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Patient Engagement Keystone Summit White Paper

Patient Engagement Keystone Summit White Paper

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On October 2, 2018, healthcare IT leaders (19 leaders from healthcare organizations and 29 leaders from vendor organizations) gathered outside Salt Lake City for one day to discuss patient engagement initiatives, outcomes, strategies, and best practices. The goal of this summit is to create a patient engagement framework that organizations can use as a compass to guide their goals and strategies and as a scorecard to assess progress along the way

Patient Engagement

On October 2, 2018, healthcare IT leaders (19 leaders from healthcare organizations and 29 leaders from vendor organizations) gathered outside Salt Lake City for one day to discuss patient engagement initiatives, outcomes, strategies, and best practices. Goals of the summit included:

  • Define patient engagement and its key pillars
  • Establish a common, patient-centric language
  • Align HIT capabilities
  • Explore patient engagement outcome measurements
  • Gather best practices

Objective

Patient engagement is as old as medicine, but the use of information technology to engage patients is just taking shape. Broad visions and experimentation abound, but pathways are still being cleared, and there is a lack of consensus regarding end goals. The resources needed to move forward are scarce, with investments largely being dedicated to more obvious business cases that are tactical and departmental. The goal of this summit is to create a patient engagement framework that organizations can use as a compass to guide their goals and strategies and as a scorecard to assess progress along the way.

Patient Engagement Barriers

Nebulous Definition

Patient engagement can mean many different things to many different people. Administrators, clinicians, IT staff, payers, and patients all have unique points of view.

Siloed Efforts

One cause of these differing points of view is that the various players often operate in silos. Goals and investments are established at a departmental level based on short-term needs that are often financially based.

Skewed Incentives

External pressures to improve patient engagement, such as government regulation, often result in a checklist mentality that drives patients to feel manipulated rather than engaged.

Patient Disinterest

Too much focus on organizational needs and too little focus on patient needs results in patient disinterest, hindering the ultimate goal of active patient participation.


definitions

Principles of Patient Engagement - What We Learned

Over the years, KLAS has worked with leaders from provider and vendor organizations to develop HIT-focused frameworks in areas such as population health, interoperability, and enterprise imaging. The primary goals of these collaborations have been to create consensus definitions and choose metrics for HIT performance measurement. 2018’s Cornerstone Summit on patient engagement began with similar objectives, but feedback from attendees was clear: the patient-engagement framework must be patient-centric.

What Does Patient-Centric Mean?

Like other KLAS frameworks, the initial version of the patient engagement model was technology–centric, organized around HIT market segments and tool sets. Based on early feedback, the model evolved to a more provider–centric framework that concentrated on activities that provider organizations participate in to activate patients (and consumers) in their care.

In table discussions at the summit, opinions about various elements of the framework were wide ranging and sometimes even contradictory. There was no disagreement, however, on the need to shift from a provider–centric to a patient–centric point of view. Instead of placing providers in the central role, the framework needed to treat patients as the primary actors. This patientcentric approach needed to account for the following:

  • Care should be driven by patients’ own goals for their health rather than by provider needs
  • Providers need to be able to get to know their patients and meet them where they are
  • Patients and providers should work together, actively and effectively, toward their goals
  • Technology should support patient-provider relationships, not just patient and provider activities

All in all, summit attendees described seven key principles that provide a foundation for patient participation, provider strategies, and vendor development.

The Seven Principles of Patient Engagement

  1. Patient-centric: Actively helped by their providers, patients achieve their own goals for their health and care.
  2. Personalized: Providers get to know their patients and provide a personalized experience, meeting patients where they are (for example, by taking into account social determinants and patient preferences).
  3. Connected: Providers maintain constant and meaningful communication with patients, patient families, and other caregivers. Care is wellcoordinated between all parties.
  4. Simple: Engagement tools and processes are as easy and convenient as possible for patients and their families.
  5. Timely: Care delivery and interactions happen on time. Information, including health data, is made available to patients in real-time.
  6. Continuous: Patient-provider relationships extend beyond individual episodes of care. Care plans and other patient requirements (including financial) are documented and communicated and represent a pathway into the future.
  7. Measured: Providers continuously measure their performance in achieving their patients’ goals and in achieving their own organizations’ patient engagement goals, adjusting strategies as needed over time.

The Patient Engagement Framework

The concept and practice of patient engagement is as old as medicine. However, the use of information technology to enable and scale patient engagement is relatively new, especially when done in a strategic and coordinated enterprise-level way. As a result, the term “patient engagement” means different things to different people—whether provider, vendor, or patient. Creating a framework for patient engagement helps by establishing a common scope and language among all stakeholders and can provide guidance around key concepts.

