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Alexa Can Truly Give Patients a Voice in Their Health Care (Part 3 of 3)

Posted on October 20, 2017 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Earlier parts of this article set the stage for understanding what the Alexa Diabetes Challenge is trying to achieve and how some finalists interpreted the mandate. We examine three more finalists in this final section.

DiaBetty from the University of Illinois-Chicago

DiaBetty focuses on a single, important aspect of diabetes: the effect of depression on the course of the disease. This project, developed by the Department of Psychiatry at the University of Illinois-Chicago, does many of the things that other finalists in this article do–accepting data from EHRs, dialoguing with the individual, presenting educational materials on nutrition and medication, etc.–but with the emphasis on inquiring about mood and handling the impact that depression-like symptoms can have on behavior that affects Type 2 diabetes.

Olu Ajilore, Associate Professor and co-director of the CoNECt lab, told me that his department benefited greatly from close collaboration with bioengineering and computer science colleagues who, before DiaBetty, worked on another project that linked computing with clinical needs. Although they used some built-in capabilities of the Alexa, they may move to Lex or another AI platform and build a stand-alone device. Their next step is to develop reliable clinical trials, checking the effect of DiaBetty on health outcomes such as medication compliance, visits, and blood sugar levels, as well as cost reductions.

T2D2 from Columbia University

Just as DiaBetty explores the impact of mood on diabetes, T2D2 (which stands for “Taming Type 2 Diabetes, Together”) focuses on nutrition. Far more than sugar intake is involved in the health of people with diabetes. Elliot Mitchell, a PhD student who led the T2D2 team under Assistant Professor Lena Mamykina in the Department of Biomedical Informatics, told me that the balance of macronutrients (carbohydrates, fat, and protein) is important.

T2D2 is currently a prototype, developed as a combination of Alexa Skill and a chatbot based on Lex. The Alexa Skills Kit handle voice interactions. Both the Skill and the chatbot communicate with a back end that handles accounts and logic. Although related Columbia University technology in diabetes self-management is used, both the NLP and the voice interface were developed specifically for the Alexa Diabetes Challenge. The T2D2 team included people from the disciplines of computer interaction, data science, nursing, and behavioral nutrition.

The user invokes Alexa to tell it blood sugar values and the contents of meals. T2D2, in response, offers recipe recommendations and other advice. Like many of the finalists in this article, it looks back at meals over time, sees how combinations of nutrients matched changes in blood sugar, and personalizes its food recommendations.

For each patient, before it gets to know that patient’s diet, T2D2 can make food recommendations based on what is popular in their ZIP code. It can change these as it watches the patient’s choices and records comments to recommendations (for instance, “I don’t like that food”).

Data is also anonymized and aggregated for both recommendations and future research.

The care team and family caregivers are also involved, although less intensely than some other finalists do. The patient can offer caregivers a one-page report listing a plot of blood sugar by time and day for the previous two weeks, along with goals and progress made, and questions. The patient can also connect her account and share key medical information with family and friends, a feature called the Supportive Network.

The team’s next phase is run studies to evaluable some of assumptions they made when developing T2D2, and improve it for eventual release into the field.

Sugarpod from Wellpepper

I’ll finish this article with the winner of the challenge, already covered by an earlier article. Since the publication of the article, according to the founder and CEO of Wellpepper, Anne Weiler, the company has integrated some of Sugarpod functions into a bathroom scale. When a person stands on the scale, it takes an image of their feet and uploads it to sites that both the individual and their doctor can view. A machine learning image classifier can check the photo for problems such as diabetic foot ulcers. The scale interface can also ask the patient for quick information such as whether they took their medication and what their blood sugar is. Extended conversations are avoided, under the assumption that people don’t want to have them in the bathroom. The company designed its experiences to be integrated throughout the person’s day: stepping on the scale and answering a few questions in the morning, interacting with the care plan on a mobile device at work, and checking notifications and messages with an Echo device in the evening.

Any machine that takes pictures can arouse worry when installed in a bathroom. While taking the challenge and talking to people with diabetes, Wellpepper learned to add a light that goes on when the camera is taking a picture.

This kind of responsiveness to patient representatives in the field will determine the success of each of the finalists in this challenge. They all strive for behavioral change through connected health, and this strategy is completely reliant on engagement, trust, and collaboration by the person with a chronic illness.

The potential of engagement through voice is just beginning to be tapped. There is evidence, for instance, that serious illnesses can be diagnosed by analyzing voice patterns. As we come up on the annual Connected Health Conference this month, I will be interested to see how many participating developers share the common themes that turned up during the Alexa Diabetes Challenge.

