Shaping the Frontier Of Patient Engagement:

A CNO/CNIO Perspective

Mary Beth Mitchell, MSN, RN, BC, CPHIMSChief Nursing Informatics Officer, Texas Health Resources

Laura J. Wood, DNP, MS, RNSVP, Patient Care Services & Chief Nursing Officer, Boston Children’s

HospitalDISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Disclosure

Mary Beth Mitchell, MSN, RN, BC, CPHIMS

Laura J. Wood, DNP, MS, RN

Have no real or apparent conflicts of interest to report.

© 2014 HIMSS

Learning Objectives

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Shaping the Frontier Of Patient Engagement: A CNO/CNIO Perspective

This session will explore CNO and CNIO perspectives related to the evolution of patient engagement, how engagement and experience are distinct yet increasingly integrated to promote patient/family activation in their own care / health management, and the value of informatics principles to transform and improve health.

1. Describe the evolution of contemporary patient engagement frameworks; 

2. Identify key organizational strategic priorities for creating meaningful patient and family experiences;

3. Explore current and emerging technologies to impact patient experience across health care delivery models; and,

4. Outline core measures of success to lead rapidly changing patient expectations. 

Boston Children’s Hospital (BCH)

Care

Research

Teaching

Community

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Boston Children’s Hospital:Organizational profile

Founded 1869. Primary pediatric teaching hospital of Harvard Medical School.

World's largest pediatric research enterprise & leader in translational scientific innovation.

3 satellite locations, community health center, and 18 hospital and health center affiliations.

Broad and historic commitment to patient and family-centered partnerships and shared decision-making via advisory councils and participation from point of care to board room.

Active executive prioritization of quality & safety, innovative use of information technology, and patient / family experience and engagement.

CNIO, CMIO, and clinical informatics teams actively engage re: patient / family directed priorities.

2015 BCH StatisticsInpatient Beds = 396Admissions = 17,173Emergency Room Visits = 58,782Inpatient Surgical Cases = 7,037Outpatient Surgical Cases = 19,497

Hospital Photo: 1919

Complex care management demands: Quality, innovation & informatics

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Ranked #1 in 8 out of 10 pediatric specialties by US News & World Report: 2014 Honor Roll.

Leapfrog Group Quality and Safety Designation 2014 & prior.

Only Massachusetts HIMSS Analytics Level 7 designated hospital 2014 & prior.

Healthcare’s Most Wired designation 2014 & prior.

Nursing practice impacts patient & family engagement + outcomes

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American Association of Critical Care Nurses (AACN) Only hospital with 6 Beacon

Awards. Only pediatric or adult

hospital with 100% Beacon Awards in all ICU’s, including only NICU with Beacon designation.

Magnet designation / redesignation in recognition of exemplary professional nursing practice.

One of (8) 2012-15 recipients: Recognized for quality & innovation in Emergency Dept (ED) nursing.

Welcome to the value revolution:The Triple Aim meets patient engagement

IHI Triple Aim. Accessed March 4, 2015. https://images.search.yahoo.com/

The Patient Engagement (PE) Enigma:

The operational definition of patient or person-centered engagement continues to be widely debated in healthcare.

PE is increasingly conceptualized to include a composite of practices that impact key behaviors and health.

Commitment behaviors by the patient, provider / system, technology partner are all involved in an individual’s well being and increasingly include:

Understanding Communication Delivery Consumption Retention Compliance

Antekeirer, K. (2013). The Patient Engagement Enigma. Accessed March 4, 2015. http://engagingthepatient.com/2013/04/18/the-patient-engagement-enigma/

The Evolution of Contemporary PE Models: HIMSS Five Phases of Patient Engagement

http://www.himss.org/ResourceLibrary/genResourceDetailPDF.aspx?ItemNumber=28305

HIMSS Patient Engagement Framework

http://himss.files.cms-plus.com/HIMSSorg/NEHCLibrary/HIMSS_Foundation_Patient_Engagement_Framework.pdf

