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Patient Experience – Top of the Mind for Healthcare Organizations

October 29, 2012 at 1:32 pm PST

Back in September, I had the opportunity to attend HIMSS APJC in Singapore and was really excited to learn more about the key trends in that part of the world, which houses some of the largest economies, populations, and economic growth.  After talking with several customers and listening to several panel discussions, one common theme kept recurring – patient experience.  It was my belief that patient experience was more of a USA hot-button as healthcare organizations in the USA are being forced by patient “consumerism”, whereby patients want their money’s worth and have a certain level of expectation.  I was surprised to learn that patient experience is more of a global trend and that got me thinking as to what exactly is patient experience and how healthcare organizations are addressing it.

After talking with customers on a world-wide basis, I have learned that customers really do not have a standard definition for “patient experience”.  In fact each one of them has a different interpretation and there are widely divergent views in the healthcare industry.  The 2009 HealthLeaders Media Patient Experience Leadership Survey — covering more than 200 healthcare CEOs, CFOs, COOs, CNOs, directors, senior vice presidents, and other C-suite high-ranking healthcare officials — found that 33.5% of respondents said the patient experience is their “top priority,” and 54.5% said it’s “among their top five priorities.” And most responders thought it would be a priority in the future as well: 45% said it would be their top priority five years from now, and 50.5% said it would be in their top five priorities. Read More »

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Nominate a Nurse Today: Innovation in Technology Award

NurseIs there a nurse in your organization who has taken the lead in implementing technology in order to deliver better patient care?  If so, the American Organization of Nurse Executives (AONE) wants to hear from you.

AONE, the national organization of nurses who design, facilitate and manage care, is now accepting nominations for the 2013 AONE Innovation in Technology Award.  This award, sponsored by Cisco, honors an outstanding nurse leader who demonstrates innovation, creativity and entrepreneurship in the implementation and adoption of information or systems technology in their organization.

Nominations must be received by 5:00 pm CST November 9, 2012. Award recipients will be notified by December 7, 2012, and will then be honored at the 2013 AONE Annual Meeting and Exposition, March 20-23 in Denver.

At the 2012 AONE Annual Meeting and Exposition, Rhonda Struck, BSN, RN, MS, vice president of quality and patient safety at Wheaton Franciscan Healthcare in Glendale, Wisconsin, was awarded the 2012 AONE Innovation in Technology Award for her work in improving inpatient records while working at University of Wisconsin Hospitals and Clinics.

Learn more and download the application.

The 2013 AONE Innovation in Technology Award is sponsored by Cisco.

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Can you see your doctor while at work?

In today’s society, it is really easy to ignore one’s health. Today, I found out just how valuable it can be to have medical care available to me on campus. Here at Cisco, we have about 60 buildings on campus and in a day full of meetings, I walk or drive to the other buildings as needed. There are times when I am so busy that I choose to ignore that cough or yearly exam. And, at what cost? Do I choose to get in the car and drive to my doctor which is 45 minutes away and take at least half a day off with productivity compromise? In the old days, I would say “No way”!

So, today, I joined the ranks of the immediate gratification generation. I found out how to gain access to care in such a way that it allows me to keep working when I need to do so. We have a clinic here on campus named Life Connections (http://www.cisco.com/web/lchc/index.html). Unfortunately, I learned the hard way just how valuable it can be!

I was walking from one building to another and happened to fall. The klutz in me tripped over my pants leg and I fell. I thought I had broken my wrist and could not wait to see the doctor – not to mention the bleeding. Read More »

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Healthcare for all?

October 11, 2012 at 8:39 am PST

As we all just witnessed the presidential debates last Wednesday, the hot topic was Obamacare.  I knew this act was aimed at decreasing the number of uninsured Americans and reducing the overall costs of healthcare.  These high level goals sounded great until I bumped into an article this week that some popular casual dining establishments will no longer offer full time work schedules to employees starting in 2014 aimed to help address the cost implications health care reform will have on their business.

The Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare was signed into law back in March 2010 with multiple provisions to be enacted over a 10 year period. A provision starting January 2014 states that companies with over 50 employees will be required to provide health insurance to employees working over 30 hours a week.  There is a punishment of $3,000 per each uncovered employee for companies who do not follow the law. Read More »

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Accountable Care Organizations – Increase Shared Savings and ROI Through Video, Collaboration and Telehealth

September 28, 2012 at 6:39 pm PST

The need to control healthcare expenditure (per capita Medicare expenditure at $8973) is no longer in doubt. With over 36% of the $599 Billion Medicare spend on inpatient care, almost 19% on post acute care and over 13% on outpatient services healthcare is looking to new business architectures to contain costs as well as maintain quality. Accountable Care Organizations (ACO’s) is one such business model structured from a fee for service to a pay for performance model.

The aim of an ACO is to reduce healthcare costs, improve quality as well enhance patient experience. ACO’s are legal entities that organize around the concept of a patient centered medical home with primary care physicians forming the core who become the focal point for engaging with the patients to participate in driving superior outcomes. The ACO’s enroll healthcare participants in the care continuum who collaborate together in concert to meet the goals of the ACO.  These participants would include specialists, extended care providers (skilled nursing, hospice, extended care), physicians, nurse, dieticians and social workers. Primary Care Physicians can participate in only one ACO; the others may participate in more than one ACO.

ACOs may be fully integrated or they may draw members from outside the organization into the legal structure through agreements to complete all needed participants in the care continuum.

ACO’s have shown benefits. Cigna has done a study showing significant savings in Accountable Care Organizations. Michigan’s Value Partnership Program or Blue Shield Blue Cross MA and others have shown promising savings.

Can this shared savings be increased using collaboration, video and Telehealth technologies? There are indicators that it can:

  • VA has shown a 19% reduction in hospitalization through its Telehealth program
  • Geisinger Health Plan has shown a 44% reduction in readmissions with Telehealth
  • Over 75% of Asthma admissions could have been avoided by using Telehealth

The payout to an ACO is calculated as:

Payout to ACO= (Cost Saving) x (Shared Saving %) x (Quality Performance)

An ACO is a business architecture where caregivers need to collaborate in the delivery of care, very closely, across the care continuum. The Primary Care physician needs to remain engaged with the patient as the patient transitions through different touch-points in the care continuum. Patients remain engaged and vested in their own well-being. The physicians will practice at the top of their license leaving certain functions to appropriately trained nursing.

Healthcare IT will play a major role; one of the requirements is for at least 50% of the primary care physicians to be meaningful use users. ACOs also have to demonstrate evidence-based practice. The ACO eco system should collaborate around an EMR that could be delivered on the cloud as a service to the ecosystem.

The ACO needs to identify at-risk patients and maintain close contact. Case Managers or care coordinators will leverage technology to keep the high touch with at risk patients.

Patients also need to have access to their trending health records as well as receive focused education

An ACO can increase its cost savings through immersive video and collaborations:

  • Care transitions managed through proactive video collaboration between caregivers help in reducing medical errors and re-admissions
  • With immersive video based collaboration where the specialists and the primary care physician examine a patient at the same time using multi-point Telehealth saves costs. Such interactions also allow the primary care physician to make more informed decisions over a period of time. ACOs can see huge savings through this provider partnership.
  • Care coordinators can maintain a video based touch with outpatients and direct nursing visits where needed or bring in physicians or specialists into a video consult with the patient avoiding unnecessary visits to an ER
  • Telehealth can provide specialist access to patients in skilled or extended care facilities cutting down avoidable ER visits
  • Telehealth solutions that create physician groups can allow the right care provider, based on specialty or language, to provide care where needed
  • Technology can be leveraged to manage chronic conditions.  “No show patients” is a huge drain in the operational waste in healthcare systems. Whether delivering virtual care in mental health situations, or examining patients who have difficulty traveling to clinics, video consults for movement disorder, neurologic or cardiac patients post operative consults – Telehealth can bring down healthcare costs.
  • Telehealth can allow specialists to avoid travel to remote clinic. The time saved provides efficiencies whereas the additional patients that a specialist can examine in the time saved provides transformational benefits
  • Structured collaborative education using technologies such as Webex can be more effective than a written brochure

