As I was going up the stair, I met a man who wasn’t there.
Then I read an article espousing the ROI of EHR. I leave it to you to decide if these two activities are one in the same.
I also read an article on reducing readmissions in this month’s HealthLeaders, Readmissions: The Big Picture. Perhaps it is because my synapses do not work the way they were intended to work, but the first thing that came to mind for me was How could Patient Experience be reinvented to help contribute to the goal of reducing readmissions? Could deliberately coloring outside of the lines help to solve a real problem?
It absolutely can. One reason patients readmit is because of their failure to comply with their discharge instructions. They do not do what they are supposed to do, they do not do it with the frequency with which they are supposed to do it, or they do not understand what to do, who to contact, how to contact them or when when something goes akimbo. And worst of all, nobody at the hospital knows anything about these failures until the patient is readmitted.
Many of us have been discharged. I remember the discharge process as the only thing standing between me and the front door. I would have nodded to anyone and signed anything to be home and to have the hospitalization behind me. I would read the fine print once I was paroled, once I had a real television remote in my hand, not some off-white three-channel device that was tethered to the hospital bed. Is it possible that more than a handful of patients feel this way?
Since you cannot give patients a test to confirm they understand their instructions prior to discharging them, and you have no control of patients once they leave, is the situation hopeless?
Patient experience continues once patients are discharged. Or it could. Post discharge, most patient experiences—and family experiences—consist of calling the hospital for a variety of reasons; understanding discharge instructions, scheduling a follow-up appointment, scheduling a lab, understanding a bill, filing a claim—reasons very similar to those encountered by patients before they are admitted. Unfortunately, the people being called may not know the right answer to any of these questions. Unfortunately, the line may be busy; it may be after hours, or during the lunch break. Access 8 a.m. until 6 p.m.
They call the hospital. How well did that work? If the answer is not well, they may be on their way to having a very poor experience. If it concerns their discharge instructions they may be on their way to being readmitted.
Here’s how we can tie reducing readmissions to patient experience. It is not complex, it does not require and MD or a PhD, and it is not really all that innovative unless innovation means looking at solving the problem in a way that differs from the way solving problems is normally looked at.
It is all about access, two-way access. Two-way access between the hospital and the patient. Digital and mobile access. Twenty-four by seven. I know you do not do it this way, and the natural reaction to this idea is that some of you will have a long list of reasons why this cannot be done or why it will never work at your hospital. It won’t work for people who do not want it to work, or who may not have the skills. One invalid excuse for it not working is not because it cannot be done. It can, someone just has to tell someone to make it happen.
Let us take a non-natural reaction, just for a minute. I envision the following—this is not exhaustive, it does not come from hours of research. It is just a back-of-the-napkin idea that I would like your opinion as to whether it is worth another napkin or two.
What if the complete discharge summary, and everything patients needed to do, could be available to the patient and the primary care provider in real-time, at the time of discharge? What if the patient’s behavior and compliance could be recorded, tracked, and reported? Online access. Perhaps on an iPad type of device. Let’s use me as an example, me, the guy who was in too big of a hurry to get discharged to pay attention to my instructions.
Now that I am home I read the instructions. I register on the website using some form of secure ID that pulls up what I need. I read about my medications—what they are for, when I have to take them, possible side effects. I discover that I can track my recovery progress on the site, enter when I take my meds, record when I may have exercised or gone to therapy, perhaps enter what I ate, my blood pressure, and weight.
Maybe my wife logs in and helps me schedule an appointment, therapy, or a lab. If I schedule a lab the site tells me my instructions prior to having the lab work done, and I provide an electronic signature to confirm my understanding of those instructions.
If I have questions I use the online chat function, or I submit a question that will be replied to within an hour.
My primary care provider can access my progress.
This is certainly not an exhaustive list of tasks, and it deserves more consideration than the twenty minutes it took to write this post. However, if you pair the idea of decreasing admissions and increasing access, and do so using user-centered design to create an intuitive user experience you may be surprised by the results.
