Tag Archives: patient reported outcomes

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Older patients have demonstrated that they will use mobile technology to push successful outcomes in their own healthcare. 

Will Older Patients Use Mobile Technology?  YES!

As the US population ages, adults age 50+ are expected to increase by 17 million in the next 12 years.  Today, an estimated 57% of baby boomers use technology, up from 40% in 2012(1).  The increase can be attributed to people more willing to adopt technologies that keep them connected and entertained. 

In a survey conducted by Marketing Charts, almost 50% of respondents indicated an interest in learning about new technology, while at the same time they adopt new devices like smart TVs and voice activated home assistance devices.  Baby boomers are slightly behind their younger counterparts with tablet ownership, but are catching up on social media use.  

What does that mean to the medical industry? 

Trends indicate that technology adoption, and a comfort level with the use of mobile devices, is becoming more ubiquitous in the older population.  And while over 91% of older adults own computers, more users are getting tablets, connecting to the internet through mobile devices, using social media, and entertaining themselves with device-based games. 

As medical care needs increase with aging, elderly patients are more open to using technology.  This offers an opportunity for healthcare providers to leverage mobile technology to collect real-time  recovery progress from patients. Home device usage to complement medical care can keep patients connected during a typical “zone of darkness” following surgery, opening windows to prevent infection that were previously not visible. 

Mobile Technology for Patient Outcomes – Clinical Study

Trusted Patient CoachTM, our patient reporting tool, was designed as an easy-to-use mobile app, specifically tested with an elderly population.  Our clinical study showed how to prevent unnecessary office visits and hospital emergency department visits, and that patients well into their 70’s and early 80’s were willing – and able – to use mobile technology without difficulty.  Moreover, these patients reported benefits of staying connected to their clinical team after discharge.

The opportunity to prevent readmissions and reduce medical costs for hospitals, clinicians and patients is significant.  Clinicians are using TPC to stay connected to their patients, reinforcing medication compliance, and collecting real-time data to intercede before infection occurs.  Let’s call that a win-win-win.

(1) Marketing Charts, May 9, 2018.  Tech Update: Mobile & Social Media Usage, by Generation

 

 

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A Physician’s Perspective

Interview with an Endocrinologist About Patient Reported Outcomes

Health Helm’s Operation Lead, Lisa McCarron, sat down with an Endocrinologist to discuss the challenges of patient centered care for clients with diabetes.

1. What are some key challenges for physicians in helping patients manage chronic medical conditions?

The challenge becomes how to improve care between visits and how do we help the patient overcome the difficulties that they face. They may contact the office with questions or concerns and then the next time you see them in 3 or 6 months, they are not better off. This in between time is a “zone of darkness” with little feedback or communication.

Diabetes as a chronic condition has about 10% compliance to care plans in patients, with relatively poor outcomes. Drug compliance is difficult to quantify but I believe most patients take their medication although not as prescribed. We need a better way to communicate and motivate the patient. If we can’t motivate them to change their lifestyle, we can’t improve the outcome. Those who do get well at the beginning, after hearing their diagnosis, are motivated but that motivation diminishes over time.

A platform to communicate and motivate can help improve the doctor-patient relationship. There is no doubt that interacting with patients between visits would be beneficial. The patient feels that if the doctor cares more then they will care more and be more motivated.

2. What are some key challenges for patients as they manage chronic medical conditions?

Staying motivated is the most difficult. There is no feedback loop in between visits to let them know how they are doing against their plan. We even tried to incentivize patients with a $0 co-pay if they met their goals at the next visit. None were motivated by $0 co-payment.

Patients have to measure blood sugar and report to the physician’s office. Without feedback we can’t make adjustments to improve their condition. If the doctor doesn’t know what the patient is doing, they can’t motivate them.

Adherence to prescriptions is reasonable with about 50% compliance. Again, if the doctor could monitor this more we could then motivate them to do better or discuss issues with regard to cost, side effects, motivation, etc., in between visits.

3. What type of data do you have in supporting patients? What information are you lacking?

We use the glucose readings and weight primarily. Hemogoblin A1C is the gold standard for diabetes management. The higher the A1C, the higher blood sugar and the more likelihood of complications. The reading is an average blood sugar over 2-3 months.