Video, collaboration and Telehealth can also help in increasing the quality performance measures for ACOs:

  • The ability of a patient using immersive video and collaboration to stay in touch through care coordinators with physicians, specialists, nurses or social workers enhances the patient caregiver experience.
  • To succeed ACOs have to create appropriate team plays. Collaboration allows ACOs to dynamically build appropriate care teams to manage patients in different care settings. This helps in driving care coordination and patient safety metrics
  • Appropriate technologies as well as high touch virtual collaboration through immersive video can help with at-risk patients in any care setting. Structured education and trending personal health records drives adherence, compliance and better outcomes.

All that is good but is there an ROI for collaborative solution video and Telehealth? Yes, our ROI models have shown that such solutions can increase shared savings as well as improve the quality metrics.

 


However, the health of the ROI will depend on  a sound network architecture and the investment in appropriate Video and Telehealth solutions:

  • The Telehealth solution should be scalable. Statistically 20% of the patients are responsible for 80% of the costs. Even with the smallest ACO with 5000 patients that translates to at least 1000 patients that need closer care. Even if 20% of these are at-risk that translates to over 200 patients that need a high touch video collaboration. This besides the Telehealth network across the care continuum of the ACO eco-system.
  • The Telehealth solution should accommodate and adapt to a variety of tethered and untethered end points as well as bandwidths
  • The Telehealth solution should be resilient and stay alive in the case of server failure
  • The Telehealth/Video and Collaboration solution should be built on a medical grade network infrastructure with a solid foundational architecture
  • The Telehealth solution should be simpler than a telephone to use. Single click collaboration will widen adoption
  • Primary care physicians and specialist need to collaborate on patients. The Telehealth solution should allow physicians, specialists and radiologists seamless collaboration with medical images without having to exit out of the collaboration session
  • The Telehealth solution should have the ability to push or pull data to/from EMR’s
  • ACOs are team plays so the Telehealth solution should allow the primary care physician and a team of specialists or care givers to examine a patient at the same time with vitals being shared to providers that need to see or listen to the telemetry. A variety of telemetry devices will allow different specialist to take advantage of the solution and provide cost saving virtual care
  • The Telehealth solution should allow grouping of specialists from different systems by specialty, care team or language. The system should abstract all complexities of contact center, collaboration technology, presence, firewall traversal and build these virtual groups as if they existed in one physical organization
  • Physicians are not always available, the solution should indicate presence status of the care givers so that the available care provider can be brought into a consult when needed
  • Finally an ACO creates a virtual organization and the Telehealth solution should integrate into the business and IT architecture of the ACO

An ACO is a collaborative organization. Healthcare services will be delivered over the network. The business architecture will implement on the IT and Network architecture; it is important to ensure that the network architecture foundation is strong and secure.

There will be big ACO successes and some not so big. Factors that will drive success are:

  • Strong leadership
  • Healthcare ICT and careful architecture considerations
  • Immersive and pervasive collaboration and team play
  • Process

An ACO creates a new way to deliver care. Process will be key to ensure operational efficiencies. Mapping out the care process across the continuum for each condition, cardiac bypass or diabetes or any other condition, then creating a checklist and ensuring adherence and compliance with the process across the care continuum will help in predictable outcomes. A team of process designers to design these processes and then measure them through appropriate metrics will allow optimizing and realizing desired outcomes as well as shared savings. Success will depend on vision, strategy and execution.

 

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