Patient Engagement

A healthcare startup made a wild pitch to Cara Waller, CEO of the Newport Orthopedic Institute in Newport Beach. The company said it could get patients more engaged by "automating" physician empathy. It "almost made me nauseous," she said. How can you automate something as deeply personal as empathy? But Waller needed help. Her physicians, who perform as many as 500 surgeries a year, manage large numbers of patients at various stages of treatment and recovery. They needed a better way to communicate with patients and track their progress. [Also: Patient-physician emails improve care quality] The California startup, HealthLoop, told Waller its messaging technology would improve their satisfaction and help keep them out of the hospital. High satisfaction scores and low readmission rates mean higher reimbursements from Medicare, so Waller was intrigued. So far, she's been surprised at patients' enthusiasm for the personalized -- but automated -- daily emails they receive from their doctor. "There's a limited number of resources in health care. If you do 500 joint replacements in a year, how do you follow up all of those patients every day?" Waller said. The technology "allows you to direct your energy to people who need the handholding." "Automating empathy" is a new healthcare buzzword for helping doctors stay in touch with patients before and after medical procedures -- cheaply and with minimal effort from already overextended physicians. It may sound like an oxymoron, but it's a powerful draw for hospitals and other health care providers scrambling to adjust to sweeping changes in how they're paid for the care they provide. Whether the emails actually trigger an empathetic connection or not, the idea of tailoring regular electronic communications to patients counts as an innovation in health care with potential to save money and improve quality. [Also: Healthcare security: Adapt or die] Startups like HealthLoop are promising that their technologies will help patients stick to their treatment and recovery regimens, avoid a repeat hospital stay, and be more satisfied with their care. Similar companies in the " patient engagement " industry include Wellframe, Curaspan, and Infield Health. HealthLoop's technology is being tested at reputable medical centers including the Cleveland Clinic, Kaiser Permanente-Southern California, the University of California, San Francisco, and the Newport Orthopedic Institute in Orange County, company officials said. Doctors can send daily emails with information timed to milestones in surgery prep and recovery and ask patients or caregivers for feedback on specific issues patients may face during recovery. The doctors may write their own email scripts, as Newport Orthopedics' physicians did, or use the company's suggested content. An online dashboard helps doctors and administrators keep track of which patients are doing well and who might need more follow-up care. Patients can also communicate with office staff about medications and office visits. Their responses to daily emails can trigger a call from the doctor's office. A patient might see this message: "How are you? Let me know so I can make sure you're okay. I have four questions for you today." Such a call may have been a lifesaver for David Larson, a Huntington Beach retiree. After Larson responded "yes" to an email that asked if he had calf pain after knee surgery, he got a call from his doctor's office telling him to come in immediately. An ultrasound confirmed he had a blood clot that could have landed him back in the hospital -- or threatened his life. With treatment, the blood clot dissolved and he resumed recovery. "There were times when it was like, 'Oh brother, they're contacting me again,' but none of this would have been caught if it wasn't for the email," said Larson, 66. "So it was more than worth it to me. Now I'm back to walking the dog, surfing, riding a bike." How to keep patients like Larson from hospital readmission because of avoidable complications after a hospital stay has long been one of health care's most vexing and expensive challenges. Almost one of every five Medicare patients discharged from a hospital -- approximately 2.6 million seniors -- must be readmitted within 30 days, at an annual cost of more than $26 billion, according to the Centers for Medicare and Medicaid Services. For decades, hospitals had no financial incentive to keep patients out of the hospital after they were discharged. But under the Affordable Care Act, financial penalties were established for hospitals with readmission rates higher than the national average for certain conditions. Also under the ACA, hospitals are financially rewarded for high scores on patient satisfaction scores and good performance on other quality measures set by CMS. Doctors' groups increasingly are affected financially by this sea change, either because they are part-owners in a hospital, as Newport Orthopedics is with Hoag Hospital in Newport Beach, or because they participate in other risk-sharing financial partnerships with hospitals. With that kind of money at stake, hospitals and other health care providers may be willing to pay for programs like HealthLoop, if the tryouts prove successful. And you could see your own relationship with your physician change as a result, whether you're on Medicare or not: HealthLoop is aimed at all patients, whatever the payment source. Some experts worry that health care providers will come to rely too heavily on electronic communication as a cheap substitute for the hard work of improving the doctor-patient relationship and the quality of care that patients get. "Automating personalized messages isn't a terrible thing; we all get some of that in our everyday lives," said Michael Millenson, a health industry consultant. "The real question is whether this kind of automated messaging is in conjunction with a cultural change in how doctors think about their patients or not." Health care providers have long experimented with ways to prevent complications that can land a patient back in the hospital, with varying success, said Kristin Carman, vice president of health policy research at the American Institutes for Research. Robo-calls reminding you to take your medicine, for example, don't seem to be very effective. And the new technologies don't always address demographic, cultural and language barriers that can prevent patients from communicating with their doctors. For now, HealthLoop is only available in English. Dr. Jordan Shlain, a San Francisco internist, said he founded HealthLoop because he wanted a simple way to keep track of his patients' progress after a hospital visit or procedure. "Every human has the same kind of trajectory of concerns and anxieties with regard to medical situations," Shlain said. [Like Healthcare IT News on Facebook] HealthLoop, based in Mountain View, offers "a digital extension of the doctor," he said. "You know your doctor can't email you every day; you know your doctor usually will not call you. Now you're in a world where your doctor says I'd like to use this system to stay in touch with you and guide you through your recovery." Dr. Thomas Vail, professor and chairman of the department of orthopedic surgery at the University of California-San Francisco would agree -- up to a point. With his UCSF colleagues, Vail is testing HealthLoop's system with his patients, and the university will be evaluating whether patients who use it have fewer adverse events than their peers. UCSF helped create some of the language for the automated emails and has a financial relationship with the company, said Dr. Aenor Sawyer, who directs UCSF's Skeletal Health Service and is a leader at the university's Center for Digital Health Innovation. While Vail thinks HealthLoop is potentially promising, he's cautious about its role in his practice. "I don't think it substitutes for face-to-face communication," Vail said, "but it does help us collectively to not overlook something that might be important." This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. Twitter: @HealthITNews

