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In the initial years of my career, I trained as a general internist. Since then; I have been in healthcare IT for 26 years now. I have been directly involved with EHR for the past 13 years and been the CMIO at Ochsner for the past three years.
I would like to focus on three ways tech can improve patient engagement—consumerism as a strategy, digital engagement and precision medicine.
Major Trends Set to Shape Patient Engagement
As we move away from a fee-for-service toward a value-based healthcare, we focus more on outcomes and one of the most important factors in these outcomes is patient engagement. In the traditional model, the health system is a resource which the patient would come to for their healthcare needs. Now it’s much more about having healthcare organizations come to the patient and engaging with them not just when you need us as a resource. It is shifting from “a healthcare system to a system that provides health.”To be effective in, we need to remove the friction points for patients and prospectively reach out to patients to get them engaged earlier.
From the technology point of view, this is about ensuring that all portals of entry and all points of communication are occurring using the digital tools that today’s consumers are using to provide a seamless experience. For instance, in the traditional retail process, when you need something, you go to the store and buy it. Today, it’s about the online experience; we can offer customers things that they might be interested in through data and predictive analytics. The same can be done in healthcare. We are creating a proactive and predictive approach so that we can reach out to you in a prospective way. This process should be seamless; everything should be able to take place in one click, such as getting your appointment done, seeing lab results and talking to the doctor to convey a message. The consumer experience then becomes the center of the engagement strategy; it started with optimizing the patient portal, but now has expanded beyond that to population health and interactive education. Viewing our patients as consumers drives the system to remove friction and create a flawless experience.
Key Elements of Digital Patient Engagement
We can provide improved outcomes and more cost-efficient care if we can understand all the ways patients engage with healthcare services. Unifying care then becomes very important, not just for us, but also for the patients well-being. Prior to consumerism, typically doctor-patient engagement occurred sometimes via phone or with physical contact during a clinic visit. Now, we now offer innovative technology and solutions to interact with patient when and where they want it with even better outcomes. Digital and virtual care are now mainstay methods of providing care.
What digital medicine allows us to do is to re-engage patients in a digital platform in a way that’s above and beyond what their experiences were from traditional encounters. For example, in Hypertension Digital Medicine Program, patients with uncontrolled blood pressure (BP) have access to a wireless; digital blood pressure cuff which is sends BP readings via a smartphone directly into their EHR. Whereas in the more traditional model, a patient with this condition would visit the doctor for a blood pressure check-up three or four times in a year, and those BP readings determined the assessment and suggested treatment. By receiving more frequent, digital blood pressure readings we can intervene more quickly allowing us to deliver better care and achieve better outcomes.
The program is successful due to the technology that reviews those readings and uses predictive analysis to determine which readings represent a significant change from the patient’s base line.
If there is a change, a digital medicine pharmacist is notified, connects with the patient and decides on what treatment intervention is needed such as a drug adjustment. This improves outcomes not just because of a more rapid turn-around cycle, but also because of improved patient compliance from increased engagement. The digital platforms have become a crucial tool in our consumerism strategy to improve patient engagement.
Another aspect of digital engagement we have innovated involves new functionality in our patient portal. Traditionally the portal has been used for billing, requesting medication refills and sending messages to providers. We have now started to use our portal to push interactive care plans to patients with certain conditions. This program, called Care Companion, allows us to push through patient portal education, questionnaires and tasks to our patients creating another avenue for patient engagement. Ochsner was one of the first health systems in the country to go live with the Care Companion program. Currently, our kidney transplant patients are enrolled in the Care Companion plan post-transplant to ensure all aspects of their care are being addressed in real-time, including adequate post-transplant medicines, comfort with wound care, and monitoring of weight and blood pressures. We are expanding this program to our orthopedic and heart failure patients in the near future.
Precision Medicine Initiative
When we traditionally think about patient engagement, we are talking about the more traditional ways that we make assessments of the individual patients. Patients come in and they either have a chief complaint; have something that they are interested in or something that they need attention. With precision medicine, we’ve expanded care that can look at areas like whole genome sequencing to customize treatments for diseases such as cancers and metabolic diseases. Engagement and treatment plans based upon their genetic predispositions are a new way we are actively engaged our patients.
A different aspect of precision medicine goes beyond genetic analysis. We will soon have the ability to bring big data to the bedside. In the near future, we will shift from just using our medical knowledge and the knowledge which came from established research to make decisions on treatment and coupling it with large data sets of millions of patients and real-time data to decide what precisely is best for this patient. This predictive approach will allow our systems to identify patients, and review past treatments and outcomes to then determine the best optimal treatments. This will also allow us to change the outcomes and course correct if needed faster as well as improve shared decision making between providers and patients, where in the past we would have to rely only on outcomes measured in a published research trials. This shared decision making is an even more advanced way to engage patients.
Piece of Advice
As we move into 2020, one of our leadership strategies focuses on the big ‘I’ and little ‘i’. The big ‘I’ refers to big innovations and little ‘i’ to incremental optimizations. I think for CMIO’s today, it’s about balancing these two concepts. You need to stay focused on little ‘i’ issues that make things easier for your providers. This customization is key to preventing burnout, keeping providers happy so they can best engage with patients. At the same time, we also need to maintain focus on the big “I” to stay in line with tomorrow’s vision of healthcare with projects like digital health and big data analytics. Organizations that can maintain this focus, centered on patient engagement, will achieve better outcomes for their patients at a lower cost and thrive in the new world of value-based healthcare.