Many health systems have found that a silver lining of the terrible pandemic is that it has allowed them to make considerable progress on digital transformation in one year.
Indianapolis-based Community Health Network, which has five hospitals in central Indiana, has been able to make a concerted effort to extend its deployment of patient engagement tools enterprise-wide, said Patrick McGill, M.D., a family medicine physician who serves as executive vice president and chief analytics officer.
“The pandemic accelerated the work we needed to do. In the spring, as staff were redeployed or shifted to other locations of care or need, a lot of the manual work that was going on around things like appointment reminders and calling people after they had COVID was ripe for automation,” he explained. “That was where we decided to expand our partnership with CipherHealth and make it enterprise-wide so we can automate and expand some of those digital offerings. The CipherHealth solutions deployed include nurse leader rounding, appointment reminders and a post-discharge call when a patient leaves the hospital.
McGill said that Community Health has always been a technology leader. “Perhaps we have not been an innovator but definitely a fast follower,” he said, “but we are hoping the partnership with Cipher will allow us to do some innovation on both sides and leverage both our strengths to do some co-development work.”
Among the things they will work on is a deep integration with Epic around appointment reminders and rescheduling. “The integration we have is now is your typical HL7 interface,” he said. “By early in 2021 we hope to have a beta version of a deeper type of API integration with Cipher into Epic to allow us to surface this information at the right point in the work flow,” McGill said. “We are starting with appointment reminders so that patients can cancel and reschedule right from their phone via the text functionality through an API and we can move into other functionality after that.”
Another upcoming use case for the patient engagement platform is that every state is handling the COVID vaccine differently. In Indiana, you have to register through a state portal, so Community Health has people coming in to get vaccinated but who are not necessarily patients of theirs but who they want to follow up with. “We are going to leverage this platform to do a post-vaccination contact two days afterwards to make sure they are doing OK and not having side effects.”
Telehealth and remote patient monitoring is another area where Community Health hopes to innovate. “Remote patient monitoring is an area where quite frankly Community Health is falling a little bit short and we want to leverage this partnership to innovate in that space.”
Because his title is chief analytics officer, I asked McGill if their analytics work informs their patient engagement strategy. “I have that title, and we have a unique structure at Community. I oversee all our data and analytics, and all our IT and informatics and business process management as well. Our CIO actually reports to me,” he explained. “It is kind of an unusual structure and we mean it when we say we are a data-driven organization. The chief analytics officer position happens to be a physician and I report to the CEO.”
So the patient engagement work is very data-driven, he said. “We have been a long-time partner of Health Catalyst. We had a conversation yesterday between Cipher and Health Catalyst. When we are developing analytics around readmissions or bringing in social determinants data, we think about how we can leverage the analytics platform to deliver the last mile to the patient, and Cipher with that patient engagement.”
“The message I was giving in this three-way conversation was that we often talk about the last mile, but often we try and fit the patients into the same journey in that last mile vs. a patient-centric approach of that journey, meaning every patient wants to be engaged a little differently,” McGill said. “If we have only one solution to engage with patients — for example, an EMR portal, that doesn’t feel very patient-centric to some people and in a lot of ways it drives disengagement. So what we are trying to do is leverage the analytics platform through patient feedback, patient journey mapping and other things to partner with Cipher to deliver that last mile in a patient-centric, customizable way.”
That includes texting, automated phone calls and chat is on the roadmap as well, he said. “People now have an expectation of how they want to interact with companies that they work with. Healthcare is lagging behind,” McGill said. “What we are trying to do is bring that experience they get outside of healthcare into healthcare. For some reason, people have an expectation that that is not how healthcare is going to function and we disagree with that.”
One goal is to unify the patient experience across care settings in the organization. “Our north star is that we create seamless patient journeys that are digitally powered. I am a family care doctor. Historically you have a relationship with your primary care doctor. Then when you interact with other parts of the health system, it is very transactional,” McGill said. “You go to the ER or get a CT scan or get a test. What we are trying to create is that relationship across the spectrum where it doesn’t matter if it involves going to primary care or for a test or inpatient, you know me, respect me, and deliver the services to the level I desire and with my desires at the center. Other industries do this very well. A bank doesn’t say you are a checking account customer or a credit card customer with two different experiences. They are the same experience across the board. That is what we aim to do.”
I asked McGill whether it was a challenge to measure the impact of patient engagement efforts. “When you are talking about how it is changing the patient experience, it is hard to get very granular about a manual process being converted to a digital process, and how that impacts patient experience,” he said. “This year we are switching patient experience measurement vendors to Qualtrix because we want that full patient journey at every touchpoint, whether it is the clinically driven touchpoint or an interaction with our website or paying a bill. We want to be able to measure the 360-degree view of the patient but also the caregiver. We don't want to launch initiatives that burn out caregivers even more than they are already burned out from dealing with COVID.”
Other types of automation have taken the load off staff during the pandemic. “When we reopened our ambulatory clinics, we needed to screen people for COVID symptoms before they could come in for a routine visit,” McGill explained. “That was a 100 percent manual process. We had front desk staff calling patients and if they didn't answer they had to call back. We converted all of that to an automated process where the patient received a text and could respond. For patients who didn’t get a text or didn't respond, that required a call, but the call volume went from thousands a day down to just a few a day to check on those patients who fell through the cracks.”
Could the changes they have made for COVID be long-lasting? “Changes we have made in 2020 accelerated things we should have been doing all along,” McGill said. Some will persist, he said. “Removing the waiting room and allowing people to come in right when their appointment is, I think will stick.” Once the vaccine is widespread, they won’t have to do the COVID screenings. “But we might pivot that tool to do other types of screenings, such as for social determinants or mental health screenings, so patients are not answering a bunch of questions when they come into the office. The technology is there to pivot to do anything we want to do.”
