Patients as partners in health IT
■ By enlisting tools that patients can use, a medical practice can become more efficient -- and increase patient satisfaction
Like many practices, Women's Wellness Place is continually upgrading its technology to better serve and empower providers and patients.
The practice has used an electronic medical record system for eight years and recently implemented e-prescribing; a website with comprehensive patient information; and a portal where patients can update their medical history and contact information and request prescription refills.
Despite the cost and initial sacrifices associated with EMR and other technologies, "we're not done yet," said Kristen Kratzert, MD, a partner in the three-physician obstetrics and gynecology practice in Syracuse, N.Y. She said Women's Wellness Place plans to implement a knowledge-based system to aid in patient management and diagnostics and online scheduling in the near future.
"We're always trying to make our practice better and more efficient," Dr. Kratzert said.
Practices such as Women's Wellness Place are investing in the technologies that involve helping the patient make his or her own experience more efficient -- and, as a result, helping the physician make the practice more efficient.
"It's a really exciting time in health care," said Deanna R. Willis, MD, a family physician in Indianapolis, associate professor at Indiana University and chief medical officer of quality and medical management for the 200-physician Indiana University Medical Group Primary Care. "I think if we look at the banking industry over the past 10 or 15 years, and the way they have automated with ATMs and online account management, we're about to take a similar leap forward in health care.
"Eliminating unnecessary waste from the processes that support the [doctor visit] helps the patient feel like their time is valued," Dr. Willis said, especially when patients believe the real value of a visit "is the person-to-person interaction with the doctor."
New communication tools
Patient portals, for example, allow both patients and physicians to communicate over a secure website to share test results, schedule and cancel appointments, make online payments, and review or add prescription and other patient information.
"A portal can provide a [Health Insurance Portability and Accountability Act]-compliant and secure way to communicate with a patient," Dr. Willis said. "If a patient reviews their medication list and health history before they go into the office, it will be more accurate, safer and more efficient for the office team."
Through in-office patient kiosks and tablet computers, patients also can update health and insurance information and consent documentation before they see the doctor. With education materials -- provided online or at an in-office work station -- patients view information relevant to their condition and age and in their primary language.
In addition, some practices are using online coaches to help patients improve their diet or manage a chronic condition.
"A coach can touch more people in a Web environment than face to face," Dr. Willis said. "Online coaching also can reduce emergency department visits and hospitalizations and effectively change outcomes. This will be particularly important for practices working to adopt patient-centered medical home formats."
For many doctors, the challenge is if they have the time or money to implement these technologies. Fortunately, many are offered through a physician's existing EMR software.
Thirty-four percent of all U.S. physicians and 39% of all primary care physicians had EMR technology in 2011, according to the Centers for Disease Control and Prevention. Yet most of these practices are not implementing the expanded communication tools that their systems provide, such as portal services for making appointments, said Rosemarie Nelson, a Syracuse, N.Y.-based principal with the Medical Group Management Assn. health care consulting group.
Electronic scheduling, prescription management and patient portals often are available, or can be added to an EMR system, for a nominal fee -- $20 to $45 per month or on a per-transaction basis, Nelson said.
Other systems and upgrades may require a greater investment.
Tablet- and kiosk-based systems, for example, can cost between $2,000 and $5,000 up-front, Nelson said. These systems may require an additional $3,000 to $5,000 for installation, staff training and set-up; $2,000 to $10,000 to fully integrate them into the physicians' systems and procedures; and, in some instances, a $250 to $400 monthly user fee.
For staff, technologies that manage a practice's administrative functions can mean drastic changes in responsibilities and procedures.
"I do think [new systems] require you to think about the roles in your practice," said Timathie Leslie, vice president of Booz Allen Hamilton, who specializes in health care information technology.
For example, "a portal can be a very efficient way to communicate with a physician, as long as there are processes in place within the practice for reviewing and responding to new information," Dr. Willis said. However, "if the office is not responding in a timely manner to a request placed in the portal, the patient is going to have to pick up the phone and call the physician's office. Now the office has to deal with both the phone call and the new portal information."
Getting patient buy-in
Dr. Willis also said patient input, acceptance and knowledge of these new technologies are critical to success.
"Listening to the customer and understanding what the customer wants and needs is essential to designing any changes in office processes," Dr. Willis said. The process can be "informal" -- simply asking patients for their opinion on a proposed change -- or involve the expertise of an external facilitator to manage focus groups and provide a more comprehensive assessment.
"Seeking input from patients doesn't have to be difficult, yet it is essential," Dr. Willis said.
Nelson suggests informing patients of new technologies and procedures at various stages of the office visit.
"Practices with the most success in getting patients to use new tools introduce [them] in the exam room," Nelson said. "The nurse explains the what, why, etc."
Then, at checkout, patients are told how to access their lab results, email the physician and use any other new communication tools. Someone in the reception area can be designated to assist patients with a new waiting room kiosk.
Ultimately, integrating these new technologies will save time and money, Nelson said.
"I've done a cost-value analysis," Nelson said. "The transaction fee [for portal use] is less than ... the staff time and benefits that you are utilizing to complete these tasks. If we trade that value, it's clearly a deal."
Meaningful use bonuses offered by the U.S. Centers for Medicaid and Medicare for practices that upgrade their patient technology offer further incentives.
Physician practices and hospitals are eligible for bonuses -- up to $44,000 through Medicare and $63,750 through Medicaid -- for meeting federal EMR objectives. For the moment, many technologies that would improve office efficiency aren't included in the criteria for bonuses.
But beginning in 2014, physicians will need to include greater patient access through e-prescribing, Web-based portals and online patient messaging and payment to continue to receive bonuses. Insurance companies and employers also are offering incentives for improving practice technology, patient-physician communication and information access.
"We're entering meaningful use phase 2 with a greater emphasis on the exchange of information and quality measurement," Leslie said.
Although not every technology that focuses on efficiency is eligible for Medicare or Medicaid bonuses under meaningful use, practices are finding that systems that allow for a more streamlined process can cut costs and boost patient satisfaction.
Customer demand also will be a market force as more patients -- and even new medical school graduates -- choose practices that provide the latest technologies.
"We're going to select our provider network based on the ease of access and the ability to track care online, especially as we start to manage chronic illness and the care of our parents and children," Leslie said.