Category Archives: Practice Enhancement

Humanizing Virtual Care for Patient Satisfaction

Although only 8% of American patients had previously attended a telehealth visit before the pandemic, up to 83% expect to continue telehealth visits even after the pandemic subsides. In 2019, only 28% of physicians reported using telehealth technologies. Now, virtual consultations and online visits are beginning to replace the traditional model of in-office appointments.

Growing Demand, Declining Patient Satisfaction

While some healthcare professionals have expressed concern about the impact of telehealth on patient-provider relationships, arguing that digital care will be hinderance to personal connections, the past few months have revealed that virtual visits can effectively support and even deepen relations with patients. However, the effective delivery of online care requires strategic efforts that go beyond traditional patient-provider interactions.

Although patient demand and desire for digital visits continues to rise, overall patient satisfaction with such services is reportedly decreasing. “As patients become more engaged, informed, and involved with their health care decisions, and demand better access to care, virtual health solutions will play an important role in meeting expectations,” a recent report by Deloitte highlights. Virtual healthcare needs to continue efforts aimed at humanizing online care by extending the patient-centered care delivery model.

Humanizing Virtual Care

There are several ways to connect with patients virtually, all of which work to strengthen the patient-provider relationship. Some, such as automated messaging services, can even help lessen clinician workload by handling mundane administrative tasks while continuing to foster the patient-provider connection. Primarily, healthcare professionals need to prioritize using technological solutions to their advantage and as communication tools to develop a consistent relationship with patients.

Life-Centric Care:

The ubiquity of technology in our lives, ranging from smartphones to smart watches, allows for continuous tracking, monitoring, and communication. Focusing on embedding virtual healthcare into a patient’s digital life, providers can leverage the technology and tools they use on a daily basis to foster patient engagement. This can include utilizing data and content sharing applications to create personalized, high-quality interactions, sending reminders, and other communications that emphasize a life-centric care model.

Two-Way Texting:

As a decreasing proportion of the population now accepts incoming phone calls and many do not even check their voicemail, text messaging has become the preferred method of communication; up to 47% of patients express wanting to be able to text back and forth with their healthcare provider. With quick, efficient communications, two-way texting is an important step toward humanizing the virtual relationship.

Educational Communications:

Regularly sharing educational content, such as newsletters, blogs, and emails, can reinforce the feeling that providers care about their patients’ health. During the pandemic in particular, it is important to consistently communicate with patients by sending targeted educational information – to at-risk individuals especially – that provide individualized recommendations for staying healthy.

Automated Post-Visit Calls or Emails:

The majority of patients fail to remember all of the details of recommendations and treatment instructions provided during visits. Here, the use of automated messaging – including phone calls, voicemails, texts, and emails – can help remind patients of post-appointment care instructions. Such reminders will also improve treatment adherence while reinforcing the message that providers care about patients and their health.

Appointment and Billing Reminders:

Another facet of care can easily be automated using messaging systems; sending patients automated reminders of upcoming appointments and overdue bills can be used to increase touch points, triggering name recognition as well as remembrance. Patients will likely recognize and appreciate these efforts to simplify their lives, benefiting the overall relationship they have with their medical practice as convenience is increasingly valued.

The modern medical practice can leverage this ongoing shift toward digital care, taking advantage of the many virtual opportunities for connection and communication with their patients. While in-person interactions may be limited at this time, patient-provider relationships need not  fall to the wayside. With a healthcare industry primed for expanding adoption of telehealth, virtual health will increasingly become a part of consumers’ daily routines. If clinicians commit to telemedicine at a personal and organizational level, they can take advantage of the growing opportunities to deliver connected, coordinated, and comprehensive care.

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Open Notes: Patient Transparency and the New Federal Mandate

Alongside a surge in telemedicine adoption and increasing reliance on technology, the growing shift to digital healthcare delivery has prompted a cultural shift in medicine forcing many clinicians to abandon the traditional model in favor of a more modern approach. An elemental component of the modern medical care model is patient transparency, which has been at the forefront of discussions in recent weeks due to the forthcoming implementation of a new federal mandate.

To support universal patient transparency, beginning November 2, 2020 all patients in the United States will have immediate access to clinical notes and thus, will be able to read and review clinician’s writings, test results, and other health reports. Per the 21st Century Cures Act systems need to “support patients’ access to their EHI in a form convenient for patients, such as making a patient’s EHI more electronically accessible through the adoption of standards and certification criteria and the implementation of information blocking policies that support patient electronic access to their health information at no cost.”

Open Notes Policy 

Referred to commonly as “open notes”, the new federal mandate requires the release of all inpatient and outpatient notes for immediate patient access, including test results with potentially sensitive information. The information now made available to patients immediately includes consultation notes, discharge summaries, medical history, physical examination findings, imaging narratives, laboratory and pathology report narratives, and procedure and progress notes. Unsurprisingly, the plan has been widely contested by healthcare professionals who fear it will result in increased workloads and adverse patients reactions. However, there has been a growing adoption of the new protocols with time as evidenced by several institutions which have already implemented the policy.

