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EMRs Can Enhance Patient Engagement

The following is a guest post by Scott Zimmerman, President of TeleVox Software, Inc, whose bio appears below.

It’s well known that when EMRs are partnered with patient engagement technology, physicians can communicate more effectively and tailor their treatment plans to meet the needs of their patients.  For example, a patient who has diabetes can receive communications about monitoring blood sugar, while a patient who has high blood pressure can get daily reminders to exercise and take their medication.  This type of engagement can be highly beneficial, as TeleVox Healthy World research found that 83 percent of people across the nation admit they don’t follow treatment plans exactly as prescribed.

Though the use of EMRs is still debated among medical professionals, research has suggested that by transcending the in-office visit using digital technology to communicate with patients on a more regular basis, doctors may finally begin to achieve the amount of communication their patients desire.  It has been estimated that three in ten U.S. consumers would trust their provider more if they received text messages, voicemails or emails that provide patient care between visits.  Of the 66 percent of Americans who have received a voicemail, text or email from a healthcare provider, many report a variety of positive outcomes:

Fifty-one percent reported feeling more valued as a patient.
Thirty-five percent said digital communication improved their opinion of their provider.
Thirty-four percent reported feeling more certain about visiting that healthcare provider again.

When asked about how they felt about office visits in a virtual setting, an astounding 85 percent of patients in a study responded that communications such as email, text messages and voicemails are as helpful, if not even more helpful, than in-person or phone conversations with their healthcare provider.  And when it comes to patients giving consistent full disclosure when communicating digitally, TeleVox’s research showed the following:

Thirty-four percent of U.S. consumers said they would be more honest when talking about their medical needs through an automated call, email or text message than in person with a healthcare provider.
Twenty-eight percent said they would talk more frankly about nutritional habits.
Twenty-seven percent said they would be more open to discussing their fitness regimen.
Eighteen percent said they would talk more freely about their bad habits or personal vices through digital communication rather than in-person visits.

When healthcare providers link EMRs with notifications technology, engaging patients between visits becomes as easy as writing a prescription.  Physicians can use both to create and nurture that personal, human touch during the treatment process.

Scott Zimmerman is a regularly-published thought leader on engaging patients via ongoing communication between office visits. He is the President of TeleVox Software, Inc, a high-tech Engagement Communications company that provides automated voice, email, SMS and web solutions that activate positive patient behaviors by applying technology to deliver a human touch. Scott spearheads TeleVox’s Healthy World initiative, a program that leverages ethnographic research to uncover, understand and interpret both patient and provider points of view with the end goal of creating a healthy world–one person at a time. Zimmerman possesses 20 years of proven performance in the healthcare industry, with domain knowledge in the surgical, interventional and pharmaceutical arenas. Prior to joining TeleVox, Scott served for nine years at GE Healthcare in a variety of cross-functional and global leadership roles in sales, services, quality, marketing, pricing, finance and product development. Scott is a graduate of the John M. Olin School of Business at Washington University in St. Louis.
June 28, 2013 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Patient Engagement: Who are the Real Targets?

As I further considered the ideas generated by the breakfast panel I had the opportunity to participate in recently, Doctors and Patients: Bridging the Digital Divide, I was reminded of a stimulating comment made by Nikolai Kirienko, a patient advocate with Crohn’s disease. He stated that we need to use the current technology to reach patients who need it most.

But who are these patients, really?

Are they the well and well-to-do, middle to upper-class population who are internet-savvy, highly educated, and compliant with following the plans suggested by the healthcare provider?

Are they the patient struggling with chronic illnesses, the symptoms of which may tend to wax and wane on a daily basis, making their issues a daily struggle?

Are they the poverty-stricken residents of typically lower class neighborhoods in metropolitan areas, who may have more limited access to digital technology?

From my personal experience in a downtown metropolitan area, namely Washington, DC, I can tell you that most of the patients who are engaged in seeking out new information regarding their health conditions tend to be highly educated, middle to upper-class patients with excellent access to digital technology.

But I have to come back to the initial comment in question, which begs the question of who should we really be targeting?  Who can really take the most advantage to gain from the digital healthcare revolution?

I could take the Pollyanna-esque view that everyone should be able to take advantage of everything equally and we should all just get along and be happy.  However, real-world experience tells me that there may be a different answer this question.  There are also limited resources for healthcare outreach campaigns.  Therefore, it would seem appropriate to do more research into the area to really define who the best targets are for the maximum benefits. It certainly seems like a valuable question to answer and one that’s worth going after.  What do you think?

