As seen in Advance for Health Information Executives
Published July 27, 2009
By David Printz
Where's the patient in a paperless process?
Much of the attention surrounding the $20 billion in funding designated for health IT in the American Recovery and Reinvestment Act of 2009 focuses on getting the necessary IT infrastructure in place across America's hospitals. These funds will help defray the enormous budgetary costs and address technical challenges when facilities purchase and implement electronic health records (EHRs), computerized physician order entry (CPOE) and other technologies that improve how we communicate with colleagues about patient care.
But it is not just health records and prescriptions that are moving online. Those ubiquitous stacks of glossy educational brochures are also making the move from paper to pixel, at relatively low cost and with minimal start-up support. This trend, which has been quietly growing in popularity, has the power to immediately transform not just the data we transmit about patients, but the way in which we communicate with them, thereby empowering them and putting them at the center of care.
Still a way to go
The move to CPOE is often slow because of lack of funding and organizational commitment, as well as doctor resistance. David Blumenthal, MD, MPP, of Massachusetts General Hospital, the newly appointed National Coordinator for Health Information Technology in the Department of Health and Human Services, conducted a survey on EHRs published online in March in the New England Journal of Medicine. The survey found that cost was a major barrier to EHR adoption, as cited by CIOs of the 74 percent of hospitals without EHRs. In addition, slightly more than one-third of respondents were concerned about physician resistance. A mere 1.5 percent of the 2,952 hospitals surveyed had adopted a comprehensive, hospital-wide system and only 17 percent had CPOE in place. The researchers agreed that we have a long way to go in terms of achieving the sort of EHR adoption rates that will transform the health care industry.
Nonetheless, it is important to move in that direction, because EHRs and CPOE will increase efficiency, productivity and patient safety. Of course, federal economic incentives will help boost future adoption rates.
Today's forward-thinking hospitals are finding that inexpensive and easy-to-implement Web-based patient-engagement tools can be a perfect early step on the long road toward going paperless. Using computers to help teach and engage patients is a process with which providers in general are comfortable. And the process may encourage even the most reluctant doctors to embrace technology in their practice.
In December 2004, Central DuPage Hospital (CDH), where I serve as CIO, purchased an annual subscription for Web-based patient education from Emmi Solutions, a provider of interactive online programs for patients. We use these programs to deliver consistent health information - and track patient participation - for a library of health topics including preparing for surgical procedures, giving clinical instructions and teaching patients how to manage chronic conditions. The fee was reasonable. It was simple to set up and required no IT resources as the educational programs are available via the Web and Emmi Solutions' hosted system. The staff felt comfortable "prescribing" the programs after just a 15-minute training session. Physicians on the medical staff at CDH, clinical staff and patients are pleased with the program and its results, and it helps us to meet a number of regulatory requirements.
Patient communication
It makes sense that hospitals would turn to Web-based solutions to improve communication with patients. Given tight budgets and a shortage of caregivers, it is not always feasible to allot more time for face-to-face patient communication. Investing in technology is the most cost-effective way to extend provider reach and efficacy. Use of technology reduces patient call volume and thereby increases provider productivity, according to a 2005 study published in the Journal of Healthcare Information Management.
However, when seeking efficiency, the provider side of the equation paints only half the story. The benefit of patient engagement is just as compelling, as it plays a critical role in reducing cancellations that drain millions of dollars in wasted time, materials and labor, and increases patient satisfaction.
In March 2008, the Centers for Medicare & Medicaid Services (CMS) released results from the Hospital Consumer Assessment of Healthcare Providers Survey (HCAHPS). It found that all five drivers for improving HCAHPS scores relate to patient-provider communication.
Additionally, according to "Hospital Pulse Report 2008: Patient Perspectives on American Health Care," released by consulting group Press Ganey Associates, communication is a key driver to patient satisfaction.
Furthermore, a paper titled "A Better Hospital Experience," published in The McKinsey Quarterly in 2007, noted that communication is the top non-clinical criterion used by commercially insured patients when choosing a hospital - outranking patient room amenities, billing transparency and value, and on-time meetings. More than three out of four (77 percent) surveyed patients said they would switch to a hospital that provided more information about their care.
Improving clinical quality without addressing the patient experience is financially unsustainable. Patients want both. And they'll take their dollars to whomever gives them both. The beauty of interactive educational Web programs is that they simplify and clarify complex medical information in a way that makes it easy for patients and their families to understand. The animated and narrated presentations enhance learning, engage patients and encourage them to take an active role in their health care.
Web-based patient education
The staff at CDH has been impressed with the Web programs and their usage, which has dramatically increased over the past year. Each program is assigned a unique access code enabling patients to log on to the program. From 2007 to 2008, the number of access codes issued by the hospital nearly doubled, from 8,441 to 16,049. That was more than four times the number of codes issued in 2005, the first full year the hospital embarked on the program. Since then, on average, we've found that slightly more than half (53 percent) of patients who receive program access codes will log on to the program. Once logged on, the vast majority (88 percent) will view it to completion.
Much of this jump in use is due to recent proactive measures on the part of the CDH staff. Patients and families may access the programs from any PC wherever they have browser access to the Web.
Within the hospital, caregivers bring wireless mobile computers to patients' bedsides to teach them how to manage their conditions. The respiratory therapy department, for example, recently started using an asthma education Web program, which is available in English and Spanish, as a way to standardize what is being taught. Respiratory patients can view the program at their own pace, pausing and watching again as needed, and typing questions they may have for their provider.
The hospital also employs online presentations in high-risk areas such as labor and delivery, pre-op and cardiology, as well as in gastroenterology, a department in which patients often lack knowledge about certain screening procedures and their complications. The program complements the hospital's informed-consent process. A flyer for patients, listing 20 educational programs, from depression and diabetes to heart failure and hypertension, was introduced earlier this year.
I also speak from personal experience. Three years ago, my then three-year-old grandson was about to have a tonsillectomy at CDH. I watched the online tonsillectomy program along with my wife, son and daughter-in-law, and realized that I had never before fully understood the procedure. We all felt much more comfortable knowing the risks and benefits. And it made me appreciate how difficult it must be for patients who are considering more complicated procedures, such as joint replacement.
The future of technology
Just as CPOE is the wave of the future in clinical integration, online technology is the future of patient education.
Ninety-five percent of respondents in a survey conducted by Emmi Solutions on behalf of CDH said it improved their understanding of what to expect; 91 percent said it provided them with new information; and 88 percent said it made them feel more comfortable. Nine out of 10 said they'd share the program with family and friends; 85 percent learned about risks they had been previously unaware of; and 83 percent reported increased confidence in their doctor.
For these reasons, along with the low start-up costs, subscription-based Web education ranks as one of the best IT investments Central DuPage Hospital has ever made.
Mr. Printz is vice president/CIO at Central DuPage Hospital in Winfield, Ill.