HIT Capabilities

The capabilities—and thus value—of different vendor solutions is highly variable, even within the same market segment. Including HIT capabilities in the patient engagement framework provides a map that provider organizations can use to differentiate vendors and assess their own HIT portfolios. The patient engagement framework includes three broad pillars (Access, Partnership, and Navigation), each of which contains multiple capability groups.

Principles Foundation

Too often, technology becomes a means rather than an end, and organizations depend on HIT to define strategy instead of merely automating it. By virtue of its name, patient engagement is about relationships in a broad context that goes far beyond tool sets. Framework principles connect HIT to patient-provider relationships and the overall goal of wellness.

How to Use This Framework

Aside from providing a common scope and language, the patient engagement framework is meant to serve as an assessment and planning tool. Its potential value is not only in what it says but in what questions it raises for patient engagement stakeholders.

Providers can use the framework to assess their current patient engagement capabilities, leverage investments across the enterprise, and select vendors. When planning a new initiative, providers might ask themselves and their vendors, How well will this effort or solution advance the principles of patient engagement?

Vendors can use the framework to evaluate their current product portfolios and guide development and market strategies. When considering product development, a vendor might ask, In what ways will this product help providers more closely align with the seven principles?

KLAS plans to use parts of the framework to measure vendor performance in two ways—first, as a method to validate with live customers the capabilities of vendor solutions, and second, to measure customer satisfaction in terms of how well vendor solutions meet the needs outlined in the framework.

HIT Capabilities

Access

Finding a Provider

Triage/symptom checker
Web-based provider search/matching
Provider profile/quality data
Care-setting guidance

Arranging Care

Self-scheduling/rescheduling
Pre-registration forms/intake
Insurance verification
Self-registration/check-in
Prescription refill requests

Patient Account Management

Price transparency (including longitudinal TCO and financial steps)
Online bill-pay
Bill details/explanations

Marketing and Communication

Contact management
Market intelligence/analytics
Marketing campaigns
Broadcast messaging

Presence/Awareness

Community/social media tools
Social media optimization
Reputation management
Advertising
White-labeling

Key HIT Solutions

Consolidated patient portal
Telemedicine/virtual visits
CRM/PM platform
Language translation tools/services
Kiosk support

Partnership

Knowing the Patient

EMR integration
Interoperability tools
Risk assessment/analytics
Care-gap identification/reminders
Access to social determinants of health
Readiness/behavioral assessments
Capture of patient health goals
Capture of patient communication preferences
Capture of other patient-generated data
Tracking of patient-reported outcomes
Remote patient monitoring

Patient Empowerment

Patient access to own data
Ability to share own data
Provider messaging
Shared decision-making tools
Family/caregiver enrollment
Family/caregiver collaboration tools
Provider/care team visibility
Care plan/schedule visibility
Multi-language support

Patient Experience

Patient satisfaction surveys/analytics
Provider satisfaction surveys/analytics
Patient and staff rounding tools
Patient access to requests/orders (e.g., meals)
Environmental controls
Service recovery tracking
Entertainment/programming

Key HIT Solutions

Secure communications
Secure email
Interactive patient systems (IPS)
Bedside communication

Navigation

Education

On-site education
Pre-visit education/instructions
Discharge education/instructions
Wellness education
Longitudinal care planning

Coordination

Care management/care planning tools
Referral management
Transitions-of-care planning
Care-gap reminders
Appointment reminders
Care-adherence reminders/tracking (e.g., medications)
Post-visit follow-up
Visit-planning tools

Wayfinding

Online patient guides/directions
Mapping/geolocation (inside and outside facilities)
Virtual tours
Transportation arrangement

Patient Self-Management

PHR capabilities
Patient self-assessments
Online coaching
Fitness/activity tracking

Key HIT Solutions

Comprehensive mobile apps
Multi-modal patient outreach


High-Level Learnings from Outcome-Measures Discussion

Having discussed patient engagement strategies and ways to enable HIT, attendees turned their focus to the use of outcome measures to track the effectiveness of patient engagement efforts. In table discussions, a number of key ideas developed:

  • Every patient engagement initiative must be clearly defined. Given any particular context, participants imagined numerous options for measurement.
  • HIT capabilities can be easy to measure in terms of changes in patient behavior. For example, does an appointment-reminder solution reduce no-show rates? Are patients using a mobile app?
  • While the measurement of HIT capabilities can track the effectiveness of initiatives (e.g., patient access, utilization, etc.), it doesn’t necessarily reflect patient success.
  • Patients can help define measures that are meaningful to them. Patients want to be heard and understood, and providers must ask themselves how well they know their patients. Provider organizations must assess how good they are at gathering feedback and insights that reflect the voice of the patient.
  • Another type of measurement is to gather feedback regarding what things patients do after a care episode. Do they recommend their provider to friends and family? Such net-promoter and loyalty measures reflect individual patient success.