Alexa Can Truly Give Patients a Voice in Their Health Care (Part 2 of 3)

Posted on October 19, 2017 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The first part of this article introduced the problems of computer interfaces in health care and mentioned some current uses for natural language processing (NLP) for apps aimed at clinicians. I also summarized the common goals, problems, and solutions I found among the five finalists in the Alexa Diabetes Challenge. This part of the article shows the particular twist given by each finalist.

My GluCoach from HCL America in Partnership With Ayogo

There are two levels from which to view My GluCoach. On one level, it’s an interactive tool exemplifying one of the goals I listed earlier–intense engagement with patients over daily behavior–as well as the theme of comprehensivenesss. The interactions that My GluCoach offers were divided into three types by Abhishek Shankar, a Vice President at HCL Technologies America:

  • Teacher: the service can answer questions about diabetes and pull up stored educational materials

  • Coach: the service can track behavior by interacting with devices and prompt the patient to eat differently or go out for exercise. In addition to asking questions, a patient can set up Alexa to deliver alarms at particular times, a feature My GluCoach uses to deliver advice.

  • Assistant: provide conveniences to the patient, such as ordering a cab to take her to an appointment.

On a higher level, My GluCoach fits into broader services offered to health care institutions by HCL Technologies as part of a population health program. In creating the service HCL partnered with Ayogo, which develops a mobile platform for patient engagement and tracking. HCL has also designed the service as a general health care platform that can be expanded over the next six to twelve months to cover medical conditions besides diabetes.

Another theme I discussed earlier, interactions with outside data and the use of machine learning, are key to my GluCoach. For its demo at the challenge, My GluCoach took data about exercise from a Fitbit. It can potentially work with any device that shares information, and HCL plans to integrate the service with common EHRs. As My GluCoach gets to know the individual who uses it over months and years, it can tailor its responses more and more intelligently to the learning style and personality of the patient.

Patterns of eating, medical compliance, and other data are not the only input to machine learning. Shankar pointed out that different patients require different types of interventions. Some simply want to be given concrete advice and told what to do. Others want to be presented with information and then make their own decisions. My GluCoach will hopefully adapt to whatever style works best for the particular individual. This affective response–together with a general tone of humor and friendliness–will win the trust of the individual.

PIA from Ejenta

PIA, which stands for “personal intelligent agent,” manages care plans, delivering information to the affected patients as well as their care teams and concerned relatives. It collects medical data and draws conclusions that allow it to generate alerts if something seems wrong. Patients can also ask PIA how they are doing, and the agent will respond with personalized feedback and advice based on what the agent has learned about them and their care plan.

I talked to Rachna Dhamija, who worked on a team that developed PIA as the founder and CEO of Ejenta. (The name Ejenta is a version of the word “agent” that entered the Bengali language as slang.) She said that the AI technology had been licensed from NASA, which had developed it to monitor astronauts’ health and other aspects of flights. Ejenta helped turn it into a care coordination tool with interfaces for the web and mobile devices at a major HMO to treat patients with chronic heart failure and high-risk pregnancies. Ejenta expanded their platform to include an Alexa interface for the diabetes challenge.

As a care management tool, PIA records targets such as glucose levels, goals, medication plans, nutrition plans, and action parameters such as how often to take measurements using the devices. Each caregiver, along the patient, has his or her own agent, and caregivers can monitor multiple patients. The patient has very granular control over sharing, telling PIA which kind of data can be sent to each caretaker. Access rights must be set on the web or a mobile device, because allowing Alexa to be used for that purpose might let someone trick the system into thinking he was the patient.

Besides Alexa, PIA takes data from devices (scales, blood glucose monitors, blood pressure monitors, etc.) and from EHRs in a HIPAA-compliant method. Because the service cannot wake up Alexa, it currently delivers notifications, alerts, and reminders by sending a secure message to the provider’s agent. The provider can then contact the patient by email or mobile phone. The team plans to integrate PIA with an Alexa notifications feature in the future, so that PIA can proactively communicate with the patient via Alexa.

PIA goes beyond the standard rules for alerts, allowing alerts and reminders to be customized based on what it learns about the patient. PIA uses machine learning to discover what is normal activity (such as weight fluctuations) for each patient and to make predictions based on the data, which can be shared with the care team.

The final section of this article covers DiaBetty, T2D2, and Sugarpod, the remaining finalists.