Doctor on Demand has expanded its telemedicine platform to include board-certified psychiatrists, the company announced on Tuesday. In December 2014, Doctor on Demand began offering mental health services with the addition of psychologists to its provider network. Extending the network to include psychiatrists will complete the mental health cycle, from therapy to medicine, officials said. "Mental health is a vital area, where there may be the most need for telemedicine," said Donovan Wong, MD, medical director of behavioral health at Doctor on Demand. [Also: Telehealth's biggest roadblock: physician reimbursement] "There's really a lack of access to care," he said. "Rural areas have the worst access, but even in big cities, like Los Angeles, the wait time is up to five weeks or more for 80 percent of the population. That's really our mission: increasing high quality care. With mental health, that's really what we'd like to do." Doctor on Demand's telemedicine platform connects patients with care providers. It started in 2012, with board-certified physicians, later expanding to offer consults with lactation consultants and psychologists. More than 300 mental health professionals can be found on the network in 27 states, including licensed psychologists and board-certified psychiatrists. The company plans to expand the services nationwide by mid-year. Currently, many patients pay out-of-pocket, but Wong said Doctor on Demand hopes to change that in the near future. The platform has partnered with dozens of employers and health plans, such as United Healthcare, providing 45 million Americans access. Last month, the company announced it signed its 400th corporate customer. “Many Americans don’t have access to mental health treatment, and for those that do, long wait times, distance, cost and stigma are still barriers to getting care.” Wong said in a statement. "These are all challenges telemedicine can address." [Like Healthcare IT News on Facebook] A 2013 National Survey on Drug Use and Health estimated one in five adults aged 18 or older had a mental illness, but only 45 percent of these affected parties received treatment. Furthermore, 55 percent of the nation's 3,100 counties have no practicing mental health workers and the average wait time to see a psychiatrist is two months in some cities and eight months in rural counties. "Too many people don’t know where to turn for mental health care, so they get overpriced care, the wrong care, or no care at all," said Adam Jackson, co-founder and CEO of Doctor on Demand, in a statement. "By adding psychiatrists, we're striving to meet our mission of increasing access to high-quality care.” Twitter: @JessiefDavis

The Medical Group Management Association, which represents medical practice leaders across the country, has signed up for space in the Catalyst Health-Tech Innovation development, a new healthcare technology hub in Denver. It will join other health-focused organizations, practice groups, health finance companies and high-tech organizations as a tenant. [Also: Extend meaningful use reporting, says MGMA] MGMA, which represents more than 33,000 medical practice administrators and executives in practices of all sizes, types, structures and specialties, is headquartered in Englewood, Colorado, with a government affairs office in Washington, D.C. The 5,000-square-foot addition to MGMA's existing campus in Englewood will be part of the Catalyst Health-Tech Innovation development, which encompasses a full city block in the River North neighborhood of Denver. [Like Healthcare IT News on Facebook] The additional space will provide an environment for MGMA staff and leaders to collaborate with other industry leaders on developing efficient and cost-effective strategies for medical practices and improving care for patients, said MGMA President and CEO Halee Fischer-Wright, MD, in a statement. The hub is slated to open in 2018. Twitter: @Bernie_HITN

