Using Social Technologies To Engage Patients Across the Continuum of Care

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This session will explore the integration of social media and underlying technologies into a healthcare organization’s communication and patient engagement strategy.

It will include a review of opportunities to leverage social media as tools for business intelligence, enhancing care coordination processes and facilitating effective communications.

The role of social technologies in clinical and operational initiatives and processes across the entire care continuum and for improving health outcomes will be highlighted.

About the Speaker:
Christina Thielst, FACHE, is Vice President of Social Media at TOWER, a patient experience consulting group. She advises healthcare organizations on strategies to engage consumers across the continuum of care and apply emerging technologies to positively transform experiences – from the patient’s perspective.

Christina has blogged since 2005 and is a thought leader in the continually evolving field of health IT. Her book, Social Media in Healthcare: Connect Communicate Collaborate is now in its second edition and a new book of social media innovation case studies is scheduled for publication in early 2014.

Christina received a Masters of Health Administration from Tulane University, School of Public Health and Tropical Medicine and is a member of the American College of Healthcare Executives, Health Care Executives of Southern California, Health Information Management Systems Society (HIMSS), American Telemedicine Association and The Beryl Institute.

Published in: Health & Medicine, Business
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  • Aligned with the National eHealth Collaborative’s 5 Phases of the Patient Engagement Framework
  • National Research Corporation, Feb 2011 and YouGov Healthcare, 2011
  • According to ForeSee, 2012 Healthcare Satisfaction Benchmark
  • Note: AHRQ is developing a measuring system that will rate how well EHRs support patient education. This is the result of the info shared in this slide.
  • 1. Tang, et al, AMIA 1996: 12-16 and 2. Scheitel, et al. Mayo Clinic Proceedings, 1996
  • RWJ Foundation, “Care About Your Care” 2013
  • Study of urban multiethnic, low socioeconomic status caregivers http://www.ncbi.nlm.nih.gov/pubmed/18762597
  • Misky, Wald, Coleman JHM 2010; 5:392-397
  • *PEW Internet and American Life Project
  • Ver
  • Using virtual worlds and avatars to educate and communicate information to patients and consumers
  • http://www.well-fx.com/social-networking-is-good-for-the-health/
  • http://www.childrens.com/new-and-current-patients/current-patients/childrens-social-network/
  • http://archinte.jamanetwork.com/article.aspx?articleid=1570086#AuthorInformation
  • *MobileSQUARED and Single Point, “Conversational Advertising” **SafeAmerica Foundation, Text First, Talk Second
  • according to a study published in the journal Annals of Emergency Medicine, 
  • according to a study published in the journalAnnals of Emergency Medicine,
  • Using Social Technologies To Engage Patients Across the Continuum of Care

