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Podcast Library > NextGen Advisors Podcasts > Health Information Technology and Patient Engagement – Making it Work for Consumers and Providers

October 12, 2021

Health Information Technology and Patient Engagement – Making it Work for Consumers and Providers

In this podcast, the NextGen® Advisors discuss the role of Health Information Technology (HIT) in supporting patient engagement. Recently, NextGen Healthcare commissioned Xtelligent Healthcare Media to conduct a survey of leaders of ambulatory care provider organizations on this subject. Listen to this episode to hear the Advisors reflect on the survey results and discuss priorities for advancing patient engagement.

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Transcript

Dr. Martin Lustick:

Hello, this is Dr. Marty Lustick with NextGen Advisors. For today's podcast, I'm joined again by my colleagues, Graham Brown and Dr. Betty Rabinowitz. Welcome to you both.

Betty Rabinowitz:

Hey, Marty.

Graham Brown:

Hello, Marty.

Dr. Martin Lustick:

Providers have experienced significant change over the past decade as advances in health information technology have pushed them to transform the way care is provided. The pandemic has further influenced this transformation with the rapid adoption of new tools and increased patient expectations about how technology should improve access, availability, and continuity of care received from their provider. Today we're going to talk about the role of HIT in supporting patient engagement. Recently, NextGen Healthcare commissioned Xtelligent Healthcare Media to conduct a survey of leaders of ambulatory care provider organizations on this subject. Before we get into the results of the survey, Betty, can you remind our audience of what we mean by patient engagement?

Betty Rabinowitz:

It's a great question, Marty, because I think we, and certainly clinicians use patient engagement in more than one way, and we need to clarify which part of patient engagement we're referring to today. The first clinician inclination is to say patient engagement has to do with patient activation, the willingness of patients to engage in their care, and the methods and techniques that physicians, clinical teams, care managers use to engage patients in their care and increase their participation and responsibility for their care. But what the second component of patient engagement in which we're talking about today is the questions of access, questions of patient acquisition or patients choosing physician groups, the question of the ways patients can communicate, receive care are all part of patient engagement that we will spend a bit more time talking about today. It's also the area where technology plays a very significant role.

Dr. Martin Lustick:

Thanks. It's a helpful distinction. In some ways it's obvious that technology that enabled virtual visits supports patient engagement, yet many providers view technology as getting in the way of their relationship with the patient. Graham, you've worked for years with providers on adoption of HIT, what do you is the issues that create this disconnect?

Graham Brown:

I think Marty, for a lot of providers, they're very much adept at knowing when they walk into the examination room and sit down in front of a patient, what they need to do, what conversation they need to have, what questions they need to ask and how they utilize technology, both in advance of the face-to-face time with a patient, during their patient visit and after can be complicating to what they naturally feel like they need to undertake during that session. So where we've seen I think a lot of success is with physicians who are very structured and intentional around working with their care team before they get into the room with the patient to ensure that all of the pre-visit documentation, the vital statistics, all of the things that can be done by other members of the care team are completed in advance, that the provider has the opportunity to review that information before they step into the room.

Graham Brown:

And that they're very conscious in their time with the patient of how they're using their laptop to document, whether they have an individual in the room with them to scribe the notes for them, whether they do that after the session. The opportunity for many providers really is to use that time with a patient to really understand their story, their goals, engage them in that care, the other element that Betty was talking about in terms of patient engagement, have them understand their condition, what they can be doing to activate around their own care. But technology, if it's not being utilized properly by the care team before and after the visit, can be a barrier as it were in time with the patient, because providers are trying to capture important diagnoses or documenting the chart. So how they set all of that up and the structure around that is often one of the complicating factors in terms of how they best use their time with patients to achieve the outcomes they want on engaging them in their care.

Dr. Martin Lustick:

So I hear you talking about impact on their workflow and how you build the right workflow, which kind of brings me to my next question because we know that at this point, most practices already have a digital infrastructure. And in the survey, 83% of the respondents said that optimizing that technology is a medium to high priority for them. So what do you see as sort of the key components of defining that optimization or driving to it? Betty, you want to start on that one?