We get feedback on patient’s progress every 3 to 6 to 9 months. Success is when patients call in between visits and then the doctor can monitor the status of the patient. A doctor is not going to call a patient in between visits. The patient needs to provide that information.

4. What makes for successful outcomes in managing chronic medical conditions?

Motivation is key to keeping the patient on their care plan, especially when there are complications. And preventative measures, based on feedback in between visits, would help to keep the patient motivated and aligned to their goals.

5. What will be most practical for doctors and their teams to get patients to share information on their care plan compliance and clinical status between visits?

The answer is TPC (Trusted Patient Coach). It provides proof of provider outcomes with data collection directly from the patient. It can also be a potential for reimbursement for monitoring patients in between visits.

Trusted Patient CoachTM is a reporting and engagement platform designed to connect and communicate with patients in acute and chronic care to improve outcomes and reduce costs.

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Addiction treatment has gained much attention with the veracity of overdose deaths and a spike in the increase use of opioids. (Substance Abuse and Mental Health Services Administration, 2017)(1). Much has been studied and learned about the disease of addiction, including elements necessary to support and sustain long-term recovery. However, solutions beyond traditional inpatient and outpatient treatment have been slow to evolve. One women’s residential treatment program in the Northeast enhanced their evidence-based treatment program to expand support to their graduates. They augmented their Modified Therapeutic Community treatment program with recovery coaches and Health Helm’s mobile app, Trusted Success CoachTM, to stay connected with graduates over a year following graduation. Read more about the success of this innovative program and the use of Trusted Success CoachTM as an integral program element.

(1) Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Rockville: SAMHSA.

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February 2019

Bob Kocher and Bryan Roberts, health care investors and partners at the venture capital firm Venrock, predict “Telemedicine Takes Off,” in their Fortune article, “10 Health Care Predictions for 2019 From a Pair of Venture Gurus” (December 10, 2018).  They note that payers are finally realizing it’s better to “embrace and encourage telemedicine usage as opposed to burying it in their unengaging member portals and clunky mobile apps.”    

The time for telemedicine is now!   Patients, as consumers, are demanding this.  It’s been well established that patients of all ages and socioeconomic backgrounds are using mobile technology in their lives – from all the conveniences of retail or travel, to simply sharing photos and stories with family and friends.  According to a recent global survey by Cisco, 74 percent of patients prioritize access to health care services over in-person interactions with health care providers, and 70 percent said they were comfortable communicating with providers via text, email, or video, in lieu of an in-office visit.

Yet some clinicians still ask or protest: “My elderly or low income patients won’t use mobile health technology.” Smartphone adoption continues to grow rapidly in the US market:  Pew Research in 2018 reports 77% of Americans own a smartphone vs. just 35% in 2011, and 53% own a mobile tablet device (e.g., iPad or Android). 

In our experience, patients over age 65 using our Trusted Patient Coach mobile solution on their smartphones or mobile tablets are just as, if not more compliant than other demographic groups.

Some providers protest, “They can use our electronic medical record (EMR) portal.”  But those are also clunky to use.  Many are web based or supported by clunky mobile apps and are used for episodic tasks such as viewing diagnostic test results, refilling a prescription, or scheduling an appointment.  Sara Heath, in Patient Data Access News, reports that even among patients registering to use EMR portals (and many patients do not), their utilization is only 20-35% of the time. 

Clinical evidence shows that patients who track themselves do a better job of managing their health and have better clinical outcomes – e.g., managing a chronic condition or recovering after surgery.

At Health Helm we focus on Patient Reported Outcomes and self-tracking, providing clinical teams and their patients with a secure, reliable way to track and report meaningful information about their progress on a daily or routine basis . Clinicians know that when communications with patients are better, they can identify complications or problems earlier and then intervene to address them earlier. 

Kocher and Roberts note that even medicare is adding codes to reimburse telemedicine. Other insurers are, also – recognizing that meaningful, sustained connection using telehealth results in better outcomes at lower costs, with a better patient experience.  Bottom line:  Kocher and Roberts, “Expect telemedicine usage to more than double in 2019, while making substantive inroads beyond flu and cold into areas such as chronic disease management.” 

Sources:


https://www.healthaffairs.org/do/10.1377/hblog20150723.049490/full/

https://newsroom.cisco.com/press-release-content?type=webcontent&articleId=1148539

Heath, Sara, “Patient Access to Health Data, Patient Portal use Increases.” Patient Data Access News, Patient Engagement HIT, October 12, 2017.