Alexa Can Truly Give Patients a Voice in Their Health Care (Part 1 of 3)

Posted on October 16, 2017 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The leading pharmaceutical and medical company Merck, together with Amazon Web Services, has recently been exploring the potential health impacts of voice interfaces and natural language processing (NLP) through an Alexa Diabetes Challenge. I recently talked to the five finalists in this challenge. This article explores the potential of new interfaces to transform the handling of chronic disease, and what the challenge reveals about currently available technology.

Alexa, of course, is the ground-breaking system that brings everyday voice interaction with computers into the home. Most of its uses are trivial (you can ask about today’s weather or change channels on your TV), but one must not underestimate the immense power of combining artificial intelligence with speech, one of the most basic and essential human activities. The potential of this interface for disabled or disoriented people is particularly intriguing.

The diabetes challenge is a nice focal point for exploring the more serious contribution made by voice interfaces and NLP. Because of the alarming global spread of this illness, the challenge also presents immediate opportunities that I hope the participants succeed in productizing and releasing into the field. Using the challenge’s published criteria, the judges today announced Sugarpod from Wellpepper as the winner.

This article will list some common themes among the five finalists, look at the background about current EHR interfaces and NLP, and say a bit about the unique achievement of each finalist.

Common themes

Overlapping visions of goals, problems, and solutions appeared among the finalists I interviewed for the diabetes challenge:

  • A voice interface allows more frequent and easier interactions with at-risk individuals who have chronic conditions, potentially achieving the behavioral health goal of helping a person make the right health decisions on a daily or even hourly basis.

  • Contestants seek to integrate many levels of patient intervention into their tools: responding to questions, collecting vital signs and behavioral data, issuing alerts, providing recommendations, delivering educational background material, and so on.

  • Services in this challenge go far beyond interactions between Alexa and the individual. The systems commonly anonymize and aggregate data in order to perform analytics that they hope will improve the service and provide valuable public health information to health care providers. They also facilitate communication of crucial health data between the individual and her care team.

  • Given the use of data and AI, customization is a big part of the tools. They are expected to determine the unique characteristics of each patient’s disease and behavior, and adapt their advice to the individual.

  • In addition to Alexa’s built-in language recognition capabilities, Amazon provides the Lex service for sophisticated text processing. Some contestants used Lex, while others drew on other research they had done building their own natural language processing engines.

  • Alexa never initiates a dialog, merely responding when the user wakes it up. The device can present a visual or audio notification when new material is present, but it still depends on the user to request the content. Thus, contestants are using other channels to deliver reminders and alerts such as messaging on the individual’s cell phone or alerting a provider.

  • Alexa is not HIPAA-compliant, but may achieve compliance in the future. This would help health services turn their voice interfaces into viable products and enter the mainstream.

Some background on interfaces and NLP

The poor state of current computing interfaces in the medical field is no secret–in fact, it is one of the loudest and most insistent complaints by doctors, such as on sites like KevinMD. You can visit Healthcare IT News or JAMA regularly and read the damning indictments.

Several factors can be blamed for this situation, including unsophisticated electronic health records (EHRs) and arbitrary reporting requirements by Centers for Medicare & Medicaid Services (CMS). Natural language processing may provide one of the technical solutions to these problems. The NLP services by Nuance are already famous. An encouraging study finds substantial time savings through using NLP to enter doctor’s insights. And on the other end–where doctors are searching the notes they previously entered for information–a service called Butter.ai uses NLP for intelligent searches. Unsurprisingly, the American Health Information Management Association (AHIMA) looks forward to the contributions of NLP.

Some app developers are now exploring voice interfaces and NLP on the patient side. I covered two such companies, including the one that ultimately won the Alexa Diabetes Challenge, in another article. In general, developers using these interfaces hope to eliminate the fuss and abstraction in health apps that frustrate many consumers, thereby reaching new populations and interacting with them more frequently, with deeper relationships.

The next two parts of this article turn to each of the five finalists, to show the use they are making of Alexa.

Where Patient Communications Fall Short?

Posted on October 12, 2017 I Written By

The following is a guest blog post by Sarah Bennight, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

We are constantly switching devices to engage in our daily lives. In fact, in the last ten minutes I have searched a website on my desktop computer, answered a phone call, and checked several text messages and emails on my cellphone. Our ability to seamlessly jump from one device to the next affects our consumer behavior when interacting with places of business.