September 24, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Patient engagement in the digital era

In the not-so-old days of medicine, patient engagement used to involve things like looking the patient in the eye when speaking to them, facing the patient, asking them how they felt, and asking them if they had any other questions before ending the visit. These so-called rules of engagement have now been augmented by the computer in between the patient and the provider.

No longer are the former etiquette protocols sufficient for interacting in the digital era. Now, patient engagement includes Internet searches using “Dr. Google” for what in my opinion are typically anxiety-fueled questions that are frequently unnecessary and irrelevant and would not have been asked prior to the arrival of Internet searches.

However, the internet isn’t going anywhere anytime soon, and so providers have to be able to deal with this new level of interaction. Fortunately, not all patient engagement is so maladaptive.

Patient engagement is a funny thing though. It seems to be confused by doctors, staff and patients. Some people think patient engagement involves E-medicine, or rather electronic visits over secure messaging systems. I laughed the other day when I viewed a YouTube video showing a woman talking about a third party for-profit software vendor company using their technology to allow patients to pay bills online and therefore be more” engaged”. Right. That’s twistier than Presidential campaign rhetoric.

Another speaker put it well when he said that “reality struggles to keep up with the rhetoric” when he was commenting on the difficulty in defining patient engagement, yet everyone wants to use the jargon liberally.

I prefer to think of patient engagement in the digital era as being positive in several respects. I expect the patients to take an active role in their healthcare, in gaining knowledge about their disease, and in gaining knowledge about health prevention and treating ongoing illness issues. In doing so, the patient becomes empowered to take an active role in the decision-making process during the testing and treatment phases of care. This is not to say the patient should get to consult Dr. Google and then dictate what tests are being done on them regardless of what the ordering provider thinks is appropriate. I think the most ethical and appropriate response to such requests are to, first, consider them seriously; second, discuss with the patient which tests are medically indicated and which tests are medically unnecessary; and finally, to stand one’s ground in either writing or not writing for any medically unnecessary tests to be ordered.

I also completely agree with the definition of patient engagement as defined by the Society for Participatory Medicine. It says that patient engagement is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.

In order to get patients more engaged in participating in their healthcare, I think we need to make it fun, make it interesting, and communicate using means where the patient actually is, on multiple levels of “is”. In the case of the digitally connected patient, we should be considering communicating using the Internet, smartphones, and mobile devices such as iPads. We need to be able to make this communication valuable to the patient so that they, in turn, want more of it, and so that the movement grows.

September 17, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

EMRs’ big gaping hole of secure messaging

Today’s post begins a series inspired by my recent participation in a breakfast panel in Washington, DC, Doctors and Patients Bridging the Digital Divide. There were a lot of useful ideas discussed during this panel, and so I decided to capture and share some with you.

One of the biggest holes in electronic medical records currently seems to be a lack of secure messaging systems built into the software.  Although maybe not universally true, this still represents a huge problem that also represents a great opportunity for gains in technology that will enhance the doctor-patient relationship and move digital healthcare forward into the future.

Currently, my electronic medical record vendor does not supply this feature as part of its software package.  However, as part of the Meaningful Use Stage 2 requirements by the federal government, the use of a certified EMR system that supports this function will be required.  A HIPAA-compliant secure messaging system will be needed as a part of every electronic medical record going forward.

Currently, if I wanted to use secure messaging to communicate with my patients, I would have to purchase a separate third-party vendor’s online software to communicate in a HIPAA-compliant fashion.  This involves an additional service agreement between the third-party and me, as well as monthly fees they can be expensive.  This would grant me the right to not only communicate with patients but also to bill third-party insurance companies for providing such electronic health services.  However, what may people do not appreciate is the small reimbursement allowance for such services, which is quite minimal.  Thus, regardless of the demand by patients, it’s currently more financially lucrative simply to see another patient in the office for a follow-up visit rather than answer a message electronically.  If an electronic medical record vendor builds secure patient messaging into their platform, when there is already a contractual arrangement between the doctor and EMR vendor, then a third-party cost would potentially become unnecessary.  The prospect of using a built-in, HIPAA-compliant, secure messaging system suddenly becomes much more attractive and potentially fiscally responsible.

Unfortunately, many EMR systems are in still developing stages at which they do not yet have built-in secure messaging features in their PHR or personal health record modules.

But what a wonderful and potentially powerful area for future development in order to further promote patients to become more engaged in playing a more active role in their own health care.  The ability of a patient to reach their doctor through the Internet is certainly an attractive feature if done right and seems potentially better than a patient spending five minutes on hold listening to elevator music only to finally speak to a front desk staff member who will only be able to forward a message, which may or may not be forwarded accurately.

September 12, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.