With the focus primarily on the hospital or inpatient setting, it’s easy to forget about the ambulatory or outpatient setting when it comes to patient experience.  However, as the country continues to shift its efforts to preventing medical problems rather than simply fixing them, the spotlight is moving to the outpatient setting.  Therefore, it is equally, if not more important for those  in the medical practices to take the necessary steps to assure their patients’ experiences are top notch in this new care delivery model. 

Positive Outcomes and Opportunities

The benefits to improving patient experience are plentiful, regardless of the care setting.  However, the Language of Caring has done a great job highlighting and explaining specific areas within the outpatient setting where increasing quality patient experience can bring about positive contributions and opportunities.  Here are the exact details they provide:

1. Improved outcomes and healthier patients – Improved quality patient experience in medical office settings brings about optimal health outcomes. Patients are less anxious in their visits and communications with the physician and care team. The physician and other staff are more successful eliciting needed information from patients and engaging them in decisions that affect their health. Because of greater trust, they are more likely to relax and cooperate during procedures, take their medicine, adhere to their care plans and follow-up with their care, improving care outcomes.
2. Patient retention, loyalty, and growth - By providing consistently satisfying patient experiences, medical practices and other ambulatory care centers win patient loyalty and become a provider of choice. Patients spread the word, which brings in even more patients.  As people engage in provider-shopping, services that provide a quality patient experience attract new patients via positive word-of-mouth from their current patients. Also, provider scorecard initiatives are proliferating to assist purchasers in their buying decisions. Providing a quality patient experience is a powerful growth strategy.
3. Success with accreditation and regulatory agencies - Agencies that accredit health plans now scrutinize patient satisfaction data during the accreditation process. Health plans annually measure patient satisfaction as an external review and accreditation requirement of the National Committee for Quality Assurance (NCQA), which instituted a member satisfaction survey as part of its Healthcare Effectiveness Data and Information Set (HEDIS) quality standards as well as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey that measures the experiences of patients with their physicians and medical groups.
4. Favored relationships with health plans - To become the plan of choice for consumers, health plans want to show high CAHPS scores to prospective customers. They know members defect when they are dissatisfied and they want to retain them in their plans, so most have instituted several incentives or sanctions—all designed to encourage practices and other ambulatory care settings to enhance the patient experience.  The better a medical practice or ambulatory care center satisfies its patients, the greater negotiating power with payers.
5. Lower costs of doing business – By providing the exceptional patient experience, medical practices and ambulatory care centers also reduce the costs of doing business. Patients more satisfied with their experience are also less likely to file malpractice lawsuits that drain provider time, energy and coffers. Also the work climate is more satisfying to staff which in turn reduces costly staff turnover.
6. Reputation, pride and satisfaction – In an atmosphere of consumer savvy and scrutiny, the quality patient experience wins physicians and ambulatory care centers an admirable reputation and a grapevine that results in widespread respect in the community. Members of the care team build relationships with patients that last. People trust the care team, and because they are more satisfied, they complain less. All of this translates into the psychic rewards of greater job satisfaction for the care team and greater pride in their impact on their patients’ health status.
7. Profitability - By providing an exceptional patient experience, medical practices and ambulatory care centers win favor from consumers, purchasers, accrediting agencies and health plans that affect their practice’s financial health and profitability. 

As the U.S strives to change patient experience from a fad to a priority in how we deliver care, outpatient medical practices need to understand the positive impact improvement can make, not only to their business operations, but more importantly to the outcome of patient care.

What other benefits do you see by improving your patient’s experience?

1. geospatial,
2. genomic and
3. geocaching.

Let me show you how all of these have relevance to healthcare:

Let’s start with geospatial. 

I am fascinated by the heat maps of disease prevalence, patient engagement and demographics that have started to electrify Healthcare.  Duane Schafer, Director of Microsoft Business Intelligence for Perficient, recently revealed a great demo at HIMSS, based on Population Health statistics from ProHealth in Wisconsin.  Using basic tools from the Microsoft stack, Duane was able to visually map important population health statistics from ProHealth and present that data in a way that entices the viewer to explore deeper.  It allows the organization to see, at a glance, major population demographics in their region.  This can then be combined with additional analytics to determine trending of disease in the area, frequencies of patient visits to the Emergency Departments over time and correlations of missed appointments to care gaps in specific chronic disease management.   Geospatial mapping even hit the news recently when a contamination at Lake Champlain caused concern about the risk of spreading disease and therefore assisted with facilitating a rapid Public Health response in this  situation. Of course, there are many more examples but you get the idea.

