Last October, at the College of Healthcare Information Management Executives (CHIME) Fall CIO Forum, the Ann Arbor, Mich.-based CHIME conducted a roundtable discussion that broadly focused on patient engagement. Included in the discussion were several prominent healthcare IT figures: Tim Stettheimer, CIO, Ascension Health; Brennan Lehman, CIO, Heartland Health; Marc Probst, CIO, Intermountain Health; Tom Crawford, CIO, Jupiter Medical Center; Brad Carey, vice president and general manager, population health, Cerner; Frank Nydam, healthcare vice president and chief technology officer, VMware; and Jim Giordano, CEO, CareTech. Matthew Weinstock, director of communications and public relations at CHIME, served as the moderator of the roundtable discussion. Below are excerpts of the discussions, edited by Healthcare Informatics.
Weinstock: This roundtable is really to collect your ideas and thoughts on the topic we're going to be touching on, which is patient engagement, and all the things that go into patient engagement, from security to disease monitoring, all of those topics, and get a sense of how hospitals and health systems and vendors are working together to achieve better patient engagement and achieve better care.
The theme that we're looking at here is patient engagement and how hospitals, health systems and their vendor partners are working to achieve greater coordination and engagement with their patient populations. And, Marc, I kind of want to start with you on this topic. So, we have a lot of definitions of patient engagement. I know a few years ago Intermountain kind of replaced the idea of patient experience with the patient engagement. Tell me what that meant organizationally and especially from your role as CIO how you were involved in that conversation.
Probst: So, it really came down to the payment mechanisms that are coming out. I mean, that's certainly what started the thinking, and what we really needed to focus on. I mean, we still need to have a great experience for our patients, but the goal is to not have them there at all. If you're not going to do that, then you need to be able to engage them well before they show up, if they're at a clinic or at a hospital, or wherever else we might have an interaction with them. That's what really started the thinking of how do we better engage with the patients. We even redefined the term patient to mean anyone, a member, a family member, any of those people, because the engagement wasn't external to the facility itself. And we didn't like the word consumer, so we went in that direction.
From an information systems (IS) perspective, what it meant was how can we use technology to better create that engagement or help facilitate it—the portals, mobile, telehealth, even voice communication is much better coordinated. So building call centers and professional centers and that type of thing, so that's really the direction we went and how IS got involved.
Weinstock: And as Marc said, the definition of patient engagement is when they looked at them. I'm curious, for the rest of you, is that something you guys have struggled with internally? How do you define a patient, and then how do you define patient engagement?
Stettheimer: You know, we have had discussions now for years on this topic, some of it originating in the idea of patient centeredness, but then as you go deeper into that conversation and you realize that what we do is really not just about some acute incident in the patient's life, it is about the whole person, and you begin to expand your vision and the conversation. So, you know, we've gone back and forth. We've thought about the ideas, concepts of patients, customers; but we really laid it on a little bit with a few more words to describe this, which is, those we serve, because we realize it's not just the person who might be in a hospital bed or coming into a physician's office. It really is about them and their families. It's also about our providers, our clinicians who are interacting with them. And so this concept of service, and really it's about all of these people, makes its way into our vision of engagement.
Crawford: I’m with Jupiter Medical Center, a small community hospital in Florida, and half our population leaves, comes from, and goes back north. But we worked on an actual meaningful use, in terms of IT, it was a driver for us with the patient portal and getting those standards, and we were very active. This isn't high tech, but we brought in college kids to meet with the patients while they're in the beds in the hospital and actually showed them the portal, educated them on the portal, gave them a login, and actually when they left the organization, that same person called the patient back and said, hey, remember me, I'm Tom, and helped them log in.
So we got our meaningful use numbers up very quickly with the hands-on approach. But patient engagement in Jupiter really starts with the leadership team. We're all involved in community clubs and organizations. There's nine of us, and we are very active in the community, talking with patients, engaging in the community. It's a wealthy community, so they help us with our mission, which is very important.
On the technical site we're running McKesson right now, a very splintered platform. We don't have one medical record across the community. And our goal is to have one record across all of Jupiter, actually, with the independent doctors, hopefully, and with our small employed group of doctors. So we're looking at Cerner and Epic, and a few other vendors right now. We're going to make a decision. But our goal is to have everything in one place for the patient. The patient portals are kind of boring. You go out there and look at information, but make it an interactive portal, and that’s our goal too. And the technology's out there. You can load your FitBit and have your scales and your blood pressure, your glucose monitors, so the patient can actively participate in the care, and that's where we want to be in about two years is right there. So that's kind of it in a nutshell.
Lehman: Tom hits the nail on the head, and that’s the ability to actually provide a service that is wanted by the patient and not just, here's your medical record, here's your data, and then we wonder why no one is engaging with us. Well, it's because it's a one-way street right now. We're looking at the loyalty clients and some of those other wellness-type reward programs for ours as well. We're trying to really transform a warrant to a digital front door. How do we interact out in their homes versus come in and see us and we'll get you signed up.
