Patient Engagement Through the Use of Information Technology
Ohio State University Medical Center created the OSUMyChart portal, which gives patients an online connection with their health care provider’s office, easing renewal of prescriptions and appointment scheduling. More than 21,000 patients use the system to read and compare test results, view their medical records, and communicate to the doctors and nurses from the convenience of their homes.
The portal has a feature called an e-visit that allows health care providers to use email to advise patients regarding minor symptoms. The system is also able to provide patient monitoring at home, as patients can upload results into the system. Online patient surveys also may be administered through the system.
“Patients responded very favorably to this, as did physicians. … Having patients engaged has always been important to me,” said Milisa Rizer, a family medicine physician and clinical director of EMR at Ohio State’s Medical Center.
Patients own their records and can take the information via a data format that’s transferable – allowing them to keep their health information available in the event that they need care while traveling, for example. The online collection of data also allows patients to provide some personal details – such as tobacco or alcohol use – without any embarrassment that some might feel in a face-to-face interview.
“It allows us to get much better data,” Rizer said.
Encouraging Patient Participation Through Social Media
Cleveland Clinic also uses MyChart, noted Kathryn Teng, director of the Center for Personalized Healthcare at the Cleveland Clinic. She described efforts to engage patients who are not already in the Clinic’s system.
Facebook is a good example of engagement, Teng says. It has a common theme: Users want to feel that they are special and unique, and want to share that with others. And it’s personalized. In health care, clinicians want to embrace that same concept by convincing patients that they are unique in their genetic makeup, environmental exposures and behaviors, and all that contributes to their health.
One strategy at the Clinic is linking personal uniqueness with family history and ancestry. Family history is the most accurate predictor for disease. “Knowing who we are genetically … helps us to make better choices when it is our turn to carry our family’s genes,” she said.
Statistics about social media use support the idea of using these tools to engage patients. The Clinic has an active social media strategy using Facebook, Twitter and YouTube videos. The Clinic prompts dialogue on Facebook about a health care topic and then directs patients back to Clinic websites for more information. Twitter is used to update live events and post daily health tips. The strategy seems to be paying off: Social media is ahead of word-of-mouth in generating brand awareness. Web visits, contacts and appointments are all up by about 25 percent.
The primary audience is patients rather than clinicians. When they are driven to the website, they might find Teng’s blog about personalized health care and what it can mean, or the main Personalized Healthcare site.
Employee Wellness – Ohio State’s Your Plan for Health Program
Gretchen Feldmann, benefits strategy & engagement manager in the Office of Human Resources at Ohio State, discussed how promoting health and wellness among faculty and staff is an important business strategy for the university.
The goals of Ohio State’s program, Your Plan For Health (YP4H), include: optimizing wellness and improving productivity among employees; maintaining and strengthening Ohio State’s “Employer of Choice” status by demonstrating culture of support; and reducing health care cost inflation – and allocating those savings to faculty and staff salaries and initiatives.
The university took a staggered approach; programs were rolled out gradually so “people could be comfortable with it, and could embrace it,” Feldmann said. Between 2006-09, the program was focused on three initiatives: faculty and staff engagement, health risks identification and management, and reducing barriers to obtaining health care. It’s now a comprehensive program offering multiple benefits and opportunities.
Risk stabilization or actual health improvement of continuously enrolled faculty and staff resulted in positive health change that represented approximately $3 million in avoided costs in 2008. Meanwhile, an 8 percent increase in health care costs between 2006 and 2010 can be attributed to an aging employee population, and the prevalence of chronic diseases in employees and dependents – making it critical to continue partnering across the medical center to implement P4 medicine and keep faculty and staff engaged in the way that works best for them.
“We’re able to … control our health care cost trend, and show our health plan utilization is being controlled,” she said.
YP4H 2.0, a second iteration of the program, represents the need “to take it to the next level,” Feldmann said. This program:
• Encourages making health/wellness social norm
• Focuses on engagement in a healthy lifestyle
• Approaches creation of a personalized model
• Educates faculty and staff about the relationship between health care costs and behavior
For 2012 and beyond, plans are to optimize plan design and funding, providing incentives that promote health and help associate member benefit costs with health choices; transforming health care delivery, allowing members participate in health-care decisions; and managing members’ care by reducing risk factors to optimize health and productivity.
Q: The patients you really need to reach the most are those who don’t have access to technology. How can they be engaged?
Teng: Patients with low socioeconomic backgrounds do tend to have powerful cell phones, if not more technology. We do need to go out to where people live and teach them about their health.
Rizer: My first question to patients is: Do you have computer access? Many say yes. But churches, libraries and other community resources offer that opportunity to patients. We need to know where we can identify opportunities for them.
Feldmann: Some employees do not have a computer at work. We go into colleges, departments and other units to schedule biometric health screenings, and have capabilities to complete health assessments at these events.
Q: As you increase number of patients that have MyChart, it seems that that would increase the time you spend following them. How much has that increased as a percentage of your time?
Rizer: It decreases my time spent on patient communication. Patients can get their labs easily, for example. My need to write a letter is now replaced by just a quick note that goes out in an electronic message. Electronic visits are things I would have had to answer on the phone, and this reduces the time I need to track down patients by phone. It has been much better for me from a time perspective.
Teng: People limit their comments when they communicate electronically, so it is much faster than talking on the phone.
Q: The amount of information on the EMR and the amount of email communication daily is a challenge. What other resources can we utilize? Most of these questions don’t need physician attention. When we launched a departmental Facebook page, I was enthusiastic to participate. But I didn’t want to be combining it with connections to old friends. What other resources do we need?
Teng: For social media activity, you need institutional resources dedicated to marketing communication, and specifically people who can advise the clinicians posting about the communication itself. Our Facebook is all at an institutional level and does not involve my personal account.
Feldmann: From a YP4H perspective, we implemented the biometric screenings to help with management of physician time. The results can be sent to a doctor and be done in lieu of an annual exam.
Rizer: Some emails can be routed to a pool of office staff who can do the first triage of messages to make sure those that require a physician’s input do go to physicians.
Q: How do we help patients find the right information from the right sources online?
Moderator Dave deBronkart: Patient communities are very good at suggesting reliable online sources.
Rizer: I think OSU should be out front in directing patients to sites that we think are meaningful and helpful.
Teng: Large hospital systems have a reputation in the community and patients trust what we’re telling them so we have to be careful about what we recommend. There must be a more systematic way to do this. In the medical community at large, that is very variable at this time.
Feldmann: Personalized action plans in YP4H will equip patients with how they can accomplish action items, including providing them with resources and information.