three perspectives of patient engagement: a national...
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Three Perspectives of Patient Engagement: A National Study Collaboration between HIMSS Analytics, WebMD, Medscape & M-Consulting LLC Authors: Pat Wise, HIMSS, Lorren Pettit, HIMSS, Christina Hoffman, Medscape Education/WebMD, Mazi Rasulnia, M Consulting Study was partially supported by Genentech
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Learning Objectives List your 3-5 session learning objectives that have been approved by HIMSS.
1. Describe system/physician/patient views on patient engagement.
2. Identify barriers to patient engagement. 3. Discuss the differences in perceptions of patient
engagement between the patient, provider and organizational perspective.
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Source: All data collected between July-August, 2014
3
HIMSS
Medscape
WebMD
Target
Chief Information Officers (CIOs) of hospitals
Primary care physicians (PCPs)
Patients having visited their doctor within the past 90 days
National Sample
125
359
2,567
Survey
Attitudes, Practices, Beliefs on Patient Engagement (PE)
Attitudes, Roles, Practices, and PE Expectations
Expectations and values about engaging with their Health Care Provider (HCP)
Study Design
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• Different barriers for different audiences CIOs – Attitudes and
expectations of Providers and Patients
Providers – Time demands and
training Patients – Provider’s time
• Disagreement around who “owns” PE CIOs – CIOs, since PE
requires technology Providers – Patients need to take
more responsibility for their care/outcomes
Patients – Providers need to be
willing to spend more time with them
4
• Mis-alignment around what PE means Hi-Tech – For CIOs, PE is about
technology and driven by MU
Hi-Touch – For Providers and
Patients, PE is about relationships
Patient Engagement (PE) is generally viewed positively by all stakeholders… but notable differences exist
Summary of Findings
Definition Ownership Barriers
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System Perspective
HIMSS
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Conflict of Interest Lorren Pettit, MS, MBA Vice President, Market Research HIMSS Analytics Has no real or apparent conflicts of interest to report.
© HIMSS 2015
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A win for patients…
CIO/CMIO’s view of the impact Meaningful Use patient engagement activities could have on their organization
3.24 3.70
3.88 4.01
4.50 4.60 4.72
4.89 5.03 5.05 5.21
5.54 5.62
1.00 2.00 3.00 4.00 5.00 6.00 7.00
Increase physician satisfactionImprove financial results
Increase nursing staff satisfactionImprove operational efficiencies
Improve Evidence Based Medicine protocolsReduce the incidence of preventable health concerns
Increase treatment/clinical efficienciesImprove the quality of care delivered
Improve data recordingImprove patient safety
Increase patient satisfactionImprove patient education efforts
Improve data sharing
strongly disagree strongly agree
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…but a potentially harder “sell” to clinicians
CIO/CMIO’s view of the impact Meaningful Use patient engagement activities could have on their organization
3.24 3.70
3.88 4.01
4.50 4.60 4.72
4.89 5.03 5.05 5.21
5.54 5.62
1.00 2.00 3.00 4.00 5.00 6.00 7.00
Increase physician satisfactionImprove financial results
Increase nursing staff satisfactionImprove operational efficiencies
Improve Evidence Based Medicine protocolsReduce the incidence of preventable health concerns
Increase treatment/clinical efficienciesImprove the quality of care delivered
Improve data recordingImprove patient safety
Increase patient satisfactionImprove patient education efforts
Improve data sharing
strongly disagree strongly agree
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www.himss.org/ResourceLibrary/ValueSuite.aspx#/steps-app
The HIMSS Health IT Value Suite
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CIO/CMIO’s view of the impact Meaningful Use patient engagement activities could have on their organization
Measure with least agreement
Measure with most agreement
Overall Category Mean
Satisfaction Physician satisfaction (6.4%)
Patient satisfaction (48.0%) 4.11
Treatment/Clinical Clinical Efficiency (37.6%)
Patient Safety (43.2%) 4.89
Electronic Information/Data
EBM Protocols (30.4%)
Data Sharing (63.2%) 5.05
Prevention/Patient Education
Preventable Concerns (24.0%)
Patient Education (61.6%) 5.07
Savings Financial results (12.0%)
Operational efficiency (20.8%)
3.85
S
T
E
P
S
Those indicating a 6 or 7 on a 7 point scale
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Patient Engagement is not so much an “access” issue,…
Challenges to overcome in a Patient/Consumer Engagement effort
4.46
4.89
5.22
5.77
5.89
1.00 2.00 3.00 4.00 5.00 6.00 7.00
ACCESS - Giving consumers and patients electronicaccess to their health information
ACTION - Developing tools and services that helpclinicians take action using their patient's health
information
ACTION - Developing tools and services that helpconsumers and patients take action using their health
information
ATTITUDE - Shifting attitudes and expectationsregarding consumer and patient roles
ATTITUDE - Shifting attitudes and expectationsregarding clinician's roles
not at all challenging very challenging
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… indeed hospital’s are embracing patient portals,…
Challenges to overcome in a Patient/Consumer Engagement effort
38.0% 45.0%
50.7% 54.8% 62.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2010 2011 2012 2013 2014year
Percent of U.S. Hospital with Patient Portal – HIMSS Analytics Database
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…as it is a “culture” issue
Challenges to overcome in a Patient/Consumer Engagement effort
4.46
4.89
5.22
5.77
5.89
1.00 2.00 3.00 4.00 5.00 6.00 7.00
ACCESS - Giving consumers and patients electronicaccess to their health information
ACTION - Developing tools and services that helpclinicians take action using their patient's health
information
ACTION - Developing tools and services that helpconsumers and patients take action using their health
information
ATTITUDE - Shifting attitudes and expectationsregarding consumer and patient roles
ATTITUDE - Shifting attitudes and expectationsregarding clinician's roles
not at all challenging very challenging
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CIO/CMIOs believe they drive their hospital’s Patient Engagement efforts…
Who’s Most Accountable for Patient Engagement efforts in your organization?