Crawford: There is some action where we're looking at telehealth capabilities within that portal that they could talk to a speech therapist, maybe a physical therapist, avoid trips to the hospital, make it more convenient for the patient. Of course, physician interaction with PA interaction or nurse interaction, all at different fees, that's our goal, but we don't have the platform yet for it, because McKesson is going away. So we're a couple years away from this, but I think we can make it happen.
Stettheimer: And one of the challenges we have with this, it's a great, great aspiration I think most of us have is to deliver a service when and where needed. One of our challenges really, truly is still the restrictions that occur across state boundaries with our clinicians, because as a national health system what we struggle with—and even if you're a local health system, if one of your patients that you're providing care for is on vacation and they're out skiing or they're down at the beach, they are out of your community, out of your state, even when we're working with, you know, an in-your-pocket kind of access to your physician, the challenge is, what they do for you? Because you're all of a sudden across state lines. And so from a regulatory basis, the fact that the states have different criteria and licensing certification, this is something we're going to have to figure out, and we as a country have not figured this out yet.
Weinstock: So, let's stay on that a little bit and the idea of the mobility of the patient and the growth of mobile devices, and how you see that playing into patients being more engaged. Obviously, there are some of the hurdles you referenced, but how does that change the dynamic of how you interact, and what are you guys seeing in terms of the companies, the hospitals you're working with across the country, as they wrestle with these questions?
Nydam: Well, my comment to that would be, we've been so focused on building systems for the end-user, being IT, and for an X-use case, we see a lot of air time and energy helping hospitals try to figure out the deal and build for our new consumer. Not to overuse that idea, but building IT for the hospital is one thing in the use cases. Now we have a consumer that has a different, completely different expectation, completely different laws and regulations of their security. And an unsettling trend we're starting to see is healthcare IT starting to build a new silo for their consumer basic side of the IT versus the other side. And I think that's a debilitating trend to starting building new silos. I just don't think the technology and the law has really caught up and it just slows everything down.
Carey: They haven't caught up, the laws and the technology. And I do think, as I listen to the definitions that people gave as you defined, there were commonalities there. We think of it as people of a community and it gets to the point of, right, I may cross state lines, and it's also all of the members, it's not just the person who may need care. It's their families. It's who is influential in helping them stay healthy, because there's that whole element of just keeping the healthy people healthy.
And I would agree with Frank's comment. I think we at Cerner think there will be new ecosystems that will have to come up that facilitate, as I heard people say, it's anytime, anywhere, and it needs to be as real-time as possible so that you can actually take intelligence that the providers need and/or anyone else in the care team and make it actionable for them, make it actionable for the person. We've been engaging with people up at the White House and Congress a little bit. We do believe there needs to be new laws written around consent, around data so that you can truly get to data liquidity and make it truly available anywhere, any time.
And I think conceptually people, when we talk about this, they get it, it's the person's data that we've historically created, whether intentionally or unintentionally, a series of barriers that is making that very difficult to make a reality. But I do think it will evolve to that for all the obvious reasons. Many of us know out-of-control costs. There's a new expectation now, I want my data to be available. If I go on my skiing trip or go to the beach, I don't want to hear that this organization or this provider or this health navigator can't see the rest of my record or see what various plans of care that I'm on. So I do think we have barriers, but I think the industry will start moving at a different pace and we're starting to see signs out of that in some of what the government is recently announcing and starting to pass.
Stettheimer: And people's expectations are changing, too. I mean, we've always known that convenience has been growing as a determinate of where people seek care. You know, they want access, not just in physical locations, but also in the time of day, hours, and days of the week. But this idea of mobility, which you were hitting on, and the idea of anytime, anywhere is becoming rooted now in the minds of those we serve as something very significant in their determination of how they will seek care and who they will seek care with.
Nydam: The switching cost is so much higher for internal folks rather than a consumer. The switching cost for a consumer is quite low.
Probst: A lot of what we're talking about sounds like patient experience to me. You know, if I can go to the beach and get my record, that's an experience issue. I drive back to engagement, because I think we have some really interesting opportunities. And then are we building the technologies to absorb that and make it useful? So that, again, they're engaging in their healthcare. And when they're engaged in their healthcare, I'm facilitating that as an organization. They want to engage when they're sick. They're a little less excited about engaging when they're well.
Stettheimer: Please don't call me about my cholesterol when I've got a nice, big pizza or something sitting in front of me.
Giordano: Well, we are seeing that in the customers that we serve, that whole notion of experience that is being talked about in the broader context of a digital strategy. So from an experience perspective, seeing some marketing departments wanting to push information to a subset of payments that are the frequent flier, so to say, one of our hospitals that bifurcate the acute care experience, if you will, and the ambulatory experience. So, I mean, we take between seven and 10,000 patient calls a week. Now, with meaningful use with a patient portal, that's an entirely different call than a clinician call that said, how do I navigate around my Cerner record or whatever? So it's actually almost a window into the future of IT; it's anytime, anywhere, it's specialized information, it’s educational assistance, it's online scheduling, and I think it’s going to really push what we do.
