WHATS YOUR DEFINITION OF PATIENT ENGAGEMENT & DOES TECHNOLOGY PLAY A ROLE?

2. Patient Engagement WHATS YOUR DEFINITION OF PATIENT ENGAGEMENT & DOES TECHNOLOGY PLAY A ROLE? PRESENTER: LOU SEMRAD, BSN, MBA DIRECTOR, CLINICAL SERVICES HOMETOWN HEALTH

3. Patient Engagement How does your organization define patient engagement? Web based portalsPatient centered care continuity of care Social media Technology (HIT) Expensive$$$ Education Patients dictating terms of care Patient what?

4. Patient Engagement • Some events that will shape your definition. • Meaningful Use – strong emphasis on patient engagement • Growth of social media and access to the internet • Focus on improving health among targeted population • Reducing unnecessary readmissions • Improving compliance • On-going healthcare needs – chronic conditions that need continual contact with healthcare staff • Patient driven – as deductibles increase, patients may demand greater access to their health information to help them with healthcare decisions

5. Patient Engagement Overview • To successfully participate in the government’s EHR incentive payment program, it’s not sufficient to simply purchase a certified system and start using it. CMS regards patient engagement as a key component of meaningful use. • It’s not about the technology; it’s about transforming health care delivery for the benefit of patients and everybody else involved in their care. • Seidman, J. Guiding Principles for Stage 1 Meaningful Use Adjustments. • Patient Engagement: Achieving Meaningful Use, by: Elizabeth W. Woodcock, MBA, FCMPE, CPC

6. Patient Engagement Stage 1 • Patient Engagement: Achieving Meaningful Use • 4 of the 25 criteria for Stage 1 focus on patient engagement. • Provide clinical summaries for patients for each visit • Provide patients with an electronic copy of their health information, upon request • Send reminders to patients, in the manner requested by patients (≥65 years of age or ≤5 years of age) • Provide patients with timely electronic access to their information (patient portal) • For successful demonstration of “meaningful use”, physicians can get bonuses up to $64,750.

7. Patient Engagement What does certified mean? • Patient Engagement: Achieving Meaningful Use • To qualify as a certified EHR, the system must support the performance of each of the meaningful-use criteria set forth by CMS and it must enable a participating professional to report each of those objectives. The HITECH Act empowers the Office of the National Coordinator for Health Information Technology (ONC) to certify EHRs — complete systems and EHR modules — as qualified. ONC has created a comprehensive list of systems that have been tested and certified under its temporary certification program. • This list is continually updated, and can be viewed online at: • http://onc-chpl.force.com/ehrcer

8. Patient Engagement Meaningful Use • Stage 2 Meaningful Use • CMS released Stage 2 MU proposed criteria on February 23, 2012 • Published in the March 7th Federal Register • Public comments due no later than May 7th • http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4443.pdf

9. Patient Engagement Meaningful Use Proposed Eligible Hospital/CAH Objective: Provide patients the ability to view online, download, and transmit information about a hospital admission. We propose this as a core objective for hospitals in Stage 2 with the following information that must be available as part of the objective: • Admit and discharge date and location. • Reason for hospitalization. • Providers of care during hospitalization. • Problem list maintained by the hospital on the patient. • Relevant past diagnoses known by the hospital. • Medication list maintained by the hospital on the patient (both current admission and historical). • Medication allergy list maintained by the hospital on the patient (both current admission and historical). • Vital signs at discharge. • Laboratory test results (available at time of discharge). • Care transition summary and plan for next provider of care (for transitions other than home). • Discharge instructions for patient, and • Demographics maintained by hospital (gender, race, ethnicity, date of birth, preferred language, smoking status).

10. Patient Engagement Meaningful Use Proposed Eligible Hospital/CAH Objective: There are 2 measures for this objective, both of which must be satisfied in order to meet the objective. 1. More than 50 percent of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH have their information available online within 36 hours of discharge. 2. More than 10 percent of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH view, download, or transmit to a third party their information during the EHR reporting period.