Secondly, genomic mapping

Genomic mapping and personalized medicine have emerged at the forefront of cutting edge research and treatment.  Pharmacogenomics have been utilized for targeted cancer treatments, anticoagulation treatment choice and diabetes management already.  In a February 28, 2014 article in BMC Medicine, “Personalized medicine: risk prediction, targeted therapies and mobile health technology”, several forum contributors wrote about new and exciting potential uses for genomics and personalized medicine in stroke prevention and treatment, oncology and mobile health.  One particular passage summed up the future use in medicine quite well:

“My second vision for the future is the next-generation sequencing approach. This is the future of oncology, and we are really looking forward to that. The third area for the future of personalized oncology, I think, is not so much a scientific revolution as it is a sociologic revolution, and that is the issue of being able to look at so-called ‘big data’. With the advent of the use of electronic medical records in many medical practices around the US, we are going to have the ability to potentially review millions of patients’ outcomes in the future and apply the lessons we have learned from previous retrospective analyses of how patients do when they are treated in various ways.”

This encourages me to think that eventually information, genomics and individualization WILL combine to vastly improve our ability to provide healthcare for each unique individual.  So IBM’s Watson or the Oracle Health Sciences Translational Research Center could help provide the backbone.

Finally there is geocaching. 

What could geocaching have to do with healthcare, you ask?  I believe it adds the final piece to the puzzle.  Geocaching could be used for gamification in healthcare, as described by Perficient’s Martin Sizemore and Melody Smith Jones, allowing patients to do a virtual Healthcare “cache” and collect badges when they complete their prescribed exercise or educational lessons suggested by their provider.  Better still, geocaching could be used as the exercise component of a wellness program managed by a Healthcare provider, system or health plan.  Not only would it exercise the body, but it would also challenge the mind.

So is Healthcare a leader or a follower when it comes to mapping?  I’m curious to know your thoughts so tweet me @DrMarcieSC.

1. Data collection
   “Payers collect a lot of data, which can provide a broad picture of what is happening in a population and across the entire continuum of care. Health systems bring a rich vein of information related to specific components of that continuum.”
2. Transparency
   “We rely on this data to make sure we know what works, and when it doesn’t work, we use the information to identify opportunities for improvement,” says Kevin Sears, vice president of payer strategy and product development at CHE Trinity Health in Lavonia, Mich.
3. Mutual understanding
   In the past, providers worked to drive up revenue from the payer, while the payers needed to drive down costs to please their customers, both employers and employees/members. Now the two have to work together to reduce waist and improve care.
   

Now, we see that payers and providers must collaborate in order to truly drive value, more so than they ever needed to in the past.

When payers and providers work together to achieve all three of the above imperatives, they’ll identify opportunities that will become mutually beneficial. Each can begin by asking themselves whether their high-priority projects are working to help them to obtain higher transparency, data collection and sharing, and a mutual, more collaborative relationship with the other.

Combining clinical and financial data for cost management is a popular topic given the political and economic environment. This activity generally includes these data requirements:

• Claims data for diagnosis codes, patient demographics and encounter information and services provided; this data usually resides in the patient billing system
• Clinical data such as labs for quality and outcomes ; this data usually resides in the EMR, EHA or other ancillary clinical systems
• Accounting and finance data from the general ledger, budget and sub-ledger systems.

Assembling this data requires a robust technical architecture that easily stores the data relationships with contextual integrity along with the ability to resolve patient or person identity. Once the data is assembled, leaders of the organization can build disease registries to manage the cost of care for populations and to model service line profitability, analyze payer contracts and more. The most important benefit of this transformation is that the organization begins to speak a common language of accountability and front line managers begin to understand the relationships between volume drivers and departmental workload leading to increased ownership of controlling these variables.  The costing step is important ensure the data as well as the transaction level calculated cost is fully accessible to decision makers.  All too often we hear that “my patients are sicker than theirs” or my surgical device has better outcomes.  The proof is in the data!

The Oracle Enterprise Health Analytics (EHA) platform in concert with the Oracle Hyperion Profitability & Cost Management (HPCM) solution facilitates the merging of clinical and financial data to perform costing calculations. This fully burdened cost data associated with other clinical metrics such as quality and outcomes measures answer both administrative and operational questions.   Using the Oracle platform, patient volumes, outcomes and operational measures are not viewed in an independent environment but instead become dependencies to understanding case mix index, reasons for readmissions, and staffing mix (on a case level), among other things.

