Bolstering meaningful patient engagement is among the top goals and connected uses for technology that health systems are implementing. From a business perspective, they’re doing it to ensure continued use of services. But they’re also doing it from a medical perspective to ensure continuity of excellent care.
WellSpan Good Samaritan Hospital, Lebanon, Pa., for instance, has engaged with patients through MyWellSpan, a portal that provides them access to their health information and a direct connection to their care team that’s linked to WellSpan’s EHR system. And it’s used frequently: 73% of patients who have had an appointment in the past year have set up an account, and 83% of those with at least three visits have done so, according to Hal Baker, MD, senior vice president, chief digital officer and CIO.
The health system most recently received a 7 on the 0-to-7 EMRAM (Electronic Medical Record Adoption Model) scale, a widely accepted benchmark promulgated by the Healthcare Information and Management Systems Society for how well health systems are engaging their patients. “EMRAM measures specifically what hospitals are doing with EHRs to look at how to achieve best outcomes for patients,” says Anne Snowdon, RN, PhD, FAAN, chief scientific research officer at HIMSS.
Among the reasons patients are drawn to MyWellSpan is the uploading of images ranging from fetal ultrasounds to broken bones, 337,000 of which had been viewed between Jan. 1 and June 23 of this year alone, Baker says. “We actually give you a link to the images,” he says. “You can look at a video of your child kicking in the womb and show that to the grandparents. Kids like to have their moms show pictures of their broken bones. … We always said, ‘We want to have the patient portal we want when we’re patients or our family needs care.’ That’s helped us push the limit a little bit.”
The image links can show a cancer patient visual evidence that their tumor is gone, Baker adds. “Sometimes, emotional healing happens when people can see with their own eyes,” he says. “You can read a report that says your tumor is gone, or you can look at the images and see that it’s gone.”
Another portal feature is online scheduling, along with a “Fastpass” option that automatically sends text messages to those on a waitlist to move up their appointment time. “If, on a Friday night, somebody cancels an appointment for Monday morning, we don’t have anybody [on the phone] over the weekend to schedule a new appointment,” Baker says. With this system, “they can take an appointment at 8 on Monday morning. That allows somebody to be seen. They’re happy.”
And they’re not alone. “It makes the business office happy because nobody has to make a call to reschedule, and it eliminated an unused vacant appointment,” he adds. “We always had online scheduling that people could do themselves—now, the computer is going out and searching for someone to fill that vacancy.”
Tech Adapting to In-Person Needs
Technology also has enabled caregivers to engage patients face-to-face in a way they did before EHRs required so much note-taking. Using an AI-powered product, clinicians can record their conversations, have them automatically transcribed and then converted to a medical note by the AI, have those medical notes proofread by someone on the vendor’s staff, and drop them into the patient’s chart in less than two hours on average, Baker says.
“A lot of people say that the doctor pays more attention to the computer than to them,” he says. “This allows you to better focus on the patient, rather than type something into the computer.” More than 200 doctors at WellSpan are using the AI-powered, voice-enabled, ambient clinical intelligence solution, and “we’re hearing very, very strong stories about how it lets them do the thing they went to medical school for.”
The product not only transcribes the recording but reorders it so that it’s written as a medical note, Baker says. “If computers can quietly observe and take care of that, we believe our care teams will provide better care and be more empowered and content with their jobs,” he says. “Judges don’t take their own notes. The chairman of the board doesn’t take their own minutes. But we’ve asked doctors to do that.”
All these innovations are inspired by WellSpan medical staff imagining themselves or their family members as the patient, Baker says. “All of us eventually become patients. Life has a 100% mortality rate,” he says. “We want that caring, compassionate, easy access: care team members that are focused on us and access to our information wherever we are.”
Happy Patients Equals Improved Care
Enabling new and creative uses of its EHR vendor’s patient access portal has been central to patient engagement efforts at Valley Medical Center, Renton, Wash. The organization achieved a 7 on the HIMSS EMRAM scale, improving both outcomes and patient satisfaction, according to Robert Molina, chief digital officer, chief medical information officer and chair of the portal’s committee. “Patient engagement is what it’s all about,” he says. “When patients are more involved, they are happier with their care and their health improves. It’s a win-win.”