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Interview with Nurse Practitioner About Patient Reported Outcomes

Health Helm’s CEO, Pamela McNamara, sat down with a Nurse Practitioner in a pain management practice in New England, to discuss patient centered care, patient reported outcomes, and how these could enable her patients to receive a more holistic approach to care.

close-up-doctor-health-42273-300x300 The Importance of Patient Reported Outcomes from the Perspective of an NP

What does patient centered care mean to you and your practice?

We follow the CDC guidelines and apply judgment given the risk factors. For example, we ask patients how long they have been on pain medications — opioid or others. We treat each patient holistically, considering her/his situation: How functional are they, are they working or disabled? What activities do they want to be doing with or without medication? What are they doing to avoid pain? What other medical considerations, such as social and mental health ailments are they affected by?

We consider and encourage trying alternatives to opioids for each patient, such as aquatic therapy for an osteoarthritis patient, chiropractic care for a younger patient, acupuncture, massage and/or yoga.We also attempt to use other pain management options including non-opioid prescription including over-the-counter aspirin, ibuprofen and acetaminophen, pain creams and patches. Medical cannabis including CBD creams and oils can be beneficial for chronic pain helping patients with anxiety, sleep and muscle spasms. We offer surgical procedures high-tech treatments using radio waves and electrical signals or implantable spinal cord stimulation. Unfortunately not all patients have access to these alternative therapies. Many of these therapies are not covered by insurance or these patients have access to care issues causing barriers to receiving this type of care.

How would a mobile patient reported outcomes tool fit in to your practice: supporting you as a clinician, while aiding in the treatment and management of your patients, as well as enabling them to better manage themselves?

A top priority for our patients is to gauge the extent to which they are trying to manage themselves and deal with their pain, and pain-related issues, rather than solely seeking more pain medications. If we know a patient is trying, we can work with them to utilize alternative approaches to opioids.

One benefit of patient reported outcome data will be to see evidence of how the patient is trying to manage their pain and with what result.

This patient reported outcome data can provide me, as a clinician, with a better basis for building an ongoing relationship with my patients to manage their pain and make progress.
Patient reporting would enable me to track their pain and other medication, track the extent and circumstances in which pain meds including what doses, numbers, and pills are being taken.

How would the PRO tracking work in your practice?

Typically we see a patient on chronic opiate therapy monthly. Patients on non opioids therapy are followed every three to six months.

During that four week period, we monitor their pain using pain scale tools. The use of a pain scale can help guide the clinician in creating a treatment plan as well as measure the effectiveness of the treatment. Indications a treatment plan may be ineffective include if a patient scores a 10 consistently (on the traditional pain scale of one to 10), the patient also reporting that they’re repeatedly out of medication early? The mobile tracking would help us monitor that more closely.

A mobile tool to monitor patient reported outcomes would be useful during the middle of that two month period, to alert us if problems are occurring. For other patients, patient reported outcome data is useful just before or during the four week follow-up visit to assess clinical status, progress, or problems, and to focus the patient visit on key issues. In preparation for this type of patient, the data would be scanned for sleep pattern variations, increased or decreased activity levels, issues related to ambulation, and responses to questions such as “ Do the current medication you are keep you functional and able to perform the daily tasks you need to do?”

The clinician would look at a snapshot for that patient over the prior month and be better prepared for a discussion about what’s going on, what can be changed in the pain management regimen, and what may need to change in other related activities.

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Patient Engagement Leads to Successful Outcomes

One clear way to dramatically improve health outcomes is to avoid unnecessary emergency department (ED) visits and hospital readmissions.  Beyond the HHS penalties, delivering the right care to the right patients makes for good sense and good healthcare.

Clinicians indicate that following surgery or a procedure, the initial five to seven days is the critical period during which most complications occur.  Difficulties or confusion during these transitions in care, as well as poor or non-existent follow-up communication can exacerbate the risks of avoidable clinical complications. 

Strong communication between clinicians and their patients is an essential prerequisite to attaining the best possible health care outcomes.  We recognize this deep truth and seek to facilitate exactly this type of clinician/patient communication.