Perficient offers design, implementation and support capabilities for Hyperion Profitability and Cost Management (HPCM) and Oracle Enterprise Health Analytics (EHA) solutions as well as the full Oracle Hyperion EPM suite of solutions.  We are a silver sponsor for the #OracleIC14  and we are looking forward to talking with you about Health Analytics and Population Health.

Stop by to meet our dynamic team at the Partner Networking Zone, Marriott Copley Square, 4th Floor to discuss new ways to optimize your systems, along with new solutions that will take your organization to the next level.

Join us in Boston! Follow our healthcare experts on Twitter @Perficient_HC and check our Healthcare blog.

Follow me on twitter @teriemc

View my recent blogs:

Elevating the Role of Finance within the Hospital

Enterprise Warehouses: The Gift that Keeps on Giving

Balancing clinical effectiveness with profitability

The Health and Life Sciences breakouts will showcase how these organizations are implementing enterprise-wide data warehouses and analytics capabilities that provide a comprehensive view of healthcare operations—patient visits, diagnoses, test results, prescriptions, referrals, and more—making it possible to arrive at insights that can lead to improved patient care and outcomes.

Perficient is uniquely positioned to deliver the Oracle Enterprise Health Analytics (EHA) platform as well as strategic healthcare analytic roadmaps.  Our Oracle EHA based analytic solutions and dashboards provide clients with a short time to value solution that meets immediate needs around disease management, operational efficiency, costing and profitability and quality.

Stop by to meet our dynamic team at the Partner Networking Zone at #OracleIC14, at the Marriott Copley Square 4th Floor to discuss new ways to optimize your systems, along with new solutions that will take your organization to the next level.

Join us in Boston! Follow our healthcare experts on Twitter @Perficient_HC and check our Healthcare blog.

Follow me on twitter @teriemc

Why do I believe that? Well, I felt that many of the attendees at the Colloquium were seeking real how-to knowledge.  Not that the big healthcare organization’s experience in implementing population health management aren’t valuable insights, but there was a lot of buzz about whether population health management can be done in a cost effective manner, and this presentation addressed the type of informatics required to change traditional approaches.  The first step was to outline the process in a slide called Population Health Management 101.  The key concept was moving paper processes for care management to a digital platform to analyze and manage costs, see figure 1.

Figure 1. Population Health Management 101

Figure 2. Re-engineering Clinical Care

The second idea was to re-engineer clinical care to identify and manage care gaps.  The first step is to identify the key populations to be managed, then determine the key Goals for that population, and finally to manage addressing the gaps in care or Action Arms (Figure 2).  Note that different populations have unique goals but subsequently could have common Action Arms.  To address creating the care gaps and related Action Arms, the healthcare organization has to have a strategic vision for these target populations and combine that with the right tactical tools, namely informatics.  The challenge of creating these informatics isn’t simply addressed with technology tools, but requires several key steps including:

• Structured Data Capture vs Natural Language Processing (NLP)
• Diagnosis Naming Conventions
• Establishing the Digital “Gold” Standard”
• Influencing the Problem List
• HCCs and Chronic Disease Management
• Best Practice Alerting and Health Maintenance Modifiers
• Guideline Based Bundles and Closing Care Gaps

Addressing Care Gaps is very practical advice for healthcare organizations seeking to really manage populations. Creating informatics solutions that support closing preventive, chronic and restorative care gaps will drive health care value for patients and health plans alike.  Creating these informatics requires data mining, process re-engineering and the ability to extract data from modern electronic health record systems.  Building patient-centric plans of care based on this process will need to be supported through proactive outreach as well.  The key is applying technology tools in novel ways to enhance shared decision-making between the clinician and patient.

Lesli Adams outlined what I see as the key factor to population health management: cost management.  The integration of clinical information and financial data is key to cost management and often this data resides in silo’ed or separate software applications.  The ability to manage costs by having standardized pathways, then examine costs at a Patient Level will lead to better decision-making and more cost effective care.  Putting the disciplines in place to examine physician variability against the standardized pathways is the enforcement technique to bring costs under control.  When organizations commit to collecting and cleaning this level of costing information, then profitability reports by service line, DRG and Physician become reliable tools for key decisions about operations.  One of the highlights of the presentation was micro-costing examples to highlight the key decision points for clinicians.

