With Patient Input as North Star, University of Michigan Urology Builds Telemedicine Program

Jan. 16, 2018
Chad Ellimoottil, M.D., and his colleagues at the University of Michigan/Michigan Medicine have been listening--really listening--to patients enrolled in their urology video visit program--and are making use of what they're hearing

Even in an era where patient satisfaction is paramount, eliciting patient input when designing new programs in areas such as telemedicine isn’t yet an industry norm.

Chad Ellimoottil, M.D., assistant professor of urology at the University of Michigan/Michigan Medicine, found himself on this untraveled path last year when he set out to build a patient-centered urology video visit program. “Patient-centered telemedicine,” he says, “considers patients’ perspectives to make their experience as painless and seamless as possible.”

Unable to find an existing model he could replicate, he turned to Eric Ries’ Lean Startup approach, which advocates quickly testing product ideas, measuring how customers respond, and making incremental changes based on the feedback.

In April 2016, Ellimoottil piloted the program’s first video visit. Since July 2016, the program, known as Connect-M, has conducted patient surveys, interviews, or focus groups every six months to understand patient preferences and concerns about video visits, or to gather post-visit feedback. The insights generated have helped answer key questions such as what devices patients should use for video visits and whether certain types of patients are a better fit for video visits than others.

For example, early conversations with patients revealed frustrations with web browser issues, while a survey showed 84% of clinic patients owned a smartphone they could use for video visits, so the program pivoted from a web browser to a mobile app.

The findings have also revealed that customer feedback doesn’t always mirror clinician or administrator intuition. A patient survey found that older patients and those who live near the clinic were as enthusiastic about video visits as young people and those who travel long distances for appointments. This insight surprised the Connect-M team and guided their decision to neither target nor exclude any demographics.

With nearly 200 video visits completed by seven providers and feedback acquired from over 150 patients to date, Connect-M is now looking to scale and share its findings broadly.

Ellimoottil, director of Connect-M, discussed the program’s approach on September 17 at MedicineX, a health care innovation conference hosted by Stanford University’s School of Medicine in Palo Alto, California. Afterwards, he spoke with Healthcare Informatics. This interview was edited for length and clarity.

How would you advise someone who is starting to build a video visit program or has started, but is struggling?

First, take a multi-disciplinary approach. We have an e-health business infrastructure committee that’s been the driving force behind telemedicine across departments. The committee convenes every two weeks and has all the stakeholders – clinicians, project managers, IT, and others. When issues or questions come up, we work through them together.

We also have telemedicine champions in our call centers, patient engagement and patient experience leads, nursing staff, and front desk staff that make this successful. Buy-in from our department leadership has been critical, but so has working across disciplines.

Second, incorporating patient experience is essential. Volume alone isn’t a measure of success.

Third, empowering staff is critical. Create an environment where you show you care what they think and do. I tell our staff that if they hear any problems or patient complaints, I want to hear about it. One of our front desk staff members shared what she heard from patients about our patient education materials, and we used her feedback to improve the materials. These kinds of insights are invaluable, but you only get them if people feel empowered.

How can CIOs and CMIOs best support the development of patient-centered telemedicine programs?

They know more than anyone else, all the capabilities the technology has to maximize patient experience, so they should be at the table when patient experience is being discussed. They should also contribute questions to patient surveys and interviews.  

There’s so much co-creation required to create a seamless patient experience. Our IT team partners closely with us to quickly troubleshoot technical issues. CIOs and CMIOs who empower their teams to partner in this way are maximizing everyone’s ability to improve the patient experience.

A RAND Corporation study published in March showed direct-to-consumer telehealth prompted new use of medical services and was unlikely to decrease overall health spending. How do you consider these unintended consequences as you iterate your program design?

Any new technology has unintended consequences. There are people who use it appropriately, and there are people who don’t.

What’s important to consider is if you have more people getting access, the cost may go up, but that may not be a bad thing if you’re managing the population’s health appropriately. If more patients come to our clinic, but the population is getting healthier, that’s a good thing. 

The National Quality Forum recently proposed creating telehealth quality measures that capture the experience of patients, families, caregivers, care team members, and the community. What measures do you think they should consider using to assess patient experience?

I would recommend asking patients 1) whether they felt like they had enough time with their doctor, 2) whether they felt like their questions were answered, 3) whether they felt the technology was a barrier to communication, and most importantly, was this visit at least equivalent if not better than a face-to-face visit? These are all areas where video visits can fail.

What would you say to people who want to build patient-centered telemedicine programs, but are stretched thin and don’t have the time to gather all this patient feedback?

If you want to be patient-centered, but don’t do the work to make it happen, it’s a wish, not a priority. There are ways to make the work easier. We just published findings from our first survey so other people can learn from what we found, and we’ll continue to publish more of our findings.

But nothing can replace talking to your patients.

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