The EHR enables care managers to reach out to patients and remind them to schedule a mammogram, for example, or alert them of an abnormal result, Molina says. “Patients with chronic diseases are the ones that really benefit,” he says.
The advantages for patients include easily seeing their lab results and key metrics like blood pressure readings, along with notes from their physician and healthcare team; keeping them informed; and helping with understanding, accountability and worrisome responses or findings.
“This can be very effective in reinforcing lifestyle changes and medication adherence,” says Molina.
Valley Medical Center has added proxy access for families of patients who end up in the hospital, which “is just a game changer,” Molina says. “Families greatly appreciate the insight this provides into the condition of their loved one, particularly those who are out of state.”
Another EHR communication tool that’s proved very popular is automated messages sent as loved ones go through different stages of surgery, which provide designated family members a status update. “There’s a lot of neat ways we’re using technology to keep patients engaged in their healthcare. It’s better for everybody,” Molina says.
For those admitted to the hospital, rooms still have traditional whiteboards with basic information about everything from names of caregivers on shift to what’s available from the cafeteria. But one can also view that information on a smartphone. For those who didn’t bring a phone, the hospital provides an iPad, Molina says. “There’s a lot of patient engagement material on there,” he says, as well as “entertainment options and games. They can see what medications they’re receiving, including links to explain what they’re for, as well as their schedule for the day,” including physical therapy, for example, or imaging tests.
Valley Medical Center also has been making use of the Fastpass, which Molina says with a chuckle makes him think of Disney World’s feature that guests can use to access rides quicker. It fills up empty spaces. “We track how much faster patients get in, and it’s often up to 20 days quicker. Patients love it.”
To encourage even greater use of the system, Valley Medical Center has been delving into the data to determine which kinds of patients use it less frequently, Molina says. “Generally, OB and prenatal patients are very engaged,” he says. “A lot of people thought our seniors would be hard [to attract], but they’re not—they’re a lot more tech savvy than we give them credit for. The key there is their grandchildren. They have a great little moment together and get connected.”
The hospital’s patient and family advisory council, which includes patients from the community, keeps an eye on feedback to ensure they aren’t leaving out any groups, Molina adds. “We talk to them, especially, about [the patient portal],” he says. “What are your thoughts? Where are the gaps? They help to steer us and provide guidance on new ideas.”
Virtual Registered Nurse
Progress West’s use of its patient portal continues to evolve, Molina says. “Early on, it was used mainly to provide basic information and allow communication,” he says. “Over the years it had progressed to something far more sophisticated. It empowers patients to be more involved in their own health and fosters a stronger partnership with their healthcare team.”
Virtual nursing has been a positive outcome for everyone at Progress West Hospital in O’Fallon, Mo. The hospital began a pilot project in January for parent company BJC Healthcare (which it hopes to expand systemwide over time), aimed to support nurses at the bedside and hopefully encourage more of them to stay long term while engaging patients earlier and more often. “We looked at the burden of nurses, and even healthcare generally, especially the night-shift staff,” says Ekene Ejimofor, DNP, RN, CNO, Progress West, who is also an ACHE Member. “How do we use technology to support the team?”
The program complements front-line nurses in the ED or inpatient units (but not, as of yet, the ICU) who are directly caring for patients with an experienced nurse who appears on screen, via a computer at the bedside, to interact with patients and serve as a mentor for the bedside nurse, Ejimofor says.
The virtual nurse says, “Hello Mr. A, I’m going to be partnering with your nurse at your bedside,” he explains. “They go over the admission and ask questions of the patient about what brought them to the hospital. The virtual nurse completes all the initial admission documentation, so the nurse at the bedside doesn’t have to spend one or two hours doing the admission.”