Lesli Adams will be presenting at the Oracle Industry Connect event on Tuesday and Wednesday, March 25-26 in Boston.  For more information on Perficient’s informatics offerings, especially related to Population Health Management, please contact us.

Dr. O’Rourke stated that CHE Trinity was one of the largest home care providers in the United States and that their healthcare organization encompassed 86 hospitals and 21,600 physicians.  More importantly, CHE Trinity was participating in 6 bundled payment programs and 29 patient centered medical home programs.  His observation that “All Healthcare is Local, All Healthcare Standards are National” comes from an understanding of the need for clinically integrated networks and the role of data driven decision making in reducing variations in outcomes.  Terry noted that despite hard work on adopting standards that there is still a wide variation in healthcare delivery.  He also noted that the lesser but still significant variation in outcomes across a large healthcare organization was more proof of the resiliency of human body than the careful adoption of standardized procedures.

The key to his presentation was the observation that clinicians need to lead the effort to standardize care, not hospital administrations or others.  CHE Trinity created a unified clinical organization with the help of outside consultants that streamlined many silos within the large organization into a whole unit.  As a result of unifying the clinical organization, Dr.  O’Rourke noted that operating cash flow margins improved to 9.4 – 9.6% across the system.  The second step beyond unification was to improve their reporting to encourage data driven decision-making.  It was interesting to see how the metrics were converted into grades, like school grades, for easy consumption and judging performance.   The different hospital boards had GPAs ranging from a low of 2.1 to a high of 3.6 on a 4 point scale.  The goal of the data-driven decision support process was to improve the ease of consuming and acting on the information.

To summarize, Dr. O’Rourke said that “good care is cost effective care.”  Clearly, CHE Trinity is focused on bringing a level of consistency in clinical procedures in population health management and improving cash flow margins in the process.  As with most organizational business solutions, the focus on people and process yields the best results with technology playing a supporting role was my observation.  The focus on people, patients, as the central figure in their clinical processes is real population health management.

We will be having a conversation with Christine Bessler, CIO and VP of Information Technology at ProHealth Care and Juliet Silver, Director of Healthcare Advisory Services at Perficient on Wednesday, March 26. We will be discussing some of these issues as well as how ProHealth Care was the first healthcare system to produce reports and data out of Epic’s Cogito data warehouse in a production environment.

During the session, Christine will be answering the following questions:

• How did they deliver clinically integrated insights to 460 physicians
• How access to analytics allows their physicians to easily see which patients need important health screenings or care interventions, setting the stage for enhanced preventive care and better management of chronic diseases.
• How ProHealth Care’ developed their strategy to integrate data from Epic with information from other EMRs and data sources to deliver clinically integrated BI
• How ProHealth Care is positioning itself to deliver against an advanced self-service BI capability in the future.

Juliet will share insight into the methodology applied to establish data governance as a discipline at ProHealth Care, and how the Business Intelligence Competency Center came to be.

Christine Bessler will answer these questions and more during our free webinar on March 26th at 1:00pm CT.

To register for the webinar click here.

As my colleague, Lesli Adams @lesliadams writes in her blog: “A healthcare treasure map leading to a single data warehouse”, the Oracle Enterprise Health Analytics platform is a treasure trove of data.  The platform combines Oracle Database, Oracle Healthcare Data Warehouse Foundation, and data modeling, integration, and analytics capabilities in an integrated stack that runs on Oracle’s highly engineered Exadata Database Machine. The result is a scalable, high-performance data warehouse that serves as a central repository for health data analysis, which can be done using the built-in tools that come with the system, Oracle Endeca Information Discovery, Oracle Business Intelligence Enterprise Edition, or other analytics applications that are available to run on it.

Perficient is uniquely positioned to deliver the Oracle Enterprise Health Analytics platform as well as strategic healthcare analytic roadmaps.  Perficient will be at the Population Health Colloquium #pophealth, and we are looking forward to talking with you about Health Analytics and Population Health.

See our presentation on Tuesday at the Mini Summit on Shared Accountability:  How Informatics and Data for Clinical Decision Workflow Engages Consumers on the Quality/Cost Equation. Sponsored by Oracle Health Sciences and Perficient, featuring:

Sanjay Udoshi, MD, (@smudoshi) Physician Architect, Clinical Analytics, Product Strategy, Oracle
Lesli Adams (@lesliadams), MPA, Director, Oracle Healthcare Business Intelligence, Perficient, Inc.