16.0%
1.6%
1.6%
6.4%
13.6%
14.4%
46.4%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0%
Other
Physician Affairs
Finance/Business Office
Quality Assurance
Marketing
Nursing
Information Technology
Percent selecting response option
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Percent indicating the Barrier to be “very challenging” BY the presence of a Patient Engagement Strategic Plan
Barrier Yes (%) No (%) DELTA
ATTITUDE - Shifting attitudes and expectations regarding clinician’s roles 38.5 47.9 9.4
ATTITUDE - Shifting attitudes and expectations regarding consumer and patient roles 30.8 46.5 15.7
ACTION - Developing tools and services that help consumers and patients take action using their health information
23.1 16.9 -6.2
ACTION - Developing tools and services that help clinicians take action using their patient’s health information
28.8 29.6 0.8
ACCESS - Giving consumers and patients electronic access to their health information 15.4 16.9 1.5
… yet without a formal patient engagement strategic plan, the challenge of the ATTITUDINAL (culture) barrier is elevated.
Challenges to overcome in a Patient/Consumer Engagement effort
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So What? What does the CIO perspective tells us about better ways to engage patients?
• PE conversations are driven by those with a technology
focus
• PE efforts are less daunting when an organization has a PE plan in place.
• PE requires a “cultural shift”… but are CIOs the right leaders to drive this effort?
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Physician Perspective
Medscape
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Conflict of Interest Christina L. Hoffman, MS Executive Managing Director, Strategic Integration & Innovation Medscape Education/WebMD Has no real or apparent conflicts of interest to report.
© HIMSS 2015
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Sample Characteristics (Physician, N=359)
19
N Percent/Average Internal Medicine or Family Medicine 325 90.5
Male 223 62.1
Years in practice < 10 years 61 17.0
> 11 years 298 83.0
Practice type Group practice 152 42.3%
Hospital based practice 76 21.1%
Solo practice 63 17.5%
VBP program (yes) 258 71.9
Patients seen per month -- 246
Have EMR (yes) 297 82.7
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2
Source: Q10 Physicians Survey, N =359, percent of physicians who indicate item
Physician Perceptions of Patient Engagement
“For me, patient engagement is:”
39%
69%
76%
79%
84%
0% 20% 40% 60% 80% 100%
Efficient
Effective
Easy
Part of the job
Beneficial
Physicians definitely see the upside of Patient Engagement…
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21
Source: Q13 Physician Survey, N=359, (agree and strongly agree)
12.3% 17.0% 20.9% 21.4% 22.0% 30.4% 30.4%
42.3% 46.5%
59.1% 61.8%
The decision toengage
patients in theirown care isbeyond my
control.
Lack ofknowledge on
how tointegratepatient
engagementfunction into
my day-to-daypractice.
Lack ofprovider
training inpatient
engagement.
Lack of definedroles and
responsibilitiesfor patient
engagementwithin mypractice.
Do not employstaff skilled in
patientengagement.
Lack ofincorporation of
patientengagement
metrics inquality
improvementmeasures and
reports.
Concern overpatients lack ofcompetency inmanaging their
own health
Insufficientpayment forcarrying out
patientengagement
Organizationalprotocols that
constrain
Limited timewithin the
patient visit toexplain care
options
Limited timeafter the visit tofollow-up with
patients
TIME COMP
Physician Perceptions of Patient Engagement Barriers …but have very tangible concerns about PE.
“Rate the applicability of each statement as a potential barrier to regularly implementing patient engagement strategies in your practice”
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22
Source: Q14 Physician Survey, N=359, (100% of the time)
8.4%
22.6% 23.4% 29.5% 30.6% 34.0% 39.8% 44.3%
I rely on other staffin my practice to
engage andinvolve patients in
their care.
I coordinate patientcare with other
providers in or outof my practice.
I take the timenecessary to
understand mypatient needs,behaviors, and
home environmentwhen making
treatmentdecisions.
I assess my patient’s literacy
level and technology
capabilities so I can adapt my
communication with them.
I gather input frommy patient or their
family in theirtreatment and care
plan.
I include patientconcerns and
preferences as akey part of the
treatment decisionmaking process.