Betty Rabinowitz:

Yeah. So many of these EHRs, we are now far enough from the time that EHRs were implemented initially. Many of these EHRs have collected a patina of time that needs to be reevaluated. We find among the NextGen clients, for example, that groups have stayed on older versions of the technology and are missing out on incredible progress. So sometimes we find groups that are concerned about the technology's capabilities, but when you look at it, they are an older version that has been improved on fivefold or lots of new capabilities have been added. So making sure that you're on the latest version is absolutely crucial and making investments and having the institutional will to make sure that that's done on a regular cadence.

Betty Rabinowitz:

The other thing is that EHRs collect become stagnant. They collect hundreds of templates that were somebody's idiosyncratic need and are no longer used and are just cluttering up the system. The people who built or designed the systems are often no longer in the organization and there is an opportunity to retrain, reevaluate, reassess the way workflows are designed and built and change them fundamentally to support of the contemporary, current. And lastly, training, training, training. I know we'll talk about it in a moment more, but physicians get trained briefly at the beginning O of the process and that is one of the most important things to revisit.

Graham Brown:

Let me just add to that because part of this survey indicated that while over half of practices right now are considering increasing their education and training. So I think Betty raises a really important point. Think about an organization that has even 10% turnover in their providers over a year. That's 10% of a clinical team that may be working in a new tool that really needs a deep understanding of the capabilities of that tool, whether it has been upgraded to Betty's point earlier, whether it's kind of contemporary in terms of its capability and functionality, but then how they navigate it, how they work to the point I was making earlier with the other members of their care team and have clarity of role. Who's going to collect this in information? When? When will it be available for me to review? And how do I master those processes and the understanding of the tool to really get the value out of it?

Graham Brown:

So regular updates of training, refreshers, just with the basics of what the tool does and how to use within workflow, but then to Betty's point, maintaining it as really a living, operating component of your infrastructure, keeping it current, getting rid of old templates and tools that are no longer being used, or that were specific to an individual and making sure that all the members of the care team are on a regular basis really being brought up to a level where they can get the most out of these capabilities. It's a big investment for primary care providers and ambulatory practices to invest in their health information technology and training is one area where with a little additional effort, a lot more value, I think can be realized.

Betty Rabinowitz:

And just one more point about this, Marty. One of the powerful uses of HIT today are the secondary uses of the data and information that is retrieved from those systems. Making sure that the workflows that the system is built and designed and structured in a way that supports the kind of data that will then support a value-based contract success. So support meaningful measurement of quality and supporting a compensation plan for physicians that has a quality component is really important, an important part of optimization.

Betty Rabinowitz:

Because remember, in '96 or '94, or whenever EHRs became more common and more widely implemented, the notion that data would be the key usable asset from these programs was not even on people's radar. It was just the transactional support for day-to-day practice. So there's some grand opportunities there and also adopting and including all of the other features and capabilities, whether it's the mobile feature that allows an easy interface, whether it is population health, whether it is a contemporary patient engagement, patient portal capability, that truly creates a platform rather than just a standalone EHR.

Dr. Martin Lustick:

So it's really interesting to me listening to the two of you talk about training and education as being key to optimization, but at the same time, you brought up several other what seemed to be critical issues as well, the need to keep your software up to date, because it is clunky is the earliest infrastructures where they are getting better and better, and you lose out if you're not bringing in those new capabilities. But also besides training, adapting your workflow so that you're taking full advantage of what the software has to offer you and aligning the way you're leveraging technology with what the demands both clinically and from a business perspective, the evolving demands on the practice, all those different pieces that you've touched on, it seems to me all play into how you make the most of your investments in HIT.

Dr. Martin Lustick:

Let's go back to patient engagement. It's interesting that similar to the optimizing technology question, 83% of the respondents in this survey said that patient engagement was also a medium to high priority for them. And they pointed to two key functionalities in this category. One was the pre-visit or check-in workflow, and the other telehealth. Betty, do you find that at all surprising the other things you would've put on the list?

Betty Rabinowitz:

Actually, I thought especially coming off COVID and still we are in the midst for clinicians, they are still in the midst of this, virtual visits has really being the thing. And I'm proud of providers and health systems, the rapidity at which they pivoted, adopted, deployed and are using virtual visits is commendable.

