When you build it and they don't come - why remote patient monitoring completes the patient engagement circuit

Eric Rock - Print  | 

When patient portals were first mandated under Meaningful Use (MU), the idea was to facilitate two-way communication between providers and patients. They got it half right.

The portals were built, providers began placing patient information (such as visit and test results) in them, and they encouraged their patients to sign up for them. According to a 2017 report from the Government Accountability Office, 88 percent of hospitals and 87 percent of other professional healthcare providers had created online portals for patients to access their own health data.

The problem is, just 15 percent of hospital patients and 30 percent of non-hospital patients actually use these portals. And even when they do, they mostly use it passively, to receive information from physicians; they rarely use it to communicate back so they can become actively engaged in their own care.

Unfortunately, patients have been conditioned by years of behavior regarding how they interface with their healthcare providers. They see a doctor, or visit a hospital, they are diagnosed, treated and prescribed and that’s typically the end of it.

As a result, healthcare systems need to get past the idea that simply by building a portal they have successfully addressed the need to engage patients in order to improve outcomes. It is understandable that they would feel, after spending valuable healthcare dollars and effort to create these portals, that they can move on to other issues. However, just because these portals exist doesn’t mean that patients will use them correctly – or at all. Not to mention patients with multiple providers (most patients with chronic disease) tend to dislike having to log in to multiple, separate portals to obtain all of their care information.

There’s a current movement within large health systems toward designing their own patient-facing apps. These efforts are on the right track but may miss the necessary glue needed to engage populations with clinical thought and purpose. Further, most of these apps offer little more than access to lists of facilities and providers and tools for making payments.

Rather than trying to convince patients to log in to portals and download home-grown apps, an alternative approach to engagement is regular, purpose-driven outreach with patients in the least intrusive modalities available. Easy-to-use white-labeled engagement tools can be used to reach patients in ways that work and at times where impact is maximized. These tools offer an easy path for patients to their care teams while simultaneously delivering steady streams of health data back to the care team. Data coming from a large population of engaged patients in post-discharge settings is proving to be some of the freshest data in all of healthcare.

Proactive, automated care is the future of healthcare. In the case of remote patient monitoring, home health kits are constantly capturing and sharing data with care teams, and patient issues are caught earlier, enabling effective remote triage for patients to reduce unplanned care and prevent escalations to more intensive, costlier interventions.

Many health systems with post discharge remote patient monitoring programs and/or private labeled telemedicine solutions as their front door have realized their point solutions are evolving into deeper and wider connections with their patients providing unforeseen benefits and requiring a more centralized approach. In short, these worlds are merging for many systems and the solutions have evolved into a true care management platform for engaged patients. By meeting these patients where they are versus hoping that they will participate actively online, the technology can serve effectively as a patient engagement arm for these populations. In fact, well-designed engagement programs can often drive portal adoption and utilization.

Here’s a summary of how remote monitoring technology can fill the patient engagement gap:

1. Start with the basics – Most remote care programs looking to reduce length of stay and improve outcomes for heart failure patients, for example, make this the place to get started. The outcomes are clear, with reductions in 30-day readmissions, reductions in short and long-term mortality and greatly improved patient satisfaction. COPD, hypertension and diabetes are often obvious extensions, leading to various other programs like smoking cessation which support core use cases. Health systems are now using remote care across many service lines with up to 80 clinical conditions being monitored.

2. Make it easy for patients to get started – Deploying technology to a population of patients can be tricky. Patients will have widely variable comfort levels with technology. The most effective solutions are those that are purpose-built for specific patient populations. Older populations, who are the ones most likely to require remote patient monitoring for a variety of acute and chronic conditions, can be resistant to learning new or complex technologies, so it’s important to, again, meet them where they are. Pre-configured devices designed to simplify the patient experience have proven 20-30% more effective in daily compliance and adherence to remote care activities. Patient’s own smartphones and tablets are great solutions for younger, rising risk patient groups. Being able to reach patients on their own land lines is still, strange as it sounds, a necessary approach. Familiarity in terms of devices and user interfaces can help to overcome any technology anxiety a patient may have.

3. Content that’s easy to consume – Anyone who’s ever used YouTube to learn how to make simple home repairs or get instructions on other DIY projects knows that seeing is understanding. Applications that use educational videos can help answer basic questions that might otherwise lead to additional clinical visits or time spent by staff on the phone explaining relatively simple concepts to patients. These videos, combined with health tips and teach-back questions can head off these issues, so that when a patient does need to interface with their care team, that time is focused on important care issues.

4. Facilitate vital communication – Many see remote patient care as a way to stave off unnecessary (and costly) readmissions or clinical visits. That is one of the benefits, of course, but it goes further. By allowing patients to take advantage of features like embedded video conferencing, they are being given the keys to their care plan. They no longer feel like they need to wait for a new problem to reach out to their doctor or care team. Rather, they are empowered to share information with their providers more often. This is the definition of patient engagement.

5. Move beyond your clinical pathways – Engagement solutions can change a health system’s entire consumer facing image. Imagine automating many best practice processes in your post discharge care. Questions as basic as, “How are you” “Do you have a fever?” “How is your pain?” “Do you have redness or swelling around your incisions” etc., can be performed through technology-enabled, automated surveys. The patient does not feel neglected and the answers provided by the patients can then be brought to the immediate attention of the care team when key triggers are identified. By reaching out to the patient through low-cost engagement solutions, clinicians are much more likely to get active data from patients versus asking them to log in to an online portal. These technologies can be as simple as a secure text which opens into a smartphone browser, providing an app-like experience, leaving no patient data footprints on the device after the interaction.

6. Close the loop by integrating your engagement platform with your portal and app strategy. Driven from the simple text solution, patients can be guided to more information in the form of health system apps or even the EHR patient portal. Care teams will not need to spend valuable time chasing down those 85% of patients who will not go there.

At a recent conference, a contemporary used the phrase, “Never discharge a patient,” when talking about the future of hospital care in a world of value-driven care. The concept implies constant vigilance, but of course providers are still human beings and can’t be everywhere at once. Not so with appropriately applied technology.

Creating online patient portals is helpful for certain situations, but it’s not enough to actively engage patients in their own care. By utilizing technology that is familiar, comfortable and enables proactive automation, healthcare providers can close the patient engagement gap, completing the circuit of value-based care.

About the author:
Eric Rock has demonstrated repeat successes as an innovator and entrepreneur, having founded three highly successful software companies.

In 2009, Rock launched Vivify Health, delivering the first cloud-based Remote Care Management platform connecting providers with their patients via wireless mobile devices. Vivify has experienced rapid growth, now utilized by large healthcare organizations representing over 800 hospitals and health plans.

Prior to Vivify Health, Rock founded MEDHOST, the leading Emergency Department solution serving over 500 hospitals and 10 million patients annually. MEDHOST was the first touchscreen EMR, including other innovations such as geographic bed/facility views, patient self-service kiosks, multi-touch data visualization and an enterprise operational visibility engine.

Prior to MEDHOST, Rock founded ProHost, the first restaurant table management and reservations system, ultimately acquired by OpenTable.com.

Rock continues to focus on emerging technologies and business strategies for healthcare. He is a frequent speaker at events such as HIMSS, ATA, Connected Health Conference, Health Evolution Summit, Piper Jaffray and TED.

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