I provide treatmentoptions to my
patients.
I provide mypatients pros andcons of treatment
options.
Current Engagement Practices by Physicians “How often do you use the following strategies to engage with the patients in your practice?”
Shared Decision Making Effort Not My Job
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Training and resources needs seen as most valuable by Physicians—”Soft Skills”
23
Source: Q23 Physician Survey, N=359, (those indicating a 4 or 5 on a 5-point scale scale)
56.0% 57.8% 63.9% 64.3% 64.9% 64.9% 70.7% 72.4% 72.9% 73.2%
Applyingchange
managementprinciples tomy practice
Strategies forpartnering with
communityproviders andnetworks tomaximize
adherence totreatment or
improvedoutcomes
Assessingpatient literacy
andcomprehension
status
Culturalcompetence
Managingpatient
expectations
Patientengagement:
preparingpatients forbehavior
modification
Patient factorsinfluencing
patientengagement
and adherence
Strategies forcommunicatingwith caregivers
and family
Strategies forcommunicating
with non-adherentpatients
Effectivecommunicationand listening
skills
“Rate the value of access to training and resources in the following topics to you and your practice: ” “Communication”
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So What? What does the provider perspective tells us about better ways to engage patients?
• Accept that time is finite…can’t make more but can make
better use of it • Use time before and after the clinical encounter to prepare for and
pull through patient engagement • Redesign the entire clinical flow
• Accept and embrace a Value-based approach to managing patients
• Provide training on best-practice approach to transitioning from volume to value
• Transition help– Capitalize on the Chronic Care Management code reimbursing providers OUTSIDE of the clinical encounter
• Training HCP on “soft skills” (e.g. communication, etc.)
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Patient Perspective
WebMD
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Conflict of Interest Mazi Rasulnia, PhD, MPH, MBA Consultant to Medscape and Genentech Co-Founder of a patient engagement company PACK Health Acknowledgement: This study was supported by Genentech, Inc.
© HIMSS 2015
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Patient Characteristics: Study vs. WebMD User Profiles
27
Study Patients Profile
(n=2,567) WebMD User Profile Marital Status % % Married 59% 42% Education % % Graduated college (4 yr degree) 18% 31% Ethnicity % % Black/African American 6% White/Caucasian 82% Other 122% Gender % % Female 76% 65% Male 24% 35% Age % % 18-24 1% 16% 25-34 3% 25% 35-44 7% 18% 45-54 18% 16% 55-64 33% 16% 65+ 38% 9% WebMD Data Source: comScore Multiplatform November 2014; comScore Plan Metrix November 2014 Note: Study population inclusion was to have seen your doctor in the past 90 days
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There is more alignment between providers and patient on how to approach patient engagement than with organizations that house the providers or make decisions about patient engagement strategies for the organization. • Patients view PE in terms of relationship (high-touch) • Providers believe that PE is part of their job and responsibility and beneficial
to their patients. • Providers have a harder time seeing it as an easy task or efficient in their
current models for patient care. • Patients depend on providers as the primary source for engaging them (they
want more time)
Patient Perceptions of Patient Engagement: Patient-Provider Alignment
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My healthcare provider…
29
Patient Perceptions of Patient Engagement: Patient Expectations of Healthcare Providers
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21% 21% 21% 24% 24% 23% 25%
69% 69% 68% 53% 63% 56% 53%
90% 90% 89% 77%
87% 79% 78%
I haveconfidence inmy primaryhealthcareprovider'sknowledge
I haveconfidence inmy primaryhealthcare
provider's skill
I trust myprimary
healthcareprovider
I feel like I cantell my primary
healthcareprovider
personal things
I am involved inmy healthcare
decisionmaking as
much as I wantto be
I do not waitmore than 30
minutes to seemy primaryhealthcare
provider onceI'm in their
office
I can easilydiscusspersonal
matters withmy healthcare
provider
Strongly Agree Somewhat Agree
Q11. Please indicate how strongly you agree or disagree with the following statements. Base: Total Respondents (n=2,567)
30
Patient Perceptions of Patient Engagement: Patient Expectations of Providers during an office visit
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So What? What does the patient perspective tells us about better ways to engage patients?
• Engagement should start or initiate from a trusted source
• Engagement should not adversely impact the experience of the
patient (e.g. the clinicians interacting with EMR or technology rather than patient)
• Metrics of engagement should consider what matters to patients (e.g. time and empathy measures)
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• Different barriers for different audiences CIOs – Attitudes and
expectations of Providers and Patients
Providers – Time demands and
training Patients – Provider’s time
• Disagreement around who “owns” PE CIOs – CIOs, since PE
requires technology Providers – Patients need to take
more responsibility for their care/outcomes
Patients – Providers need to be
willing to spend more time with them
3
• Mis-alignment around what PE means Hi-Tech – For CIOs, PE is about
technology and driven by MU
Hi-Touch – For Providers and
Patients, PE is about relationships
Patient Engagement (PE) is generally viewed positively by all stakeholders… but notable differences exist
Summary of Findings
Definition Ownership Barriers
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Questions?