Regional Primary Care Coalition: Six Dimensions of Patient Engagement

Patient satisfaction: providers learn about patient and family experiences via surveys and feedback

Informed choice: clinicians share treatment plans and “allow” patients to guide planning

Shared decision-making: providers work with patients and families closely to better align options with preferences

Partnering with patients: patients & families and health systems jointly design the delivery of care

Ownership of health: patients & families have high health literacy and engage the health system as needed

Engagement in population health: patients and family members engage to improve health and healthcare

RPCC (2012). Accessed March 4, 2015. http://www.regionalprimarycare.org/assets/RPCC-Graphic-6-20-12.pdf

Vision for patient and family engagement:Eight strategies for change

Patient and family preparation

Clinician and leadership

preparation

Care and system redesign

Organizational partnership

Measurement and research

Transparency and accountability

Legislation & regulation

Partnership in policy

Gordon and Betty Moore Foundation. A roadmap for patient + family engagement in healthcare practice and research. Practical strategies for advancing engagement in healthcare – starting today. Accessed March 4, 2015 http://patientfamilyengagement.org/

Meaningful Use Phase 3: Identification of key engagement priorities

① Increase from 5 to 25% of patients reviewing,

downloading and transmitting their personal

data

② >35% of all patients seen by a provider or

discharged from the hospital will receive a

secure electronic message via the electronic

health record (EHR) or in response to a

secure message sent by the patient

③ >15% of patients to contribute to patient-

generated health data or data from a non-

clinical setting to integrate in the EHR. Connecting health and care for the nation. The office of the national coordinator for healthcare information technology (2015). 1-163. Accessed March 30, 2015. http://healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf

A medical note is a health care provider’s report of an office visit or hospital stay. These notes are part of the medical record. A note may have:

– a summary of what you (or others) told the clinician

– findings from a physical exam or lab, radiology, pathology or other test results

– an assessment or diagnosis of medical conditions or symptoms

– what kind of care was delivered

– the treatment plans and next steps

How do health care providers use medical notes?

A health care provider writes a note so other members of your health care team can stay up to date on your child’s condition and care plan.

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Reading health care provider’s notes strengthens communication with the care team and can help you keep families healthy. These notes can also help a family:

– fully understand their child’s condition

– make sure they are following the most current treatment plan

– remember to follow up on procedures, tests or appointments

– stay up to date with visits

– prepare for the next visit

– feel connected with doctors and nurses

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MyChildren’s

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Texas Health Resources

• 25 hospitals in North Texas– 14 wholly owned hospitals

• 133,903 Inpatient Visits• 1,238,392 Outpatient Encounters• 469,309 ED Visits• 89,452 Surgeries• 27,200 Deliveries

• 5,500 Active Physicians• 7,500 RN’s• 22,000 Employees

Doug Hawthorne – 2008

1st & 2nd place

Edward Marx

Nanda Lahoud – 2011Debbie Jowers – 2009

Semi Finalist

THAM, THD, THFW THP, & THSW

HIMSS EMRAM Stage 6 designation at all hospitals

THA, THAL, THAZ, THCTHD, THDN, THFW, THSH,

THS, THSW, THK

Top Technological Innovators across America for the 13th consecutive year

2008 Healthcare SIG Project of the Year

2013 Enterprise Award

InnovatorState Advocacy Award

John E. Gall Jr. CIO of the Year AwardEdward Marx

Edward Marx

Ranked 8Large Company

Ranked 18

14 of the past 15 years

Finalist

What is Patient Engagement? Why does it matter?

• Patient engagement is the process by which patients become invested in their own health.

• Health systems with effective patient engagement programs provide patients with the information and tools needed to take control of their care.

• From Meaningful Use to Value-Based Purchasing, patient engagement is a key feature of payment reform and is instrumental in readmissions reduction, HCAHPS, and patient loyalty.