Great post Paul. There is definitely an opportunity for online (and mobile) technologies to transform the future of healthcare (and the patient experience). I highlighted some stats in a post on Inside Patient Finance that support your article: http://www.insidepatientfinance.com/patient-centered-communications/three-reasons-smartphones-will-be-vital-to-future-revenue-cycle-success/
thank you Derek
Definitely worth a few more napkins. This is a noteworthy idea. To your point most patients/clients are so anxious to leave they “yes” you to death. Then they get home and do not recall much. Having an information/clarification support system can be of great benefit. For clients whose children are involved in their care and are long distance and working, this offers great insight to what needs to be done, when and why, at their convenience. This can decrease calls back to the hospital and the primary Physician who is probably clueless about the hospitalization. This will decrease caregiver and client anxiety.
Good News: There is already proven technology available by Vocera that records real-time discharge instructions that patients, families, and healthcare providers can access at any time using any device. I encourage you to read this latest article that explains how Cullman Regional Medical Center used this technology to reinvent the discharge communication process, improve patient satisfaction, and reduce readmissions by 15 percent.
This looks like a great tool to close some of the gap, but if we are to be part of a new approach to healthcare outsourcing it only to a tech solution may still fall short. This is especially true for certain patient populations such as the elderly. If someone records the information but doesn’t take action steps to follow through and no one knows they are not complying, then the desired outcome still is not achieved. Like most challenges, my sense is it will take a combination of tech and person to person connection to create true compliance.
I agree that this will take both a technology and person to person intervention. The Good to Go solution has other modules to add structure and accountability to the care follow up conducted by a clnician. Part of where process improvment can fall short is in staff accountability.
I’m definitely going to take a close look with that additional information you provided about accountability modules. Thanks for adding this piece of info!
Napkin scribbles have long been the medium of capturing out of the box solutions and inventive ideas. Social media has become a great way to toss them into the ring and see what it sparks in others. Yes, healthcare needs to shift to a more interactive model. There are studies that show the more involved a patient is with their health challenge, the better their outcomes. Engagement impacts outcome. Interactive real time tech tools such as what the author is describing here, offer a bridge to connect the patient to their experience, particularly after treatment ends and they return home. However, there is still a missing piece.
If compliance is one of the major challenges at discharge and the patient has been given the information, then we need to also look at what gets in the way of behavior change…because we are asking for a behavior change if the patient is recommended to do something different than before they arrived.
It all starts with training medical professionals in what we call Coach Centric skills. Armed with experience in using just empowering questions can quickly help the healthcare professional determine if, indeed, the patient understands the instructions. Motivational interviewing is a strong component of coaching interventions. A simple scaling question helps the patient focus on evaluating how much they heard/understood.
Beyond that, providing trained coaches to be the bridge from hospital stay to discharge and back home is the next important piece. But those coaches need to understand the role stress plays in limiting one’s ability to monitor behavior and make behavior changes. We first reduce the stress and then coach clients through the other obstacles they perceive are in the way of complying with recommended behaviors.
Asking a stressed patient who may be dealing with many challenges created by being ill – financial, career, family, intimacy, self-image – to take on a behavior because they “should” rarely results in sustainable change. I agree with the author, we don’t need MDs and PhDs to come up with lower cost, efficient tools and support systems for patients to help them take charge of their healthcare. And, yes, technology can play a strong role – but, in the end, if the EHR stays untapped and the patient isn’t engaged to not only interact with it, but also take action steps to follow through with the recommendations it contains, then we will most likely end up with the EHR becoming just another digital file living in the cloud. GREAT post by the author!
Thank you for taking time to offer such insightful comment
You’re very welcome…I’ve found this thread to be informative and insightful so I appreciate that you sparked some good dialogue with people who brought some wonderful information to the conversation.