"Nobody goes home at 6 p.m. and says, 'Let me log onto this amazing portal!'"
When Raj Toleti, senior vice president and general manager of patient engagement for Allscripts, said this to a room of 20 hospital and health system executives, not one disagreed.
Instead, most knowingly laughed. It's widely accepted that the patient portal has not moved the needle on patient engagement as much as the healthcare community once hoped. Now the industry confronts a greater question: What technology will?
Gathered at an executive roundtable as part of the Becker's Hospital Review 2nd Health IT + Clinical Leadership + Pharmacy 2019 in Chicago in May, Mr. Toleti led a discussion with participants about the importance of patient engagement, roadblocks to lasting patient engagement, and a new mobile solution that helps care teams meet patients where they are.
During the roundtable, Allscripts leveraged mobile polling to pose questions to executive participants and gain their insights in real time. Here are a few of the points raised during the roundtable, with summarized responses and excerpts of conversations that followed:
1. All participants indicated patient engagement is among the top three strategic objectives for their organizations. They also noted that their hospitals and health systems see engaged patients as a critical link to improved health outcomes, patient satisfaction and loyalty, patient adherence and revenue.
But as the conversation progressed, an interesting finding emerged: There is a gap between the high priority patient engagement holds among healthcare leadership and the results they will tolerate from existing patient engagement technologies. Although patient engagement is a C-level initiative with ties to the most fundamental missions of any hospital or health system, hospital and health system executives see portal engagement rates in the teens as acceptable.
Why the disconnect between such a high-minded goal and such paltry results?
"Our strategy is to think and act digitally for everything from the payer experience to the ambulatory side to office visits," said the director of quality, safety and experience for a 1,120-bed health system in the Midwest. "We have our own patient portal and quite a bit of engagement in our community – probably about 15 percent."
That low level of participation is not unique to this Midwestern health system. Of the patients who had access to a patient portal in 2018, fewer than one-third of patients accessed it once or twice in a year, according to findings released by the Office of the National Coordinator. Those who did not engage with the portal said they wanted to speak with providers in person, did not perceive a need to view their medical records, were concerned about privacy or could not access the portal website, among other detractors.
Most executive roundtable participants believe patients need to be self-motivated to engage with patient engagement technology. Other major hindrances to using this technology include complex portal logins, or content and capabilities that patients find impersonal or irrelevant, according to roundtable participants.
"We see patient engagement as necessary, but we don't use technology to our benefit to do it," said the executive director of geriatric services and quality assurance for a 30-bed hospital in the Midwest. "We're at a crux, because we need to improve patient satisfaction scores and no-show rates, but we don't invest enough or employ the right people to get those technologies out and about."
2. Beyond the portal, adoption of patient engagement technology is limited. The patient portal is but one of the five pillars of patient engagement, said. Mr. Toleti, the others being customer relationship management, patient outreach, care transitions and wearables, and patient education and satisfaction. Health systems' maturity varies for these four pillars beyond patient portals: Although 75 percent of executive roundtable participants said their organizations have online scheduling capabilities, markedly fewer have CRM capabilities.
As health systems look to move beyond the portal, they will encounter an entire ecosystem of apps and solutions designed for specific points throughout patient journey – before the patient enters the healthcare setting for wellness and preventive care, during treatment, after care and post-recovery.
If health systems bolt on a garden variety of patient engagement tech, they are likely to be left with a smorgasbord of tools that fail to create a cohesive, complete experience for patients. This leaves patients with more usernames, passwords, logins, websites and work to do, which naturally curbs their self-motivation to use the technology.
"The patient is actually dealing with six or seven systems within your organization," Mr. Toleti said. "How do you create an experience where the patient is activated and checked in on their phone, and when they leave the clinic, they receive a text with the care summary and a link? Think about one system in the middle doing all these things without patients having to do it themselves. That happens today — look at airlines or banking apps. Imagine if you had an app for your savings account and another app for your checking account. That's what we have in healthcare. How many times have you gone inside a bank in the past year? Twice. Ten years ago, how many times would you go in? All the time."
Furthermore, patients are consumers, and consumers today expect things in real-time. Receiving a patient survey in the mail two weeks after a hospital stay is a far cry from the experience consumers face for life's lesser events, such as a dinner or haircut. Patient engagement technology is a serious investment for hospitals and health systems, and it should at least enable real-time communication for these organizations to remain neck-and-neck with what patients are accustomed to experiencing in salons and restaurants.
3. Look past the portal – real-time, intuitive and painless solutions are available. Allscripts launched FollowMyHealth®, built on the Microsoft Azure cloud platform, to close the gap between the apps and solutions in healthcare that operate in isolation. Described as an enterprise patient engagement solution and universal health record, FollowMyHealth is used by hundreds of healthcare organizations and thousands of physicians across the U.S. to add another layer of patient outreach and access beyond the portal.
The solution allows hospitals to text links to patients to complete care tasks and access information on the web. Patient, provider and/or healthcare organization can connect with one another as long as they are participants in FollowMyHealth. "There's no log-in. You don't have to download anything. You can just text the patient and are able to engage them anywhere in the experience," said Mr. Toleti.
Patients can access their medical records through FollowMyHealth via their mobile devices at any time in any place with an internet connection. Healthcare organizations program the settings on FollowMyHealth, enabling functions like patient-physician messaging, requests for prescription refills, scheduling, appointment modification and bill payment. So far, FollowMyHealth has seen utilization rates between 70 and 90 percent, according to Mr. Toleti, a marked difference from portal engagement rates in the mid-teens to 20s.
Most organizations measure the return on investment of their patient engagement efforts through the achievement of meaningful use and related bonuses, according to executives at the Becker's-Allscripts roundtable. To support organizations' meaningful use attestations, FollowMyHealth includes a widget called KnowMyHealth. Available for all patients with an FollowMyHealth account, KnowMyHealth was created to address the patient education requirement for meaningful use that must be available for patient problems, medications and lab results.
And finally: It's not complicated. The "clunkiness" that hospital and health system leaders recalled about their patient portals is nowhere to be found in FollowMyHealth, as most patients are already accustomed to texting and the use of web links. The solution was also designed to be nonabrasive for providers' workflows.
"We strongly believe we have to communicate with patients in real time, and this technology implementation is not hard – it's far easier than implementing a patient portal," said Mr. Toleti.
Key points in summary:
- Most healthcare professionals agree patient engagement is important, but few organizations have a technology-backed strategy for patient engagement involving more than the portal.
- All roundtable participants indicated patient engagement is among the top three strategic objectives for their organizations, noting their hospitals and health systems see engaged patients as a critical link to improved health outcomes, patient satisfaction and loyalty, patient adherence and revenue.
- Most executive roundtable participants believe patients need to be self-motivated to engage with patient engagement technology.
- Hundreds of healthcare organizations and thousands of physicians across the country use tools like FollowMyHealth because it adds another layer of engagement and access beyond the portal, but in an intuitive, seamless, text message-driven and real-time way that supports the self-motivation care teams see as critical to long-term patient use of care technology.
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