Today, we can order coffee and groceries online, web chat with our internet service company, and research store offerings before ever physically walking into a building. Traditionally, healthcare consumers had mainly phone support until the 2014 Meaningful Use 2 rule dictated messaging with a physician and patient portal availability. Recently, online scheduling and urgent care check in has been an attractive offering for consumers of health wanting to take control of their calendars and wait times.

Healthcare is certainly expanding functionality and communication channels to meet consumer demand. But where are we falling short? The answer may be relatively simple: data integration. Much like the clinical side of the healthcare business, integration is a gap we must solve. The key to turning technological convenience into optimal experience is evolving multichannel patient interactions into omnichannel support.

Omnichannel means providing a seamless experience regardless of channel or device. In the healthcare contact center, this means ensuring live agents, scheduling apps, chat bots, messaging apps, and all other interaction points share data across channels. It removes the individual information silos surrounding the patient journey, and connects them into one view from patient awareness to care selection, and again when additional care is needed.

In 2016, Cisco Connect cited four key reasons a business should invest in omnichannel consumer experiences, but I believe this resonates in the healthcare world as well:

  1. A differentiated patient and caregiver experience which is personal and interactive. Each care journey is unique, and their initial experiences should resonate and instill confidence in your brand. We now communicate with several generations who have different levels of comfort with technology and online resources. Offering multiple channels of interaction is crucial to success in the competitive healthcare space. But don’t stop there! Integrated channels connecting the data points along the journey into and beyond the walls of the care facility will create lasting loyalty.
  2. Increased profit and revenue. The journey to finding a doctor or care facility begins long before a patient walks in your door. Most of these journeys begin online, by interviewing friends, and checking online reviews. Once an initial decision is made to visit your organization, you can extend your marketing budget by targeting patients who might actually be interested in your services. When you know what your patients’ needs are, there is a greater focus and a higher chance of conversion.
  3. Maintain and contain operating costs. Integrating with EMRs is not always the easiest task. However, your scheduling and reminder platforms must be able talk to each other not only for the optimal experience, but also for efficient internal process management. For example, if a patient receives a text reminder about an appointment and realizes the timing won’t work, they can request to reschedule via text. Real time communication with the EMR enables agents currently on the phone with other patients to see the original appointment open up and grab the slot. Imagine the streamlining with the patient as well in an integrated platform. Go beyond the ‘request to reschedule’ return text and send a message says “We see that you want to reschedule your appointment. Here are some alternative times available”. Take it one step further with a one-step click to schedule process. With this capability, the patient could immediately book without a follow-up phone call reminder or staff having to hunt them down to book.
  4. Faster time to serve the patient. When systems and people communicate pertinent data, faster issue resolution is possible. Healthcare can be scary, and when you address patient and caregiver needs in a timely manner, trust in your organization will grow. In omnichannel experiences, a patient can search for care in the middle of the night online, and when they don’t find an appointment opening a call could be made. Imagine the value of already knowing that a patient was searching for a sick visit for tomorrow morning with Dr. X. With this data in mind, you are able to immediately offer alternatives and keep that patient in your system before they turn to a more convenient option.

You can see how omnichannel experiences are going to pave the way for the future of the contact center. Right now, the interactions with patients before and after treatment provide an enormous opportunity to build trust and further engagement with your organization. By integrating the data and allowing cross-channel experiences that build on each other, the contact center will extend into the main hub of engagement in the future. The time to build that integrated infrastructure is now, because in the near future new channels of engagement will be added and expected. Are you ready to deliver an omnichannel experience?

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

Wellpepper and SimplifiMed Meet the Patients Where They Are Through Modern Interaction Techniques

Posted on August 9, 2017 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Over the past few weeks I found two companies seeking out natural and streamlined ways to connect patients with their doctors. Many of us have started using web portals for messaging–a stodgy communication method that involves logins and lots of clicking, often just for an outcome such as message “Test submitted. No further information available.” Web portals are better than unnecessary office visits or days of playing phone tag, and so are the various secure messaging apps (incompatible with one another, unfortunately) found in the online app stores. But Wellpepper and SimplifiMed are trying to bring us a bit further into the twenty-first century, through voice interfaces and natural language processing.

Wellpepper’s Sugarpod

Wellpepper recently ascended to finalist status in the Alexa Diabetes Challenge, which encourages research into the use of Amazon.com’s popular voice-activated device, Alexa, to improve the lives of people with Type 2 Diabetes. For this challenge, Wellpepper enhanced its existing service to deliver messages over Amazon Echo and interview patients. Wellpepper’s entry in the competition is an integrated care plan called Sugarpod.

