By Betsy Lee
Just a few years ago, Linda Fischer, former hospital CIO, recalls being called over to conference with a group of befuddled nurses.
As the patient waited, the nursing team passed around handwritten discharge instructions from the physician, trying to make sense out of them. Fischer said she couldn’t begin to understand what the physician wanted to communicate.
“So I said, ‘Okay, I’m going to call the doc back to the unit.’ They looked at me as if, you can’t do that. You can’t tell a doctor to come back. I said, ‘Watch me,’” said Fischer, now the DrFirst Senior Director of Product Solutions. “I picked up the phone, called the doctor back, made him rewrite the instructions, and sent him into the room to actually discuss discharge instructions with that patient.”
Fischer, along with Dr. Peter Karamanlakis, CMIO of Huntington Hospital, shared this patient-care story in a CHIME Webinar on patient engagement December 15, 2016. The simple, yet common narrative is a glaring example, according to Fischer, of missed patient engagement opportunities.
“For example, providers are supposed to, at discharge, discuss key information with the patient, like expected cause of illness, self-care, follow-up, medication use — but this is actually happening less than 65 percent of the time,” Fischer said.
Lack of communication, as numerous studies have confirmed, leads to poorer health outcomes. For example, likely due to the lack of discharge communication, only one in three pediatric patients seen in the ER for acute asthma follow-up with their primary care physician within the recommended 28 day period. With asthma, like other chronic conditions such as diabetes, follow-up after an emergency room visit is key to health maintenance and the reduction of acute events.
“Is it any wonder then, that one in five Medicare patients are readmitted within 30 days?” Fischer said. “To fix what’s broken within the system, we need patient engagement. It has to be a true partnership between each patient and their caregiver.”
Dr. Karamanlakis agrees that patient engagement —at discharge and at numerous other connection opportunities — is key.
“It really starts with that doctor-patient interaction,” Dr. Karamanlakis said. “And you need that in order to build a therapeutic relationship. To me, that’s the foundation of it all.”
Recognizing this fact, the Centers for Medicare and Medicaid Service released two new standards regarding patient engagement in 2016. First, patients should be able to view online, download, and transmit their health information; and second, providers should be enabled to conduct secure messaging with patients.
The goal is to ensure that patients leaving the ER after a pediatric asthma episode, for example, have a secure way to communicate effectively with their providers. Using secure messaging features, the primary care physician can be alerted to the patient’s ER visit and can then establish a secure chat. With the provider easily accessible, in a way the patient is already accustomed to, the primary care doctor can answer questions, follow-up regarding the patient’s status, and encourage the patient to create that important follow-up appointment.
Of course, Fischer and Dr. Karamanlakis acknowledge, this type of approach requires a shift in thinking. The “compliant patient” healthcare model no longer applies.
Today, patients want to understand what’s happening with their healthcare. Patients are beginning to view their doctors as consultants, rather than experts. Physicians have the opportunity to foster that empowerment, in all patient interactions — from hospital discharge to the primary care visits to appointments at specialty clinics.
“We need a patient-centered approach,” Fischer said. “And then, with the right tools, we can transform the engaged patient into an enabled and prepared patient.”
View the full CHIME Webinar by clicking here.