Hospitals are grappling with new, reform-oriented imperatives to "engage" patients in their own care.
The Patient Protection and Affordable Care Act requires hospitals to prevent readmissions following patient discharge for several common health conditions, at the risk of Medicare penalties. In the just-beginning second stage of the $27 billion federal incentive program for "meaningful use" of electronic health records, providers must convince at least 5 percent of their patients to communicate electronically about their care, a more daunting task than the number makes it sound.
Outcomes-based reimbursement provides additional incentive for hospitals and other providers deliver care in teams, with the patient at the center of information flow and decision-making.
Tuesday morning at the U.S. News Hospital of Tomorrow Forum, two New York City providers discussed how they are adapting to this new dynamic.
New York-Presbyterian Hospital offers its patients access to their own records and other online services through a portal called MyNYP. There, they can see discharge summaries and instructions, make follow-up appointments, pay bills and send secure messages to their doctors, said Senior Vice President and Chief Information Officer Aurelia Boyer. A new feature is the ability for patients to search for clinical trials they might be eligible for based their specific conditions.
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The portal has been online since 2009. "We have over the years had a continuous improvement in enrollment," Boyer said. In October, nearly 1,700 people signed up, she reported. It helped that one staff physician, the well-known Dr. Mehmet Oz, is on staff at New York-Presbyterian and, in the words of Boyer, was a "big believer in this." Oz speaks in an introductory video for patients about the portal.
But NYP hopes to do better. "I don't think people are jumping on as fast as we might like," Boyer said.
She identified two key barriers to wider adoption.
"I think it's our history to be rather paternalistic," Boyer said. Patients expect the doctor to know everything and don't always feel the need to bring their own records.
"I also think the patients think we are a lot more connected that we are really are," she added. But physicians do not work for the hospital, and key information often is at their private practices. Boyer said that her husband assumes that the doctors and the hospital are one and that the systems are one, illustrating the scope of the challenge.
"It's starting to change, but I don't think it's there yet," Boyer said.
Patients also don't look at health care like airlines, where they have embraced automation in ticketing, seat selection and check-in. Boyer advised attendees to be careful how they add online features so patients don't feel abandoned in an environment where they expect to encounter real people.
The Visiting Nurse Service of New York, an organization that cares for post-discharge patients in their homes and other community settings, has been working with New York-Presbyterian and an insurer to put together cross-organizational care teams, including case managers at the insurance company to manage high-risk patients during transitions of care. Many errors occur due to sloppy patient hand-offs, noted President and CEO Mary Ann Christopher.
Christopher said that VNSNY reduced 30-day readmissions for all causes by more than 50 percent among patients enrolled in the multidisciplinary program.
"We established metrics that we knew really do reduce recidivism," Christopher said. Among these is interfacing with scheduling systems at primary care physician offices so patients get follow-up care within seven days of discharge.
Predictive analytics drive interventions with patients. VNSNY found that behavioral health and falls are strong predictors of readmission. The organization continually tracks eight metrics within the electronic health record and for patients determined to be high fall risks, this system can trigger a patient- and family-centric program for preventing falls.