Healthcare organizations adopting a strategy to develop an accountable care organization and improve patient engagement often select information technologies early in the process.

Gregg Malkary
Gregg Malkary

While IT plays an important role, it may best serve the emerging ACO by being implemented later in the process, contends Gregg Malkary, founder and managing director at Spyglass Consulting, which offers market intelligence on mobile computing and wireless technologies.

He contends that if an organization does not yet have a robust patient and provider engagement plan to drive the initiative, no amount of IT will help the ACO thrive.

In a recent report, Spyglass examines findings from interviews earlier this year with more than 100 hospital professionals in 100 hospitals, and the research identified clinical process gaps for engaging patients and families within the care process, current digital engagement tool uses, barriers for widespread tool adoption during hospitalization, challenges in integrating tools with evidence-based pathways and care management programs.

In the survey, one quarter admitted that they had no patient digital engagement strategy, Malkary notes. Typically, survey respondents admitted that they don’t understand engagement, and no one in the organization knows what to do, so they lack the personnel and expertise to move forward.

The survey also found that some hospitals are hobbled by having multiple patient engagement strategies and technologies. Every department is buying its own engagement tools, and each strategy is separate from the others, Malkary observes.

What can help to reboot and build a digital experience strategy is to make the initiative part of the organization’s mission statement, Malkary advises. “It’s culture, people, processes and tools. Note that tools are the last step. You don’t throw technology out in the environment until you know what you’re trying to solve.”

A core finding from the interviews was that no one would commit to having all the answers and demonstrating a robust patient/family engagement program, Malkary notes. The reason why emerging ACOs have experienced little success in engagement is because engagement isn’t yet a priority for them.

For example, patient portals offering health information, education and access to medical records were mandated under the Electronic Health Record Meaningful Use Program, and hospitals tried to respond by offering educational content to improve patient satisfaction over their internal television networks. They found that TV was used only for entertainment, in part because patients couldn’t figure out how to use the educational features, so education hasn’t been a priority.

Too often, nurses don’t talk to patients about the value of a patient portal, and while they may explain the basics of how to sign up for the portal, the Spyglass survey didn’t identify any specific training for getting patients to use the portals. As a result, when patients and their family members are discharged, they don’t know how to use the portal, Malkary says.

In the hospital, there is little real documentation that a patient was prescribed educational content, and actually viewed it and reviewed findings with a nurse.

Nurses already are overwhelmed, Malkary acknowledges; they have no time to educate patients on the technology they can use to stay engaged, so education is not coordinated within their clinical workflow. And, doctors are focused on the brief minutes they have to talk to patients, and they also are aware that they are being scored on performance and volume, so there’s no time to educate.

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The bottom line, Malkary asserts, is that portals and educational television haven’t made a big difference in the patient experience and outcomes.

To reverse this trend, Malkary suggests that providers focus for 12 to 18 months on patients with chronic conditions, because these are the individuals accounting for much of the care delivered, and these patients can support digital engagement, he adds. “The low-hanging fruit is chronic care and congestive heart failure.”

Still, barriers remain and continue to confound patients, he bemoans. “I’m in the hospital signed up for a portal. Now, I’m in the community and have another portal, and my cardiologist has a different portal.”

What’s needed, Malkary says, is portal technology that provides a longitudinal patient record with consistent content supporting acute care and ambulatory environments, as well as bringing ancillary providers into the fold. “This requires clinicians to actually be engaged,” he warns.

For instance, the role of chief nurse information officers is all over the map and there is a need for cultural change toward acceptance of digital engagement tools. A hospital could hire a chief experience officer but the organization first must have a team focused on patient engagement before adding the experience officer, or in conjunction with the hire, Malkary explains.

The report, “Healthcare Without Bounds: Trends in Digital Patient Engagement,” is available for purchase here.

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