Those supporting the new law believe it has the potential to strengthen patient-provider communication and relationships. Certain healthcare institutions are ahead of the curve; UC Davis Health voluntarily implemented open notes a year ago although only two dozen of 1,000 staff physicians opted into the program. Nonetheless, those that did reported positive results and support for the initiative. Similarly, at the University of Colorado Cancer Center, open access to oncology notes has been granted to patients for the past 5 years with no reported issues and highly appreciated by patients.

Sensitive Health Information 

Sensitive information may present more of an issue in certain specialties, such as oncology, psychiatry, genetics, and adolescent medicine. For instance, when reading pathology or imaging notes, patients may learn they have been diagnosed with cancer without a physician’s explanation or contextualization. In oncology specifically, patients may struggle to understand their prognosis and treatment plan leaving them stressed, frightened, and/or confused. In certain cases, the importance of physician contact and empathy may be much needed and more valuable than previously thought.

Medical professionals highlight the importance of clear, open, and honest communication with their patients to better accommodate the forthcoming open notes protocols. “When I order imaging or send pathology specimens, I have already discussed with the patient the possibilities, including cancer, and what we will do next. Patients deeply appreciate these discussions, before they see the results,” Dr. Robert Breeze, vice-chair of neurosurgery at UCHealth in Anschutz, Colorado told Medscape in an interview.

As clinicians tend to write notes in medical lexicon, they may now need to write things out in lay terms for the benefit of their patients which may potentially generate more work. Although the new mandate does not require a change in writing style, many clinicians may find they will need to alter their notes to make them more readable for patients, potentially making them less useful for utilization review, billing, and other internal purposes.

Clinicians in favor believe that the open notes policy will help serve overworked physicians by empowering their patients, allowing them to better understand their treatment plan and medication which can ultimately minimize the physician’s workload. Although the federal mandate may seem daunting, the benefits may outweigh the risks if notes are compiled in a patient-focused manner in line with a patient-centered care model. Access to clinical notes, results, and other important health information may promote patient engagement and treatment adherence, as well as deepen the patient-provider relationship.

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Most Effective Strategies for Optimizing Patient Engagement

There is a growing recognition of the importance of patient engagement as the key component of high-performing, cost-efficient healthcare systems which increase treatment adherence and self-monitoring as well as improve population health outcomes. Healthcare organizations who prioritize a strong team-based care infrastructure are better positioned to optimize patient engagement programming – broadly defined as the process of actively involving patients in their care and treatment decisions.

New research reveals that it is a relationship-based approach that builds trust and promotes patient autonomy, while organizational and administrative factors provide the foundation for such patient engagement. Organizations and health systems with provider champions, clear-cut staff duties, team performance improvement meetings, and staff dedicated to patient engagement tend to be more successful, according to findings published in the Annals of Family Medicine.

Optimizing Patient Engagement 

The recent study aimed to identify specific organizational factors that were associated with a greater adoption of patient engagement care practices within Veterans Health Administration (VA) primary care clinics. At these locations, patient engagement efforts were centered on the Patient-Aligned Care Team (PACT) initiative, which leverages aspects of the patient-centered medical home model to deliver comprehensive and continuous team-based care to veterans.

Investigators evaluated the adoption of PACT protocols across the VA primary care clinic system by analyzing responses from a survey completed by 2,500 clinicians at over 600 locations across the nation. Their results revealed that respondents at high-performing clinics were more likely to report regular team meetings aimed at discussing performance improvement and dedicated leadership responsible for the implementation of PACT best practices. High performance was also associated with fully-staffed PACT teams and clearly defined staff roles.

Overall, healthcare organizations only modestly implemented the recommended patient engagement tactics as results indicated a significantly lowered adoption of motivational interviewing and self-management programming.

“Lower use of these practices may be related to clinicians’ perceptions that some elements of the patient-centered medical home may not be entirely relevant (or may be difficult to use) for particular groups of patients during visits,” the researchers explained.

Organizational Factors

Revealing the importance of organizational elements, the study emphasizes the need to create new patient-centered relationships – that were found most effective for promoting patient engagement among high-performing clinics.

“Team-based care is a key driver of the use of patient engagement care processes and may directly affect patients’ level of engagement,” the study’s authors wrote. “Factors related to patients, team members, and workload may moderate the influence of team-based care on use of patient engagement care processes.”

Clear staffing roles were tied to better adherence to PACT, including motivational interviewing and organizational programming. Team-based huddles were essential for communicating quality improvement data: “Improved team collaboration and coordination are necessary for practices to manage the increasing complexity and unpredictability of clinical care and to become more accountable for patient-centered outcomes,” the authors concluded.

Next Steps

The latest findings emphasize the need to prioritize organizational elements of healthcare practices  and organizations in order to deliver care and achieve optimized patient engagement. Promoting fully-staffed facilities, identifying clearly defined roles of team members, more effective leadership, and a practice culture of performance improvement all may increase the efficacy of patient engagement initiatives and subsequently patient health outcomes.

While the team of researchers continues to examine the specific aspects of the patient-centered medical home model that most effectively improve engagement, the outlined organizational elements can be improved to better the functionality of primary care teams and enhance patient engagement in the medical care process.

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