The Wellpepper platform is organized around a care plan, and covers the entire cycle of treatment, such as delivering information to patients, managing their medications and food diaries, recording information from patients in the health care provider’s EHR, helping them prepare for surgery, and more. Messages adapt to the patient’s condition, attempting to present the right tone for adherent versus non-adherent patients. The data collected can be used for analytics benefitting both the provider and the patient–valuable alerts, for instance.

It must be emphasized at the outset that Wellpepper’s current support for Alexa is just a proof of concept. It cannot be rolled out to the public until Alexa itself is HIPAA-compliant.

I interviewed Anne Weiler, founder and CEO of Wellpepper. She explained that using Alexa would be helpful for people who have mobility problems or difficulties using their hands. The prototype proved quite popular, and people seem willing to open up to the machine. Alexa has some modest affective computing features; for instance, if the patient reports feeling pain, the device will may respond with “Ouch!”

Wellpepper is clinically validated. A study of patients with Parkinson’s showed that those using Wellpepper showed 9 percent improvement in mobility, whereas those without it showed a 12% decline. Wellpepper patients adhered to treatment plans 81% of the time.

I’ll end this section by mentioning that integration EHRs offer limited information of value to Wellpepper. Most EHRs don’t yet accept patient data, for instance. And how can you tell whether a patient was admitted to a hospital? It should be in the EHR, but Sugarpod has found the information to be unavailable. It’s especially hidden if the patient is admitted to a different health care providers; interoperability is a myth. Weiler said that Sugarpod doesn’t depend on the EHR for much information, using a much more reliable source of information instead: it asks the patient!

SimplifiMed

SimplifiMed is a chatbot service that helps clinics automate routine tasks such as appointments, refills, and other aspects of treatment. CEO Chinmay A. Singh emphasized to me that it is not an app, but a natural language processing tool that operates over standard SMS messaging. They enable a doctor’s landline phone to communicate via text messages and route patients’ messages to a chatbot capable of understanding natural language and partial sentences. The bot interacts with the patients to understand their needs, and helps them accomplish the task quickly. The result is round-the-clock access to the service with no waiting on the phone a huge convenience to busy patients.

SimplifiMed also collects insurance information when the patient signs up, and the patient can use the interface to change the information. Eventually, they expect the service to analyze patient’s symptom in light of data from the EHR and help the patient make the decision about whether to come in to the doctor.

SMS is not secure, but HIPAA does not get violated because the patient can choose what to send to the doctor, and the chatbot’s responses contain no personally identifiable information. Between the doctor and the SimplifiMed service, data is sent in encrypted form. Singh said that the company built its own natural language processing engine, because it didn’t want to share sensitive patient data with an outside service.

Due to complexity of care, insurance requirements, and regulations, a doctor today needs support from multiple staff members: front desk, MA, biller, etc. MACRA and value-based care will increase the burden on staff without providing the income to hire more. Automating routine activities adds value to clinics without breaking the bank.

Earlier this year I wrote about another company, HealthTap, that had added Alexa integration. This trend toward natural voice interfaces, which the Alexa Diabetes Challenge finalists are also pursuing, along with the natural language processing that they and SimplifiMed are implementing, could put health care on track to a new era of meeting patients where they are now. The potential improvements to care are considerable, because patients are more likely to share information, take educational interventions seriously, and become active participants in their own treatment.

Care Coordination Tech Still Needs Work

Posted on July 26, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Virtually all of you would agree that we’ll have to do a better job of care coordination if we hope to meet our patient outcomes goals. And logically enough, most of us are hoping that technology will help us make this happen.  But from what I’ve seen, it isn’t going to happen anytime soon.

Every now and then, I get a press release from a company that says a company’s tech has solved at least some part of the industry’s care coordination problem. Today, the company was featured in a release from Baylor College of Medicine, where a physician has launched a mobile software venture focused on preventing miscommunication between patient care team members.

The company, ConsultLink, has developed a mobile platform that manages patient handoffs, consults and care team collaboration. It was founded by Dr. Alexander Pastuszak, an assistant professor of urology at Baylor, in 2013.

As with every other digital care coordination platform I’ve heard about – and I’ve encountered at least a dozen – the ConsultLink platform seems to have some worthwhile features. I was especially interested in its analytics capability, as well as its partnership with Redox, an EMR integration firm which has gotten a lot of attention of late.

The thing is, I’ve heard all this before, in one form or another. I’m not suggesting that ConsultLink doesn’t have what it takes. However, it’s been my observation if market space attracts dozens of competitors, the very basics of how they should attack the problem are still up for grabs.

