EXECUTIVE SUMMARY
As text messaging becomes more established in everyday routines by millions of users, healthcare organizations are embracing the technology as a powerful tool to allow patients to better manage their health. Two health provider networks, Kaiser Permanente and Riverside Health System, have launched successful pilots and plan to build on those initiatives.
In the midst of all the discussion surrounding healthcare reform, one topic that continues to surface is the rising cost of care for chronic conditions such as diabetes and heart disease. According to a report published by the Falls Church, Va.-based research firm CSC, spending for chronic disease management accounts for three quarters of the more than $2 trillion spent annually on healthcare in the U.S. And the problem looks to only worsen, as recent data show that 44 percent of Americans had at least one chronic condition in 2005.
With healthcare reform, we're going to be taking a closer look at keeping people out of hospitals and doctor's offices, and being more in control of their health.-Fran Turisco
The solution, many healthcare organizations are realizing, is to increase the role patients play in the care process. “This is going to be a huge priority going forward. Patients have to start taking their care into their own hands,” says Fran Turisco, principal researcher in CSC's Waltham, Mass.-based Emerging Practices division. “With healthcare reform, we're going to be taking a closer look at keeping people out of hospitals and doctor's offices, and being more in control of their health.”
And technology can potentially play a significant role in this new paradigm, both in supporting care-related tasks, and in allowing providers to monitor and communicate with patients without requiring face-to-face or telephone interaction, according to the CSC report, “Next Generation Patient Self-Care: The Role of Technology.” The most promising technology venue for self-management applications and services, it states, is the mobile phone-a technology that is already part of everyday life for most patients.
Some organizations have already begun using technology to send automated reminders and care recommendations to patients, which can both empower patients to better manage their health, and strengthen the relationship between patients and their providers.
KAISER'S SELF-CARE Pilot
One of those organizations is Kaiser Permanente, the massive Oakland, Calif.-based network that includes the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and their subsidiaries, and the Permanente Medical Groups. In 2009, as part of an ongoing commitment to engage patients in their own care, Kaiser launched a pilot in which appointment reminders were sent to a group of patients via short message service (SMS) text messaging. The project has been well received, and is being expanded in the northern California region, according to Phil Fasano, senior vice president and CIO. Patients can elect to get text reminders, if that is the most convenient mode of communication for them, or they can choose to receive notifications via phone calls or postcards. “It's all based on their preference and what's easiest for them,” Fasano says.
Attention to patients' preferences is critical, according to a report published by the Rockville, Md.-based Agency for Healthcare Research and Quality. It found that patients are less likely to use technology that does not fit seamlessly into their normal daily routines.
On the other hand, tools that already play a key role in patients' everyday lives tend to have higher success rates. According to Fasano, about 3 million of Kaiser's members regularly use the company's patient portal, http://Kp.org, to check lab results, send e-mails to physicians, and schedule visits. “We have a very successful Web presence,” says Fasano. “It's an intricate part of our system. It helps patients manage their health, and it's been very positively received.”
The organization plans to employ text messaging for more functions, such as notifying patients of lab results and providing information on maintaining a healthy lifestyle. It shouldn't be difficult, says Fasano, since all of Kaiser's systems, including the electronic medical record from Verona, Wis.-based Epic Systems, are tied to the organization's health information system, KP HealthConnect.
For Kaiser, an implementation that is relatively simple from an IT standpoint and can lead to improved outcomes is a no-brainer. “It's our belief that text messaging can be highly effective in helping support chronic care management of patients, so this was a natural step for us,” Fasano says. “We're a preventive care organization at our core, and we have systems that support those activities across our organization today.”
Fasano believes text messaging is the next channel that health systems need to exploit. “It creates a virtual environment that makes care more convenient, and can lead to better outcomes,” he says. He adds that as more organizations take steps to improve chronic care, the entire nation will benefit in ways that are obvious, like improved health and decreased cost of healthcare, and some that are not so obvious, like making care convenient and more satisfying for consumers.
RIVERSIDE'S SOLUTION
Riverside Health System, a Newport News, Va.-based network serving 13 counties across the eastern part of the state, has always been an early adopter of health IT. According to Senior Vice President and CIO John Stanley, the five-hospital system, which also includes a large group of multispecialty practices, has been live on electronic records since 1995.
When Riverside Medical Group wanted to increase the number of appointments being booked for follow-up and preventative care, Stanley and his team worked with Dallas-based Phytel to pilot a solution that sends automated messages to patients using an electronic registry.
Phytel's Proactive Patient Outreach was rolled out last fall to several practices within the medical group, which includes more than 350 physicians in 132 locations. The goal was simple-keep patients out of the emergency room. “The initiative was done from a continuity of care perspective to make sure patients come back in and see the physician, whether it's for a yearly follow-up or to have their blood pressure checked,” Stanley says. “We wanted to close the gaps, and we found that we can do a lot of prevention by just having follow-up care through the physician's office.”
The results of the pilot were very encouraging. According to Jim Foss, director of IS physician services at Riverside, patients who had an outstanding appointment were successfully contacted about 75 to 80 percent of the time using automated messaging, and of those, roughly 65 percent scheduled a check-up. Physician practices have experienced a solid boost in appointments, many of which were booked earlier than scheduled, he adds.
The data used to populate Proactive Patient Outreach is pulled from two different systems: Centricity EMR, which is live in Riverside's hospitals, and Centricity Practice Management (both from Barrington, Ill.-based GE Healthcare), which is installed throughout the medical group. “It's pulling from financial and clinical applications,” Foss says. “That's how we determine if patients have a routine physical coming up, or if they're diabetic. It goes against those protocols.”
A key factor in the success of an initiative like this is the ability to exchange patient information seamlessly throughout the health system, Stanley says. “Our EMR is set up to not be an episodic technology, but instead more of a lifetime health record. All of the labs and acute care episode data flow into the physician's office.” In fact, with just a few exceptions, all of Riverside's providers share one database, he notes. “And that information is very rich in helping us care for patients. It's one patient, one chart. So when a patient moves between different locations, we always have that complete view.”
However, when it comes to the continuity of care, what's just as important as enabling the flow of information between providers is engaging patients in their care, according to Stanley. To that end, Riverside plans to expand automated messaging to more practices, and is working with Phytel to send reminders via e-mail through its patient portal. (Patients can currently use Riverside's portal to e-mail physicians and request prescription refills.)
“This way, when they go to the portal, they can see if they are overdue for a follow-up visit or immunization,” he says. “As we continue to grow this and to show the return on investment, we can start to take a look at how it's really helping our patient communities. It's a great service for our patients, and it's the right thing for the patient, the provider, and the practice. It's a win-win.”
Healthcare Informatics 2010 August;27(8):21-23