Betty Rabinowitz:

I think for people who are not in the clinical endeavor, it's hard to imagine what a huge change that represents. It touches every aspect of your kind of process and I think people did a fantastic job regarding it. And it's not surprising to me that the pre-visit workflow has gotten this attention and people deem as medium to high or high priority. It lends itself so beautifully to automation, to artificial intelligence, to removing it from the task of a human at the time in the office and sending it to people's living rooms in the evening before their appointment, to the week before their appointment. All of these check-in people that we have in offices, greeting and creating a line, waiting to get checked in, all of those tasks can be done with effective patient engagement tools prior. All of the forms, the screening tools can be done before and then reduce both the check-in workflow, but also the rooming tasks that a medical assistant can now attend to. All of the questions that just need to be asked are already asked and answered.

Betty Rabinowitz:

And that person with some clinical capabilities can already start addressing the questions that are red flags or that need additional attention. I think the respondents are spot on, and it's very exciting. NextGen has a ton of very exciting new capabilities in this regard and I thought the two were very important components.

Dr. Martin Lustick:

So in terms of leveraging technology to improve patient engagement, what have you seen as best practices regarding both convenience and satisfaction for the patients, but also improving clinical outcomes, Graham?

Graham Brown:

Well, I think Betty really just spoke to a couple of best practices where the pre-visit screening, the documentation that can be collected from the patient's iPad the night before they come into the office is a key one. But think also about the population health level. If we're looking at a practice that has 250 diabetics and recognizing you can do outreach to those diabetics in a targeted way to identify care that they need to be consistent with overseeing their hemoglobin A1C control, for example. Those are situations where we've got a lot of capabilities now to do outreach directly to patients. If patients have the capability to then interact with a patient portal that has great functionality, they can schedule their next visit, they may have a lab requisition available to them in advance, they can go get their blood work done. They can show up with any pre-screening consultation questionnaires completed before they meet with their physician and really get into a more detailed discussion around managing that condition for themselves.

Graham Brown:

So I think those are aspects of it. The ability to review your lab results, to schedule an appointment, to pay your bill, to look at your medical record, to share your medical record with others that need to have access to it, to give family members access to your medical record if you need support and decision making, or if you have young children that need to have their record viewed and observed by parent and worked on. I think those are all really important capabilities that are showing have a real ability to impact best practice and alleviate some of the burden on providers, but also give patients a much more vested interest in being prepared for the discussion with their provider, being able to focus on the issues that they want to raise and having it be a more impactful experience.

Dr. Martin Lustick:

It's interesting. It sounds like you're describing much of what is foundational to what we always talked about as being patient-centered, which isn't a coincidence for discussing patient engagement. My last question is about patient-generated data. Another finding in the survey is that close to half of the respondents are actually concerned about receiving unfiltered patient-generated data, and also about the liability that might be associated with that data. Betty, I found this number surprisingly low, actually. Were you surprised and what do you think can be done to mitigate those concerns?

Betty Rabinowitz:

Two thoughts here. One is the issue of liability as a primary care physician I don't buy. So the notion that there are numbers that pertain or results of tests that pertain to your patient who you are not interested in, or that if you learn about you may be liable for just is... I can't wrap my mind around it and I know that even among my colleagues, I probably am in somewhat of a minority, but I feel that it is a primary care responsibility to know as much as they can about their patients. So that one I don't really feel strongly is an issue. I think 100% of physicians should worry about unfiltered patient data coming their way because it will be like opening a fire hydrant of blood pressure reading, glucose readings, weights, mood screens, sleep information, Fitbit information, exercise statistics, pulse, all of the rest.

Betty Rabinowitz:

So the good news is that HIT has figured that out and any wise system, the kind that we deploy is going to put a filter capability on that data to allow physicians to determine the frequency, the cadence, whether they want averages, whether they want just sampling of that data and which data actually comes in. And obviously, as a population health advocate, my sense is that filtering this information as well through a population health tool that analyzes it, summarizes it, synchronizes, standardizes, and gives you insights from it, so you get wisdom, not only data is probably the way to go. But I think that undifferentiated patient-derived data can be very burdensome and very dangerous and not because of the liability issues.

Dr. Martin Lustick:

Great thoughts. I think will end it there. Overall, it does seem clear that the context of the pandemic and the ever-increasing focus on value-based care, as well as evolving patient expectations, the patient engagement really is a rapidly growing priority for providers. And that HIT as we've discussed today is going to continue to play an increasingly important role in efforts to improve in that space. I want to thank my colleagues, Dr. Betty Rabinowitz and Graham Brown, and thanks to you, our listeners for joining us. Please click the subscribe icon to be notified of future podcast. This is Dr. Marty Lustick with NextGen Healthcare. Have a great day.