As I suspected it would, a casual Google search turned up several other interesting players, including:

  • ChartSpan Medical Technologies: The Greenville, South Carolina-based company has developed a platform which includes practice management software, mobile patient engagement and records management tools. It offers a chronic care management solution which is designed to coordinate care between all providers.
  • MyHealthDirect: Nashville’s MyHealthDirect, a relatively early entrant launched in 2006, describes itself as focusing consumer healthcare access solutions. Its version of digital care coordination includes online scheduling systems, referral management tools and event-driven analytics, which it delivers on behalf of health systems, providers and payers.
  • Spruce Health: Spruce Health, which is based in San Francisco, centralizes care communication around mobile devices. Its platform includes a shared inbox for all patient and team communication, collaborative messaging, telemedicine support and mobile payment options.

No doubt there are dozens more that aren’t as good at SEO. As these vendors compete, the template for a care coordination platform is evolving moment by moment. As with other tech niches, companies are jumping into the fray with technology perhaps designed for other purposes. Others are hoping to set a new standard for how care coordination platforms work. There’s nothing wrong with that, but its likely to keep the core feature set for digital coordination fluid for quite some time.

I don’t doubt among the companies I’ve described, there’s a lot of good and useful ideas. But to me, the fact that so many players are trying to define the concept of digital care coordination suggests that it has some growing up to do.

Best Practices for Patient Engagement

Posted on July 13, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Brittany Quemby, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms
Brittany Quemby - Stericycle
Knowledge is power… so the saying goes.  When it comes to patient engagement, it couldn’t be more true. Being “in tune” is the key to unlocking the ultimate patient experience. Knowing what your patients need and want allows you to close the gap and deliver on those desires, while developing a deeper connection through effective patient engagement.

Here at Stericycle Communication Solutions, we are a group of individuals with all different types of needs and wants as patients. Below are some of the best practices that we preach to our doctors and healthcare providers when it comes to patient engagement and the patient experience:

Connect with meaning – Reach us where we spend most of our time. Roughly two-thirds of us own a smartphone, meaning we have access at our fingertips.  We expect an interactive and omni experience with our healthcare providers. We are looking for simple ways to connect with our doctors, schedule appointments, and prepare for important appointments.  By engaging on these terms, healthcare practices can be sure to connect to patients on a deeper level and encourage repeat visits to their health system.

Engage through multiple and preferred channels – We expect our healthcare experience to fit seamlessly into the rest of our lives. This means integrating with the technologies that we prefer including online, in person, and on our devices.

Did you know that:

  • 91% of us email daily
  • 77% of us set up appointments with their primary care provider via phone call
  • Text messages have a 98% open rate

These simple touch points, enables you to effectively engage using more than one mode of communication, ensuring you connect with us the right way each time!

Get personal! – Patients are no different than the everyday consumer.  We love personalization. In fact, 47% of us said we wanted “personalized experiences” when it comes to our health. Communicating based on our specific needs and wants gets noticed and evokes action! This allows providers to not only connect on a more personal level with us, but also empowers us to take an active role in own healthcare.

Involve Us! – Keep us in the loop! We are more involved in our own health than ever before.  Use of health apps and wearables have doubled in the last two years. We want to play an active role when it comes to important healthcare related moments.  Both US consumers (77%) and doctors (85%) agree that the use of health apps and wearables helps patients engage in their health. We want to be involved; take advantage!

To learn more about effective patient engagement, download this patient engagement whitepaper.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

E-Patient Update:  I Was A Care Coordination Victim

Posted on June 12, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Over the past few weeks, I’ve been recovering from a shoulder fracture. (For the record, I wasn’t injured engaging in some cool athletic activity like climbing a mountain; I simply lost my footing on the tile floor of a beauty salon and frightened a gaggle of hair stylists. At least I got a free haircut!)

During the course of my treatment for the injury, I’ve had a chance to sample both the strengths and weaknesses of coordinated treatment based around a single EMR. And unfortunately, the weaknesses have shown up more often than the strengths.

What I’ve learned, first hand, is that templates and shared information may streamline treatment, but also pose a risk of creating a “groupthink” environment that inhibits a doctor’s ability to make independent decisions about patient care.

At the same time, I’ve concluded that centralizing treatment across a single EMR may provide too little context to help providers frame care issues appropriately. My sense is that my treatment team had enough information to be confident they were doing the right thing, but not enough to really understand my issues.