• Engaged patients not only have better outcomes, but engaged patients are better business.

• Not only offer electronic access to patient health records, but also provide the resources patients need for the day-to-day management of disease.

• If patients are to take charge of their health, then health systems and plans must meet them where they are--and that would be their mobile devices.

Rohde, Joanne, 2014. The process by which patients become engaged in their own health. Executive Insight: Advance Healthcare Network. http://www.advanceweb.com/EBlasts/2014/10/NOINSERTION/6755Newsletter.htm

Patient-Centered Care

• Move to patient-centric healthcare

• Patient is at the center of his experience and controls the environment.

• Use of many tools to connect the patient to the healthcare arena

– Mobile apps

– Wearable devices

– Social media

– Portals- personal health record, HER

– Interoperability

– Internet Sites-

• Patient’s Like Me

• More Data exchange and availability of data in one location

• Tools to help patient’s manage their healthcare information

Dr. Charlotte Hovet, MD, Medical Director of Global Healthcare Solutions, Dell Services/Healthcare and Life Sciences. Dec. 2, 2014 from New Mandates, New Solutions: The Evolving Roles of the CMIO and Clinical Informatics Team- Slide 8-10

Patient Directed Care

• Patient-centered care,” “is all about the patient, but it often

doesn’t include the patient [and what he or she wants].”

Patient-directed care, Chase continued, “has them leading

and taking charge.”1

• The “Patient” will see you now.

• Patient information digitalized

• Connecting patients to their care-

allowing them to take ownership.

Mapping-transitions-from-patient-centric-to-patient-directed-care,664. http://newsletter.convergenceri.com/stories/

Mapping-transitions-from-patient-centric-to-patient-directed-care,664. http://newsletter.convergenceri.com/stories/

Benefits

• A Commonwealth Fund-supported study demonstrated that patients with the lowest engagement generated 21% more health costs.

• In another study, patients suffering from depression were given interactive engagement tools. These patients showed a 33% increase in antidepressant medication adherence, decreased overall depression scores, and a 61% increase in satisfaction.

Rohde, Joanne, 2014. The process by which patients become engaged in their own health. Executive Insight: Advance Healthcare Network. http://www.advanceweb.com/EBlasts/2014/10/NOINSERTION/6755Newsletter.htm

Gartner Hype Cycle

Gartner, 2014: http://www.gartner.com/newsroom/id/2819918

What do patients want?

• Patient Engagement is “the latest big thing”

• Google returned About 6,870,000 results for Patient Engagement.

• Keys areas of Pt. Engagement:

– EHR Access-Integration of data and systems

– Mobility

– Interactive- integration

– Efficiencies

So,How Do We Do This?

THR’s cHealth ArchitectureA consumer and provider engagement framework enabling

health and well-being anytime, anywhere.

Phases of Engagement Capabilities (Examples)Seek Information - Static information retrieval

-Physician, Facility, Condition, Medication, Procedure lookups

Access Care - Online Forms- Pre-registration, questionnaires- Social Media (e.g. "Yelp reviews")- Insurance quotes- Share PHI in advance- Scan documents (e.g. prescriptions)- Well-being assessments, wellness surveys

Receive Care - eCheck-in- eCare- eReferrals- eReminders (e.g. prescriptions)

Follow up Care - Patient Satisfaction Survey- Care Management, Care Transitions- Reminders, Compliance

Manage PersonalHealth & Wellness

- Wellness plan management- Virtual coaching- Ongoing monitoring, trend analytics/alerts- Aggregate 3rd party apps- Behavior-based push recommendations- Integrate family health records- Appointment reminders- Chronic care management- Social incentives

The cHealth Consumer

• cHealth services will be consumed across five phases of engagement.

• Each phase will need to be enabled via capabilities built into the cHealth framework.