In order to be most effective, such communication must be systematic, frequent and immediate. For this reason, Trusted Patient Coach (TPC) delivers detailed, customizable questionnaires to patients up to multiple times per day. These allow patients to self-report and communicate changes in symptoms and progress along care plans with immediacy, thus maximizing the accuracy of the collected data. In addition, this immediacy allows clinicians to see and take decisive action on adverse developments well before they otherwise could.  Thus, this strong communication forms the bedrock for actionable and timely clinical intervention that can reduce inefficient resource utilization such as unnecessary ED visits, which frequently lead to avoidable hospital readmissions.

Patient – Clinician Connection Reinforces Successful Patient Outcomes

But strong communication can be just a start. Strong communication can grow into a strong connection. And this connection can strengthen care outcomes even further.

We see overabundant evidence of these connections throughout the messages exchanged between TPC-using patients and their clinicians. Patients are thrilled to get their questions answered and their worries addressed. They react by deepening their rapport with their doctors and nurses, forming a higher level of engagement that is shown to produce better health outcomes (Hibbard, Greene, 2013). Patients forming these connections are among the most enthusiastic users of TPC.

In a recent TPC study involving 75 post-surgical patients, clinicians reported actively avoiding medically unnecessary ED and office visits for 11 of those patients.

One such patient, N.L., writes to his doctor,

“Thank you for messaging with me. I feel better knowing I’m on the right track and to expect good and bad days.”

Another, J.B., writes,

“Thank you for your support and advice. It’s nice to have doctors that are so involved.”

Patients N.L. and J.B. were both spared unnecessary ED visits after establishing a connection with their doctors through Health Helm’s Trusted Patient Coach mobile app.

Clinician/patient connection, driven by strong and immediate communication, can lead to reduced readmissions and to outstanding medical care.

 

Hibbard, J.H., Green, J.  (2013). What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data on Costs.  Health Affairs, 32(2), 207-214.

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A Patient May Be Using EMR, But What About Post-Surgery or -Procedure Communication?

Patients are more savvy users and consumers of their medical records thanks to EMR systems. If the patient’s physician is connected to the network’s EMR system, the patient is solicited to register on the patient portal.

There are many advantages to doing this. The patient can reorder prescriptions, update her prescription list, see her latest lab results, check her next scheduled appointment, verify the insurance information on file, ask for a referral – all without having to call the office. Easy, convenient management of her static health records.

But what does the patient do after a procedure or surgery?

She goes home with discharge instructions. She follows them – sometimes. What happens when something doesn’t feel right a week into her recovery? She calls the office. She leaves a message on the nurse’s line. Three times. She then dials “0” to get the front desk. But she gets put on hold for 10 minutes.

Frustrated, she hangs up and sends a message to her primary physician via the patient portal. She thinks, “Ok. This can wait until tomorrow. Perhaps I’m overreacting.”

She goes online to find information. Nothing. Sleepless into the night with increasing pain and discomfort, she finally decides at 4am to go to the ED. The patient’s surgeon and office staff have no insight into this scenario whatsoever. And no control to do anything about it.

Preventing Readmissions with Trusted Patient Coach and Patient Reported Outcomes

Let’s rewrite that scenario.

The patient is discharged with discharge instructions. She downloads the Trusted Patient Coach™ mobile app recommended by her clinician onto her own mobile device – phone or tablet. She reports her symptoms immediately after getting home starting on day 1.

She follows her discharge instructions, which are reinforced by Trusted Patient Coach’s daily questionnaires and tasks. She reports her level of fever, pain, swelling and other common post-surgical indications of problems.

Her doctor now has real-time daily data to know that his patient is still experiencing fever and swelling after 7 days. The doctor messages – directly – to his patient: “Please send me a photo of what your incision looks like.” He doesn’t like what he sees and replies: “Please come into the office. Nurse John will be waiting for you this afternoon.” ED visit and potential readmission avoided.

This is a real scenario of preventing readmissions using real-time Patient Reported Outcomes.

  • It creates direct communication from patient to clinician.
  • It records recovery progress with daily, real-time reports directly from the patient.
  • It provides trending so that clinicians can spot potential issues.
  • It creates a better patient experience.
  • And it reduces costs by allowing the clinician to intervene before the ED visit.

Learn more about Trusted Patient Coach™ as an integral piece of your healthcare solution.