Industrial-style processes

My insurance carrier is Kaiser Permanente, which both provides insurance and delivers all of my care. Kaiser, which reportedly spent $4 billion on the effort, rolled out Epic roughly a decade ago, and has made it the backbone of its clinical operations. As you can imagine, every clinician who touches a Kaiser patient has access to that patient’s full treatment history with Kaiser providers.

During the first few weeks with Kaiser, I found that physicians there made good use of the patient information they were accumulating, and used it to handle routine matters quite effectively. For example, my primary care physician had no difficulty getting an opinion on a questionable blood test from a hematologist colleague, probably because the hematologist had access not only to the test result but also my medical history.

However, the system didn’t serve me so well when I was being treated for the fracture, an injury which, given my other issues, may have responded better to a less standardized approach.  In this case, I believe that the industrial-style process of care facilitated by the EMR worked to my disadvantage.

Too much information, yet not enough

After the fracture, as I worked my way through my recovery process, I began to see that the EMR-based process used to make Kaiser efficient may have discouraged providers from inquiring more deeply into my particulalr circumstances.

And yes, this could have happened in a paper world, but I believe the EMR intensified the tendency to treat as “the fracture in room eight” rather than an individual with unique needs.

For example, at each step of the way I informed physicians that the sling they had provided was painful to use, and that I needed some alternative form of arm support. As far as I can tell, each physician who saw me looked at other providers’ notes, assumed that the predecessor had a good reason for insisting on the sling, and simply followed suit. Worse, none seemed to hear me when I insisted that it would not work.

While this may sound like a trivial concern, the lack of a sling alternative seemed to raise my level of pain significantly. (And let me tell you, a shoulder fracture is a very painful event already.)

At the same time, otherwise very competent physicians seemed to assume that I’d gotten information that I hadn’t, particularly education on my prognosis. At each stage, I asked questions about the process of recovery, and for whatever reason didn’t get the information I needed. Unfortunately, in my pain-addled state I didn’t have the fortitude to insist they tell me more.

My sense is that my care would’ve benefited from both a more flexible process and more information on my general situation, including the fact that I was missing work and really needed reassurance that I would get better soon. Instead, it was care by data point.

Dealing with exceptions

All that being said, I know that the EMR alone isn’t itself to blame for the problems I encountered. Kaiser physicians are no doubt constrained by treatment protocols which exist whether or not they’re relying on EMR-based information.

I also know that there are good reasons that organizations like Kaiser standardize care, such as improving outcomes and reducing care costs. And on the whole, my guess is that these protocols probably do improve outcomes in many cases.

But in situations like mine, I believe they fall short. If nothing else, Kaiser perhaps should have a protocol for dealing with exceptions to the protocols. I’m not talking about informal, seat-of-the-pants judgment call, but an actual process for dealing with exceptions to the usual care flow.

Three weeks into healing, my shoulder is doing much better, thank you very much. But though I can’t prove it, I strongly suspect that I might have hurt less if physicians were allowed to make exceptions and address my emerging needs. And while I can’t blame the EMR for this experience entirely, I believe it played a critical role in consolidating opinion and effectively limiting my options.

While I have as much optimism about the role of EMRs as anyone, I hope they don’t serve as a tool to stifle dissension and oversimplify care in the future. I, for one, don’t want to suffer because someone feels compelled to color inside of the lines.

Value-sizing The Patient Experience

Posted on June 8, 2017 I Written By

The following is a guest blog post by Sarah Bennight, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

In health IT, we talk about the patient experience all the time. Many of us have dedicated our entire careers to improving the patient experience. It has become so central to improving healthcare that patient-reported experience results determine a significant portion of reimbursement.

But today’s patient experiences do beg the question: are they a pie in the sky dream or something tangible that can be addressed in our organizations?

To tackle the patient experience, we have to audit all contact points to determine areas of weakness. A great way to start is by creating a healthcare consumer journey map. Identifying each point a patient could potentially interact with your organization is key to ensuring their experience will be great. Once you have identified each potential encounter, mystery shop that experience as if you were the patient to test your brand’s current performance. When determining whether or not your organization provides a great brand experience, you may find yourself comparing your performance to the top brands you work with on a daily basis.

For example, I recall a time when I studied abroad in the United Kingdom. Upon arriving in a foreign country after 22 hours of travel with little sleep, I needed to eat. I vaguely recalled passing a familiar restaurant sign on the way to my flat: McDonalds. And though I didn’t really love the golden arches at the time, I chose to eat there. Why? Because I knew what to expect. I knew how to order, what menu items would be available, and what it would taste like.