• Each of the phases target one of two consumer audiences:

“Captive”, i.e. THR patients

People of North Texas

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Patient Engagement Use Cases

• Electronic Health Record

• Remote patient monitoring

• NICU videoconference• Patient education

• Mobile Apps• Interoperability- wearable devices

• Gamification• Internet Health Sites

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OtherTHR

Access to Medical Record and Portals

• Patients want and need tools that help them communicate and collaborate with their providers

• Shared medical records helps provide availability of information.

• Portals help because “They’re important because they allow patients to take charge and do the things they should be doing on their own like scheduling appointments and receiving notifications and reminders for those appointments and medications.”

Walsh, Beth (2014) Help Patients be More Engaged. Nancy Finn Quote. Clinical Innovation Plus Technology: http://www.clinical-innovation.com/topics/clinical-practice/help-patients-be-more-engaged-collaborative

Patient Portal

• Patient’s access to their record- inpatient and outpatient

• Messaging

• Online ability to make appointments, pay bills and ask questions to providers

• Integrated patient information-patient entered data- Assessments, History

• Open Notes

• Genomics- Future

Remote Patient Access & Monitoring

• Video Visits

• Telemedicine

• Peek-A-Boo https://www.youtube.com/watch?v=6XQcgx75BRw

Patient Education

• Interactive

• Pre-Admit- Auto assigned based on procedures scheduled

• Inpatient- Ordered by the RN through the EHR

• Ambulatory- Ordered by staff to be viewed at home.

© 2013 Emmi Solutions, LLC. Atrial Fibrillation program

Mobile Apps

• Mobile Apps- Mayo Mobile App

• https://www.youtube.com/watch?v=AqfNsFNud-Q Pt. Engagement Data

Used by Permission: Jason Fratzke, CNIO, Mayo Clinic. 2015.

Used with permission: Jason Fratzke, CNIO, Mayo Clinic. 2015.

Wearable Devices• Internet of Things- 20-30 Billion Things Connected to the Internet by 2030

• Apps- Healthcare Apps

• Integration with EHR

Dr. Charlotte Hovet, MD, Medical Director of Global Healthcare Solutions, Dell Services/Healthcare and Life Sciences. Dec. 2, 2014 from New Mandates, New Solutions: The Evolving Roles of the CMIO and Clinical Informatics Team- Slide 8-10

Gamification: The Avatar Will See You Now

Medical centers are testing new, friendly ways to reduce the need for office visits by extending their reach into patients’ homes.

Receiving remote medical care is becoming more common as technologies improve and health records get digitized. Sense.ly, the California startup running the trial, is one of more than 500 companies using health-care tools from Nuance, a company that develops speech-recognition and virtual-assistant software. “Our goal is basically to capture the patient’s state of mind and body,” says Ivana Schnur, cofounder of Sense.ly and a clinical psychologist who has spent years developing virtual-reality tools in medicine and mental health.

Lieber, Jessica. (2013). The Avatar Will See You Now. Business News, June 10, 2013. http://www.technologyreview.com/news/514881/the-avatar-will-see-you-now/

Websites

• Patient’s Like Me • Caring Bridge• My Lifeline.org• Healing well.com

Patients engage through access to websites for health information from other consumers.

Challenges with patient engagement-related technology

• Adoption- by patients

• Disparate systems- not a single unified experience

• Language concerns

• Nursing Challenges

– Increased workload

– Patient identification- correct patient access

– Confusion/Lack of knowledge about the portal content and functionality.

Value on Investment (VOI): Successful Patient Engagement

Used with permission Kaycee Roberson, Director of cHealth, Texas Health Resources. 2015.

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- Thank you -

Mary Beth Mitchell, MSN, RN-BC, CPHIMSChief Nursing Informatics Officer

Texas Health Resources MaryBethMitchell@texashealth.org

Laura J. Wood, DNP, MS, RNSenior Vice President, Patient Care Services & CNO

Sporing Carpenter Chair for NursingRWJ Foundation Executive Nurse Fellow

Boston Children’s Hospitallaura.wood@childrens.harvard.edu