Portals aren't just for outpatients
With all the talk about patient engagement as a component of both meaningful use and of healthcare quality improvement, it seems to be lacking in one of the most obvious places of all: the hospital room.
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"How come your Starbucks and McDonald's pays more attention to experience than your $5,000-per-night hospital?" Jaap Suermondt, vice president and director of analytics at the HP Labs division of Hewlett-Packard wondered at last week's American Medical Informatics Association annual conference.
As an example, Suermondt discussed the traditional way of summoning help in a hospital room. "An 85-year-old pushes a button and hopes someone arrives before they wet themselves," he said during a session on patient engagement in inpatient settings.
[See also: For portals, speak patients' language]
Even patient portals, a centerpiece of engagement as spelled out in Stage 2 meaningful use regulations, often are less-developed for inpatients than for ambulatory care.
"Patient access on the inpatient side is somewhat limited," said Patricia Dykes, RN, program director for nursing research in the Center for Nursing Excellence at Brigham and Women's Hospital in Boston, an institution known for its well-developed portal.
Dykes referred to a 2013 Pew Research report found that 79 percent of consumers wanted to share health data with people outside of traditional care teams and/or people they did not live with. The Brigham and Women's portal does not make that easy, she said. "We should be aiming for distinct credentials" for each user a patient wants to authorize.
Dykes said Partners HealthCare, the Harvard-affiliated parent of Brigham and Women's, is working toward a single, enterprise-wide patient portal. (Other speakers at AMIA, including Joseph Kannry, MD, of New York City-based Mount Sinai Health System, discussed the importance of minimizing the number of portals patients and clinicians have to log into.)
In a paper published in the conference proceedings, the session speakers called patient engagement a "blockbuster drug," borrowing words written by health IT consultant Leonard Kish in 2012.
"A key ingredient of patient engagement is access to timely, clear and understandable information for patients and their caregivers. As anyone who has been a hospital patient or witnessed the hospitalization of a loved one knows, the lack of information in the inpatient care setting contributes to anxiety and feelings of helplessness," the paper said.
The authors cited earlier research showing that just 28 percent of hospitalized patients were given the chance to review their inpatient medication list and that less than a third could name one of the physicians on their hospital care team.
But, they continued, informatics professionals "are creating novel and exciting systems to support patient engagement."
S. Ryan Greysen, MD, a hospitalist at the University of California, San Francisco, compared the experience of ride-sharing service Uber with the traditional taxi experience, and said hospitals should strive to make care more like Uber than a taxi. "It empowers the driver as well as the passenger," he said of Uber. "Can we 'Uberize' hospital care?" Greysen wondered.
UCSF has experimented with Fitbit activity trackers to measure patient mobility within the hospital. "Can we use 'little data' to activate inpatients and change behavior?" Greysen asked, while also suggesting "big data" from multiple sources might be able to help personalize patient engagement.
Several of the panelists said they are trying or at least contemplating the use of tablet computers at the bedside to engage patients.
In place of the outmoded nurse call button, HP deployed multilingual tablets in a nursing home that doesn't even have an EHR, Suermondt said. Now, he said, with a couple of clicks, even elderly patients who don't speak much English can specify why they need help, and get immediate confirmation that someone received the alert.
Similarly, UCSF has been experimenting with issuing tablet computers to inpatients at the bedside, according to Greysen, but that may not be necessary in a tech-savvy town like San Francisco, where many patients have their own tablets already. For patients who bring their own devices, the hospital should be able to give them an app to download or simply a link to an in-house portal, Greysen suggested.
Ann O’Brien, RN, national senior director of clinical informatics at Kaiser Permanente, Oakland, Calif., said that the organization has installed interactive patient-care boards provided by contractor IPC The Hospitalist Company. This system lets patients receive education on procedures and medications, conduct pain assessments, order meals and fill out satisfaction surveys at the bedside, also in multiple languages.