By focusing on consistent interactions and expectations for their customers, McDonalds has created a strong brand. In fact, when asked about introducing new products during a 2010 CNBC interview, former CEO James Skinner said “[McDonald’s doesn’t] put something on the menu until it can be produced at the speed of McDonalds.”

Can your healthcare consumers count on a consistent experience when contacting your organization? Your brand experience should encompass the entire health system to build confidence and loyalty in your brand. Creating consistency across each encounter begins with simple questions. Was their initial call met with a timely, sincere, and welcoming voice? Was parking convenient? Are average waiting times reasonable? Do Center A and Center B provide the same quality support? Is their bill easy to understand? If your answers are all yes, it’s more likely that patients will continue to choose your organization.

When patients feel confidence about provided services and perceive value in the care you provide, brand loyalty is achieved. What’s more, many studies show that patients who have great healthcare experiences and are confident in the level of care they receive will have better clinical outcomes. Value-based care demands consistent, evidence-based clinical interactions. But we can’t leave out the important patient experience outside the walls of the exam room.

After my exhaustive travels, I certainly had a better outcome by relying on my trust in McDonalds’ brand. I chose to value-size my meals frequently throughout my England journey – not because it was the best tasting food, but because I could always rely on consistently convenient and quality experiences. The healthcare industry can certainly learn a lot more from cutting edge commercial companies when it comes to creating loyalty. To learn more about the patient journey and loyalty, download our e-book.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

Staying Connected Beyond the Patient Visit

Posted on April 20, 2017 I Written By

The following is a guest blog post by Brittany Quemby, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms
Brittany Quemby - Stericycle
I see it everywhere I go – heads down, thumbs flexing. We live in an era where our devices occupy our lives. When I’m sitting at the airport waiting for my flight, standing in line at the grocery store, waiting to be called at my doctor’s office, I see it – heads down, thumbs flexing. Although I wish we weren’t always heads down in our phones, it is inevitable, we rely on our smartphone to stay connected.  As it stands today, roughly two-thirds of Americans own a smart phone, meaning they have access to email, voice, and text at their fingertips.

The increase in connectivity that the smartphone gives its user provides physicians a whole new way to communicate beyond the patient visit. Below are some tips that can help healthcare professionals stay connected while improving engagement, behaviors, and revenue outcomes.

Consider the patient’s preferences
Quite often only one piece of contact information is gathered for a patient and it is typically a home phone number. Patients expect to be communicated with where it is convenient for them, and in a recent survey on preferred communication methods, 76 percent off respondents said that text messages were more convenient above emails and phone calls.  If you are looking to connect with patients in a meaningful way, consider asking them their preferred method of contact to help maximize your engagement.

Use a various methods of communication
Recently we surveyed over 400 healthcare professionals to learn about the ways they are communicating and engaging with their patients. Our findings revealed that 41 percent of physicians and healthcare professionals utilize various methods to connect and communicate with their patients.  Long gone are the days when you could reach someone by a simple phone call. Today, if I need to get in touch with someone this is how it goes down: I will email them, then I will call them to let them know I emailed them, and then I text them to tell them to go read my email.  A recent report shows that on average 91 percent of all United States consumers use email daily and that text messages have a 45 percent response rate and a 98 percent open rate. Connecting with patients through multiple channels of communication can show a significant change in patient responsiveness and behavior, including an increase in healthcare ownership, a decrease in no shows, and a substantial increase in revenue.

Automate your patient communication messages
Investing in an automated patient communication solution is a great way to connect with your patients beyond the doctor’s office. It will not only increase patient behaviors, efficiencies, satisfaction and convenience, but will also dramatically impact your bottom-line.

A comprehensive automated patient communication platform allows include regular and frequent communication from your organization to the patient in a simple and easy way.  Consider implementing some of the following automated communication tactics to help you increase your practice’s efficiencies while continuing to engage with patients outside of the office:

  • Send appointment reminders: Send automated appointment reminders to ensure patients show up to their appointment both on time and prepared.
  • Follow-up communication: Patients only retain 20 to 60 percent of information that is shared with them during the appointment. Send a text or email with pertinent follow-up information to increase patient satisfaction and decrease readmissions.
  • Program promotion: Connect with patients to encourage them to come in for important initiatives your practice is holding like your flu-shot clinic.
  • Message broadcast: Communicate important information like an office closure or rescheduling due to severe weather.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media: @StericycleComms