Recommended Best Practices

During the summit, participants took part in table discussions about best practices they have seen or used. The following is an overview of often-mentioned successful practices.

Technology
  • Create easy-to-use apps
  • Create cloud-based software solutions
  • Adopt telehealth capabilities
Analytics
  • Gather and analyze social determinants of health
  • Gather and analyze behavioral habits (e.g., travel patterns, transportation)
Convenient Care
  • Enable 24/7 access to care team
  • Enable communication with care team (e.g., text, email, phone, video)
  • Enable communication with patient (e.g., text, email, phone, video)
  • Enable families to communicate with care team (e.g., text, email, phone, video)
  • Allow patients to choose how they want to communicate
Right Care Setting
  • Direct patients to the appropriate care setting (e.g., nurse practitioner, urgent care, or primary care physician)
  • Let patients go to the care setting at which they will be best served
  • Bring the right care to the patient (e.g., 24-hour nurse line, telehealth)
Personalized Care
  • Provide patient education and personalized discharge instructions
  • Assign health buddy or care manager to patients as they leave
  • Include patients in the process of setting goals and choosing interventions
  • Enable physicians and nurses to engage with patient during the encounter
  • Incentivize patients to participate in wellness activities and make healthy lifestyle choices
Provider Organization 
  • Develop a patient engagement vision and road map
  • Adopt effective change management when implementing patient engagement strategies

most significant obstacles

Summit Attendees

Laura Adams

President & CEO

Rhode Island Quality Institute

Damon Auer

VP, Healthcare

DXC Technology

Nikia Bergan

Chief Revenue Officer

GetWellNetwork

Sean Bina

VP, Access & Patient Experience

Epic

Liz Boehm

Research Director

Vocera Communications

Russ Branzell

CEO

CHIME

David Cerino

Group VP of Digital Innovation

Providence St. Joseph Health

Albert Chan

VP, Chief of Digital Health

Sutter Health

Suzanne Clough, MD

Chief Innovation Officer

ArmadaHealth

Michael Davidof

VP, Marketing & Business Development

Phreesia

Caroline DeLongchamps, B.S.

Manager, Patient and Family Centered Care

The Medical University of South Carolina

Amy Deutschendorf

Adjunct Appointment

Johns Hopkins School of Nursing

William Feaster, MD, MBA

CHIO

CHOC Children’s Hospital

Louis Filhour, PhD

CEO

Better Health for Northeast New York

Jamie Gunsior

Partner

PwC

Addison Hoover

Senior Director, Client Development

Docent Health

Morgan Horwood

Project Coordinator

Sutter Health

Chaim Indig

CEO

Phreesia

Janice Jacobs

Global Patient Engagement Lead

NTT DATA Services

Benjamin Kanter, MD

CMIO

Vocera Communications

Terri Keeling, DSc, CPHIMS, PMP

VP, Information Technology

University Hospitals

Atul Kichambare

Global Leader, Patient Engagement

NTT DATA

Adam Koch

Chief Performance Officer

TVR Communications

Roy Kosuge

Chief Commercial Officer

SONIFI Health

Shawn Lemerise

Executive VP and Managing Partner

CipherHealth

Emily Lord, MBA

Product Marketing Lead, Patient Services

athenahealth

Toran MacArthur, MD

Physician

Premier Family Medical

Jerry Mansfield

ECNO/CPXO

MUSC Health

Susan Marino

VP, Chief Nursing Informatics Officer

Hartford Healthcare

Sonika Mathur

SVP, Digital Content

Elsevier

Ben Moore

CEO

Telmediq

Lonny Northrup

Care Transformation

Intermountain Healthcare

Ru Okamoto

Research & Development

Epic

Matthew O’Neil

CEO

Ichi Go

Michael O’Neil

Founder & CEO

GetWellNetwork

Ahmad Ouri

CEO

SONIFI Health

Nikki Parham

Partner

PwC

Shannon Phillips

Chief Patient Experience Officer

Intermountain Healthcare

Tammy Richards

Assistant VP, Clinical and Patient Engagement

Intermountain Healthcare

Steve Schaefer

CEO & President

ArmadaHealth

Mohamed Shoura, Ph.D

CEO

CarePassport Corp

Zach Silverzweig

Co-Founder

CipherHealth

Ming Tai-Seale

Professor

UC San Diego

Tim Tarnowski

SVP and CIO

UMassMemorial Healthcare

Raj Toleti

CEO

HealthGrid

Glenn Updike, MD

Physician

UPMC

Jukka Valimaki

VP, Commercial, Patient, Nursing & AHP

Elsevier

Gerbrand van de Beek

Global Solutions Lead

Philips

Keith Washington

CEO

TVR Communications

Les Wold

Medical Consultant

Philips

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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2019 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.