Meet our dynamic team at booth #32 to discuss new ways to optimize your systems, along with new solutions that will take your business to the next level.

Join us in Philadelphia! Follow our healthcare experts on Twitter @Perficient_HC and check our Healthcare blog.

Follow me on twitter @teriemc

What are the benefits of online patient communities?

I find myself answering this question quite a bit lately.  It struck me this week that I have never answered this question on the blog.  But, first things first, what is an online patient community?  Online patient communities are, essentially, condition specific socially enabled support groups.  These networks provide patients with an opportunity to connect with those that are experiencing similar challenges.  Together this collective of voices provides helpful discussion and the sharing of resources.  By their very nature, their benefits are many.  However, when they are organized by a trusted authority in care, namely healthcare providers, the benefits grow quite dramatically.

So, here is my list of the benefits of online patient communities.  Have any more to share?  I’d love to hear more from your experiences in the comments section below.

• Social provides connections to those that are not mobile.  Let’s just be honest, appointment scheduling conflicts and transportation difficulties are typically a part of the patient experience.  It is oftentimes the case that patients and patients-by-proxy (caregivers) cannot physically attend a support group.  Any opportunity to lift barriers during the course of treatment is a welcomed reprieve from everyday turmoil.
• Patients-by-proxy are more likely to open up.   According to Pew research, while 33% of patients participate in online patient communities, more than half of patients-by-proxy do so.    In that same survey, 34% of these caregivers actively read patient commentary about a specific medical issue online and 22% of those caregivers actively reach out to those that might have similar concerns.
• Online patient communities provide support without bounds. Social networks are used, quite frequently, by the retail and consumer goods industries for consumer outreach purposes.  I don’t know of a loyalty program  stronger than one that could be used to save lives.     Social communities are a fabric of ties that lead to sources of support, information, and collective experience.  The goal of these communities is to foster communication between those without knowledge and experience to those that can “mentor” and provide support.  More informed patients are healthier patients.  Some of the tangential benefits of this enablement include: 1) Better understanding of health and medical conditions, 2) Improved recall of the care plan, 3) Feeling more in control of care, 4) Taking better care of themselves, and 5) Better adherence to medications as prescribed.

There are some additional benefits for the healthcare provider as well:

• Better sample groups mean better research.  For those researchers aimed at helping through analysis, online patient community demographics are actually a more accurate representative sample of a given patient population than can be found in a traditional support group.  There are two studies that back this claim up.   One study looked at an online patient community specific to scoliosis.  Researchers found that the members of this community had similar demographics to the scoliosis population as a whole.   Another insight is taken from the fibromyalgia group on PatientsLikeMe that showed this group to be representative of those with that condition at large.  Why is this?  Breaking down geographic boundaries is a great way to also break down the socioeconomic and cultural chasms that often exist in traditional groups.
• Time efficiencies in group care. Check out any online patient community and just underneath the surface you will find the voice of the members mentioning that they were unable to get the medical information they needed from their clinician.  So, these patients often turn to Dr. Google.  Using these communities, clinicians can provide accurate information is a mass customized format to an entire community of similar patients.  This is particularly helpful in those instances when new information or alerts need to be provided to the entire population at one time
• Strengthens the partnership between patient and provider.  Let’s just be honest, a typical physician schedule does not often leave time for participating in support groups.  With a provider sponsored online patient community, a clinician, in the form of the community manager, is on call 24/7.  Provider sponsored clinicians that act as patient advocates to address general and condition specific questions to the entire community are a valuable asset.  Many clinicians are surprised at how different the questions patients will ask in online patient communities are from those they will ask in the doctor’s office.  For example, migraine patients will often ask Dr. Google “will I die from this?” while physicians rarely if ever hear that question in the office.
• Social synchronization with care protocols.  When these social features are enabled through the patient portal, patients become truly enabled with knowledge.  There, within a single view, patients can take their new found knowledge and then apply that knowledge to their care protocols.  This experience can be taken a step further through gamifying that experience.  For more information, please check out “Healthcare Gamification: Is it time for Physicians to prescribe gaming to patients?” and “Beyond Gamification: Revolutionizing Healthcare with the Quanitifed Self“.