology-forward approach to patient education. Patients undergoing certain procedures get to take home an iPad, usually for about a week, with educational information specific to their procedure. The information helps prepare them for the procedure and aims to smooth the transition to care after the procedure.
The iPad was attractive because it would allow clinicians to get interactive educational information to patients. However, the team ran into a bit of a roadblock in their efforts to get them into patients' hands: regulatory concerns. Geisinger's attorneys worried the iPads could be construed as an inducement. After meeting with CMS and a "whole series of other entities," the loaner iPads were cleared. As long as the patients didn't keep them, and use was limited to medical/educational reasons, Geisinger could move forward.
Patients engage with the digital educational content, and when the procedure does take place, they already understand what will occur before, after and during.
But it's not the tools alone that have led to improved patient engagement. "It's not the tools, it's how we implement them," said Dr. Erskine.
He hopes these programs, along with others yet to be launched, will improve patient health by addressing care gaps, such as missed intervention opportunities.
To illustrate the opportunity, he pointed to diabetes care. In 2006, just 2.4 percent of diabetes patients received all possible preventive/maintenance interventions. By earlier this year, that had increased to 14.2 percent. He hopes that efforts to get more data to both clinicians and patients will further improve this number. After all, physician engagement isn't enough; a successful intervention requires a patient be available to receive it.