You probably already know Bill Bunting as @WTBunting. But even his 13,800 Twitter followers might not know what fuels the HIMSS16 Social Media Ambassador’s passion for, in his words, “shifting the future of healthcare … so that we all have a voice.” The Director of Healthcare Solutions at storage giant EMC shared what he hopes to learn at this year’s HIMSS conference, why he wanted to be a Social Media Ambassador, a health IT prediction for 2016, and more. [Also: HIMSS reveals Social Media Ambassadors for HIMSS16] And in the spirit of social media, Bunting answered these questions via Twitter. Where else? Q: For starters, here, what inspired you to apply for the Social Media Ambassador program? A: The opportunity to be part of a group of like-minded individuals all out for the cause of improving the healthcare of tomorrow. While we are all friends online, we rarely use our abilities together, and the SMA program offers us the ability to help spread the message of industry change as a unified force. And I’m in it for also the ability to learn more from my peers and really put the value of social media to work in healthcare. Q: What’s something about you that even your devout followers likely don’t know? A: High functioning Aspergers often gets the best of my abilities to express points-of-view correctly, but it’s also part of why I am so passionate about shifting the future of healthcare — so that we all have a voice, we are all treated equally, and we all have the best possible care available to us. Q: What are you most looking forward to learning about at HIMSS16? A: I always look forward to the sessions and the knowledge that can be taken away from my peers. But in recent years I have found an affinity for those vendors off the beaten path on the exhibition floor. Many of them have extraordinary technology, but only a few make it to the big leagues. It’s always fun to explore what they have to offer and hear their take on the future of our industry. Q: One health IT prediction for 2016? A: Venture capital funding will slow down for digital health startups as the market consolidates and larger entrants begin to place their claim. I also feel organizational adoption of digital technologies will pick up finally as innovation accelerates and consumers become more involved, active participants in monitoring their health. Q: What is the untold benefit of social media in healthcare today? A: I hope that social media turns into a virus that healthcare avoids finding an antidote for because it holds tremendous potential for connecting providers and patients on a level once never imagined — allowing for better patient engagement and empathy. But it also holds value for patients to connect with other patients to tell their stories and share knowledge. Twitter: @SullyHIT

 Terry Fairbanks will outline advances, challenges to more effectively tuning systems and software for patients and caregivers.

Healthcare IT News and HIMSS are accepting topic and speaker proposals for the Pop Health Forum 2016, May 19-20, in Boston. While population health management is key to bending healthcare’s cost curve and improving the quality of care, achieving those goals is easier said than done. With that in mind, the Pop Health Forum’s goal is to give attendees, 250-plus healthcare providers and payers, solid information on how to improve their population health initiatives. Click here to submit a proposal and for more information. Attendees prefer case studies and are eager to learn how their peers are addressing common challenges and pain points. As such, we place a high value on proposals from payer and provider organizations that offer practical, actionable information and real-life solutions. Proposals should focus on one or more of the forum’s three key areas, the cornerstones of population health: data analytics, care coordination and patient engagement. The deadline to submit a proposal is 5 p.m., Feb. 12.

The Patient-Centered Outcomes Research Institute has approved $70 million for nine new patient-centered research projects. The new studies will focus on conditions ranging from a type of very early-stage, localized breast cancer to diabetes, chronic lung disease and migraines. [Also: PCORI adds $142M for big data research] With these latest awards, PCORI has now approved or awarded more than $1.2 billion for research. The new studies will compare: active surveillance to traditional treatments, effectiveness of two common medications for chronic obstructive pulmonary disease, varying approaches to smoking cessation among adults with mental illness, competing approaches to managing chronic migraines and the use of inhaled corticosteroid versus symptom-based use in treating asthma exacerbations.  PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research to provide patients, their caregivers, and clinicians with evidence-based information needed to make better-informed healthcare decisions. [Like Healthcare IT News on Facebook] PCORI also awarded $6.7 million to three members of PCORnet as part of its ongoing work to establish a national patient-centered clinical research network. That money will go toward studying population health policies and interventions for type II diabetes. The agency awarded another $5.2 million to researching the effectiveness of wellness coaches for African Americans with uncontrolled diabetes. And PCORI allocated $3.8 million for a study to determine the optimal dose of aspirin for preventing heart attacks and strokes. Twitter: @HealthITNews

Researchers at Boston Children's Hospital are pressing for the healthcare industry to give patients control of their data.

OhioHealth hospitals are among the first users of Epic's MyChart Bedside to enable patients to view their health information, lab results, review videos, exchange messages with their medical team, and generally and plan for the day.

CHIME on Tuesday, through a partnership with SpaceX-affiliated crowdfunding site HeroX, launched a $1 million patient identification contest in the hope that private industry can fix the safety risks posed by patient matching.