11. Patient Engagement Meaningful Use Stage 2 MU: The second measure represents a new concept for meaningful use criteria, because it measures the hospital based upon the actions of the patient.

12. Patient Engagement Meaningful Use Stage 2 MU: Stage 2 Timeline Delay “Finally, we propose a minor delay of the implementation of the onset of Stage 2 criteria. In the Stage 1 final rule, we established that any provider who first attested to Stage 1 criteria for Medicare in 2011 would begin using Stage 2 criteria in 2013. This proposed rule delays the onset of those Stage 2 criteria until 2014, which we believe provides the needed time for vendors to develop Certified EHR Technology.” CMS

13. Patient Engagement Meaningful Use Stage 3 MU: We anticipate that Stage 3 meaningful use criteria will focus on: promoting improvements in quality, safety and efficiency leading to improved health outcomes; focusing on decision support for national high priority conditions; patient access to self-management tools; access to comprehensive patient data through robust, patient-centered health information exchange; and improving population health. http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4443.pdf

14. Patient Engagement Technology Increasing Access to High Speed Internet & the Use of Mobile Platforms (mHealth) 2000 5% of the population had access to high speed internet 2012 >50% have access to high speed internet Source: www.internetworldstats.com Kaiser Permanente allows patients access to their EHRs on their mobile devices and just launched an iphone app and has surpassed 3 million users of its online personal health record. Source: www.mobilehealthnews.com

15. Patient Engagement Technology Improving Health Among a Targeted Population We anticipate that Stage 3 meaningful use criteria will focus on: promoting improvements in quality, safety and efficiency leading to improved health outcomes; focusing on decision support for national high priority conditions; patient access to self-management tools; access to comprehensive patient data through robust, patient-centered health information exchange; and improving population health.

16. Patient Engagement Technology Reducing Patient Readmissions: CHF Patient Hospitalization

17. Patient Engagement Technology Patients With On-going Care Needs Depression Compliance issues

18. Patient Engagement Funding • $20,000,000,000 • The amount of funding made available in the HITECH Act for HIT. • Equivalent to 100,000 homes valued at $200,000 each • Healthcare organizations that do not implement EHRs will face penalties.

19. Patient Engagement Why do this • Link Between Technology and Patients Involvement • CMS is a driving force with the industry following • ACO model rewards efficient, quality healthcare • Access through technology helps begin the conversation between patient/family and care provider • A 2012 National eHealth Collaborative survey found 73% of respondents felt “better care coordination” would be the most important benefit of health info exchange

20. Patient Engagement Why do this Link Between Technology and Patients Involvement 4 federal programs will drive policy through incentives/penalties that necessitate patients being involved (engaged) in their health & well-being, improving their outcomes and their experiences: 1. VBP 2. Meaningful Use 3. Avoidable readmissions 4. ACO’s

21. Patient Engagement Challenges • Comprehension • Left behind – may not have insurance provider pushing them • Lack of physician leadership / provider adoption • Lack of motivation – personal and institutional • Access to high speed internet • Lack of recognition that they need to take command of their health • Funding • Interoperability standards

22. Patient Engagement Why patients may drive it • Patients Asking for Access to Their Health Information • Increasing deductibles • Increased activity from insurance providers for their beneficiaries to become involved (engaged) and be self-managers or active consumers of healthcare (lower premiums are the carrot) • Increasing use of mobile devices (Gen Y spends more time on the computer than watching TV)

23. Patient Engagement Key Success Factors Components of an effective Engagement Strategy Acknowledgement that your organization and patients are going to have to communicate in new ways Define not just the patients role, but the role of key healthcare members (case managers, PCP) Assessment of patients needs (comprehension level, communication ability, physical limitations) Tailor information to the individual (relevant information to a patients circumstances) Flexibility and guidance to help reduce patient anxiety and increase dialogue about health-related issues Ability of healthcare members to track patients engagement and comprehension (allows team to adjust educational materials for example) Support the care of the patient across all continuums of care (care transitions) Patient access to information that meets their abilities (based on the assessment)

24. Patient Engagement How does your organization define patient engagement? “care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions”. Joshua Seidman, PhD