Progress West has a team of three virtual nurses who log in virtually across different nursing units. “We are hoping that through this initiative, we can retain experienced and highly skilled bedside nurses who may be considering leaving the bedside,” Ejimofor says. “We hear some nurses say, ‘I don’t want to do bedside anymore. I can’t physically lift patients anymore.’ We don’t want to lose their skills and expertise. And they can support new nurses by mentoring and guiding them while caring for the patient in a different way.”
Progress West, which scored a 6 on the HIMSS EMRAM scale, has and will continue to provide specific training to virtual registered nurses in areas where they might not be proficient, Ejimofor says.
“Some of them may not be familiar [enough] with some specific procedure to provide pre- or post-education to the patient and their families,” for example, he says. “A virtual nurse will remote into your room [and say], ‘Mr. A, I’m going to provide education on the procedure you’re about to have.’ If you’re not proficient in surgical [previously], we’ve trained them in some of the basic procedures to provide education and support to the patient.”
When the ED overflows and patients are waiting for an inpatient bed, the virtual nurses can start the intake process while the patient is still in the ED, which is a patient satisfier, Ejimofor says.
“Patients no longer feel like their care is not progressing,” he says. “When they get moved to the unit, instead of waiting for the physical nurse to provide education, the virtual nurses are able to remote in when the patient doesn’t have any care going on [and say], ‘Mr. A, let’s talk about your medications’ or anything that the nurse decides is vial for the patient to be educated on. The virtual nurses are filling those gaps.”
Feedback from patients and their families has shown they believe virtual nurses are both more thorough in admission assessment and patient education and appear less rushed than those at the bedside, Ejimofor says. “They are there for you and you alone at that time,” he says. “Allowing the virtual nurse to remote in and complete the admission process gives the bedside nurse time back to deliver other necessary care to their patients.”
To date, Progress West has found that virtual nurses have saved bedside nurses about 20 hours per month, Ejimofor says, while the rate of patients whose initial admission documentation has been completed by the end of a nursing shift has spiked from 50% to a high of 90% overall, and 100% in some units. “That means that I, as a nurse, coming on to a new shift, I’m not trying to complete an admission at the start of my shift,” he says. “All the information I need has been documented.”
Progress West will be tracking its progress in retaining nurses, particularly those with less than one year of experience at the hospital, as they gain the support and mentorship, Ejimofor says. They also will be measuring the rate of incidents like patient falls and pressure ulcers as bedside nurses are able to more thoroughly concentrate on the patient rather than paperwork, he says.
“We also have seen a lot of support from our physicians,” Ejimofor says. “The future state will be that when a provider is rounding on a patient, they can activate the virtual registered nurse for collaborative rounding if the primary nurse is engaged with another patient,” he says. “The physician doesn’t have to wait for the bedside nurse to return.”
The cost of the virtual nursing programs consists of the laptop wheeled into a patient’s room—Progress West is also looking into connecting through the televisions in each room—as well as the virtual nurses themselves. But Ejimofor notes that it’s hard to quantify the cost of replacing nurses who otherwise might have left the organization due to lack of support or inability to continue as a bedside nurse. “When you have the support for new nurses, and even for seasoned nurses, there’s the retention piece, versus the cost of having that nurse leave because they didn’t feel like they had support,” he says.
In what seems like something a “Mission: Impossible” character would use, Progress West will soon begin implementing special internet-connected smart glasses that the nurse at the bedside would wear. The virtual nurse would be able to see exactly what’s in the bedside nurse’s field of vision. These smart glasses will hopefully solve for various use cases in units limited in data drops and space, including skin assessments; high-risk medication signoffs; and admissions, transfers and discharge workflows that require patient visibility to complete the assessment.
“If a nurse is performing wound care and needs expert support, all he or she has to do is to activate a virtual nurse, put on the glasses, and the virtual nurse can see exactly what that wound looks like, and guide the nurse at the bedside and provide recommendations on how to treat that wound,” Ejimofor says.
Whether used for sharing imagery, scheduling appointments, transcribing patient encounters or providing remote care, these technological innovations all in some way provide better focus on and vision into new and improved ways to engage patients, to the benefit of health organizations’ bottom lines—in all senses of that term.
Ed Finkel is a freelance writer based in the Chicago area.