Conducting clinical screenings through conventional practice is time consuming for patients and staff, the methods for collecting the information are rarely consistent, and the quality of the information collected is not always accurate.1 However, technology offers an opportunity to make clinical screenings a consistent part of patient registration. Patient self-service, delivered on tablets or onsite kiosks, is an effective tool for overcoming these challenges in emergency departments, clinics, and private practice settings. Not only does this solution help providers meet the clinical quality measures (CQMs) put forth by Meaningful Use Stage 2, but allowing the patient to answer clinical screening questionnaires through an electronic device can improve patient satisfaction, accuracy of the data, cost savings, and outcomes.
In a 2012 study at Johns Hopkins Medicine, Associate Professor of Emergency Medicine Dr. Yu-Hsiang Hsieh and his team used patient self-service kiosks to screen patients for HIV in the emergency department (ED). According to the study, 70 percent of patients preferred interacting with a kiosk over in-person bedside interviews with clinical staff. A compelling 60 percent also said they would be interested in using the kiosk to self-test in the future. By using an electronic survey, patients felt less judgment than if they were interviewed by a clinician and therefore responded more willingly and more honestly to sensitive lifestyle questions. Thus, the kiosk-based screening resulted in testing significantly greater portions of patients with high-risk sexual behavior and IV-drug users, and yielded higher rates of newly identified HIV-positive patients.2 Johns Hopkins presented a compelling use of innovative technology for meeting CQM goals.
Similarly, Dr. Edwin Boudreaux, Professor of Emergency Medicine, Psychiatry and Quantitative Health Sciences, University of Massachusetts Memorial Medical Center, conducted a study to maximize patient acceptability and data completeness of collecting patient-reported outcomes in the ED. This study replaced the conventional method of collecting patient-reported outcomes, including pain ratings, past medical history, and a battery of behavioral health screeners recommended by the National Institutes of Health, with an electronic system delivered through tablet PCs at the bedside. The system allowed for efficient collection and documentation of patient-reported outcomes with no clinician effort.
The application was optimized to improve acceptability and data completion by patients, leading to more than 95 percent of ED patients who initiated the survey completing all of the items. Key features to maximize completeness included: presenting a single question per screen, using multiple-choice response options rather than responses that require alphanumeric keying, and allowing patients to pause and return to the assessment if they were interrupted by medical testing or interventions. Satisfaction assessments revealed that 90 percent of patients found the survey length, which took an average of nine minutes, to be acceptable during their ED visit. This study shows that patients are satisfied with patient-centric technology, even in the busy, demanding setting of an ED.
Self-service technology can also be used for gathering answers to intake questionnaires. In one example, a private practice of 30 orthopedic physicians uses configurable questionnaires to gather information pertaining to the onset and mechanism of the patient’s injury, as well as family history, past medical history, social history, and key demographic information. Twenty-five percent of their patients currently complete the preregistration questionnaire prior to their appointment, and another 55 percent complete this information in the waiting room. The use of this innovative technology has reduced errors in patient data. As an added benefit to this change in workflow, this physician group has been able to pre-populate the history of present illness (HPI) for the physician, reducing dictation transcription costs in 2013 by $351,562, or 93.24 percent over the previous year.
One clinic in California that is part of a national health system effectively used patient-directed questionnaires as a tool for preventative care and achieved tangible financial results as an added benefit. By using questionnaires to screen for inappropriate use of antibiotics through kiosks and a decision support algorithm, the clinic reduced inappropriate prescription of antibiotics for its patients and subsequently avoided the cost of acute care for patients who develop pneumonia as a result of resistance to antibiotics. Acute respiratory infections (ARIs) make up 10 percent of outpatient visits at this organization’s clinics, and 20 percent of that patient population are overprescribed antibiotics. Patients with pneumonia are typically treated at the hospital for an average of two weeks, and the cost of treating patients with antimicrobial-resistant organisms versus those without can range from $6,000 to $30,000. Using the lower estimate of $6,000 in hospitalization costs, early intervention to reduce overprescription of antibiotics through the kiosks has the potential to save a clinic of 10,000 patients $1.2 million a year.
The search is on for the holy grail of best practices in preventative care. However, addressing preventative care doesn’t have to be a formidable effort – there are simple ways to produce significant return and better outcomes. Conducting simple patient-directed self-guided clinical screenings through technology is a viable way to start achieving this objective. Very small implementations have proven successful in collecting information for CQMs with a positive patient response and significant return on investment.
References
- http://pubs.niaaa.nih.gov/publications/aa65/aa65.htm
- http://www.hopkinsmedicine.org/Medicine/std/downloads/SAEM2012_HIV_Hsieh_poster.pdf
IBM announces the IBM Watson Care Manager as part of a larger move into the cloud
The new offering is designed to integrate disparate types of clinical and individual data and apply cognitive analysis to draw out insights for nurses, physicians assistants, and other care managers so they can closely monitor and counsel individuals with complex, costly conditions.
For example, a patient with chronic heart failure may receive a personalized care plan that includes tracking weight daily and monitoring physical activity. Currently, how patients report such data and how care managers evaluate and act on that data has largely been a manual process.
“With the flexible workflow tools and automated patient engagement functionality, we’re able to build evidence-based programs that support our care management team in delivering care to our patients,” says Juie LaPrade, Vice President of Quality, inHealth – a consortium that has curated technology-driven solutions in support of optimal patient outcomes. “This is proving to be enormously valuable in our work in accountable care and population health.”
With IBM Watson Care Manager, a patient can opt-in to have data collected from wireless-enabled scales, wearable devices, other types of sensors, and from assessments delivered to the patient’s device, such as an Apple Watch. Care managers receive insights derived from cognitive analysis of a patient’s integrated data streams, toward the goal of enhancing engagement with the patient so potential health problems are spotted and addressed early. The data related to that individual’s case is then fed back into the IBM Watson Health Cloud, which analyzes over time which interventions correlate with positive results and applies that knowledge to future care management options.
The move comes as part of an expansion to improve the capabilities of the Watson Health Cloud platform, including a program that will help biomedical companies with compliance for new technology.