    1. 1. Social Technologies: Engage Patients Across the Continuum of Care ePatientExperience.com December 3, 2013
    2. 2. Learning Objectives • Recognize the contributions of social media to the engagement of patients and their family caregivers • Identify opportunities to include social technologies in clinical and operational initiatives and processes
    3. 3. Great Tweet! @msbluebells I feel the same way about hospital gowns as I do using social media... I am never sure what I might be showing... :) 3:02 PM - 16 Feb 12 via web · Embed this Tweet
    4. 4. Social Media Defined Electronic tools that enhance communication, support collaboration & enable users to generate and share content – At least bi-directional – Dialogue and collaboration in building content – Easily accessible – anywhere, anytime -- on a mobile device, laptop or desktop computer – Immediate – right now
    5. 5. Apps & Widgets Virtual Worlds Microblog Blog Social Gaming Social Technologies Wiki Bookmarking Brands Social Networks Photo Sharing Aggregators RSS Video Sharing Podcast
    6. 6. Healthcare Continuum of Care Participatory Model Inform Me Engage Me Empower Me Partner with Me Support my eCommunity Static Transactional Interactional Self Management Interoperability EMR Patient Portal Patient Empowered Portal Patient Empowered Portal Information Exchange Public Website Copyright © 2013 Tower Strategies
    7. 7. Social Media Across the Care Continuum Patients & Family Create a sense of trust that this is the provider of choice by beginning to deliver a smart and personalized experience  Engaging disease/condition information  Self-management tools  Physician blogs  Maps & directions  Virtual tour  Health tips  Following tweets  Clinical trial recruiting Pre-Treatment Educate and prepare for the what, where, how and why of treatment  Self assessments  Social support & networking  Campus & indoor navigation  Interactive learning  Multidirectional information sharing  Text reminders Active Treatment Provide the right support at the right time in the right way to improve the patient’s treatment experience      Journaling Social networking Interactive learning Messaging Bookmarking & organizing information  Care coordination  Patient generated data and information  Caregiver support Post Treatment Support a positive ‘return to life’ experience  Reminders & monitoring  Self-care tools  Messaging  Social support & networking  Sharing story & feedback  Ways to give back  Ongoing engagement Copyright © 2012 Tower Strategies Worried Well
    8. 8. DRIVERS & TRENDS
    9. 9. Consumer Preferences on Social Media • 50% prefer a health provider social networking site • 14% prefer an integrated approach of hospital websites and social media • 57% say a hospitals social media connections would strongly affect their decision to receive treatment at that facility • 81% feel a strong social media presence indicates a hospitals clinical functions are cutting edge
    10. 10. Online Customer Experience Priority • Link established between online satisfaction and financial success • Highly satisfied visitors report being: – More likely to return (177%) – Recommend site to others (185%) – Use as their primary resource (234%) • Average satisfaction score for hospitals & health systems is 74 (100 point scale) 10
    11. 11. New Payment Models Shrinking Revenue/ Margins Population Health Integrated Delivery Systems Patient Satisfaction Healthcare Climate Digital & Mobile Shift Accountable Care Quality & Safety Penalties Clinical Outcomes
    12. 12. Enhancement to EHR • Can’t anticipate every question • EHR information is rarely written in way understandable and actionable for patients with basic or below basic health literacy (90M) • Too often include long text and use of medical terms • Estimates of 77M people with a poor understanding of basic medical vocabulary and health concepts (at greatest risk for poor outcomes and readmissions)
    13. 13. Patient/Physician Education In the exam room 37% of the physician’s time is spent on patient education – Patients failed to report 68% of problems – Physicians report 54% of patients missed their most important health problem
    14. 14. Understanding Home Care Instructions 80% of patients discharged from the emergency department don’t understand their home care instructions 14
    15. 15. Caregivers of Young Children • 47.8% made dosing errors after standard medication counseling and 38% did not adhere to all instructions • With pictogram dosing error rate fell to 5.4% & only 9.3% did not adhere to all instructions 15
    16. 16. Evidence-Based Communications Customized to the learning and language needs of the individual patient • • • • • Patient is part of the team Advocate for patient Engage patient Closed-loop communications Handoff
    17. 17. Readmissions • California’s goal is to reduce readmissions by 20% • The average readmission costs $8000 to $13,000 • Common drivers identified for readmissions: – Lack of standard discharge processes – Lack of engagement or activation of patients and families – Patients call 911 or return to emergency room instead of accessing a different type of medical service – Ineffective or unreliable sharing of relevant clinical information – Patients did not understand/did not correctly take medications. 17
    18. 18. Readmissions Opportunities • Causes – Heart Failure and Pneumonia (50%) – COPD (16%) – Diabetes (13%) • 51% of discharges did not have timely followup within 30 days* – 10 times more likely to be readmitted 18
    19. 19. APPLICATIONS ACROSS THE CARE CONTINNUUM
    20. 20. Patient Online Information Needs • When questions arise (not always in the exam room) • Relevant, contextual information on their condition preferred • Provider endorsement of information preferred • User-friendly tools to document and transmit
    21. 21. Apps (Widgets) • Product selection and communication with allergist about symptoms and experiences • Individualizes strategies for managing PTSD, tracking symptoms, finding local support and obtaining anonymous assistance for military & veterans • Top consumer apps: – weight loss & exercise – downloaded & more data – pregnancy – actual use 21
    22. 22. mHealth Apps by Category Verisoni, 2012 22
    23. 23. Pre-Treatment • Floyd Medical Center Preoperative Patient Guide • Pre-Conception Assessment – Gabby – High risk of poor reproductive health & family planning outcomes – Sixth grade reading level & replay aids in comprehension – Relevant, contextual communications based upon responses
    24. 24. Pre through Post Treatment • Columbia Valley Community Health - reach out to and communicate with young, immigrant and underserved mothers-to-be • West County Health Centers FQHC - eliminate the social stressors and underlying barriers to care - sharing experiences - accessing condition specific educational content - engaging patients to self-manage their chronic conditions
    25. 25. Active Treatment • Boston University Discharge Advocate – – – – – Education & aftercare plan helpful with low literacy 51 min vs. 81 min for live DA preferred by 74% of patients encourages patients to be active participants in their care – Estimate a 30% decrease in ED and hospital utilization – Estimate at least $145 direct cost savings per patient discharge
    26. 26. Treatment & Post-Treatment Phases • Northern California Health Centers – Private social platform to extend care – Patient engagement outside of provider visits • United Health Centers of San Joaquin – Safety-net provider – Online and mobile platform for providers and patients to manage chronic disease
    27. 27. Treatment & Post-Treatment Phases • Children’s Hospital Dallas – Secure online social networking community – Current and former patients and families – Personalized security settings – Increase communication, support and connections – Patients/families create and join communities
    28. 28. Post-Treatment • Social Networking platform for those recovering from addiction(s) – Secure access to support 24/7 used by payors and providers – Case managers • track across transitions • filter activity to assess risk of relapse • Prioritize outreach activities – One health plan realized a two-thirds reduction in relapse readmissions over first year – 67% reduction in readmission rates for those out of treatment for more than 270 days – App for anywhere/time access to support 28
    29. 29. Addiction Recovery Results • Improved handoff communications during transitions • Improved outcomes with increases support and regular tracking of progress • Stronger peer support networks and means to stay connected • More relevant case management from scheduled check-in and reporting (e.g. cravings, depression, pain) • Creation of a behavioral record over time (e.g. achievements, emotional status, relapse) • Regular clinical assessment of an individual’s risk of relapse • Comprehensive reporting of aggregate data • When these patients relapse, they usually go online first to get support
    30. 30. Survivorship Research • Boston Children’s Hospital – Social media to augment traditional surveillance methods - hypoglycemia in diabetics – Expand knowledge of complications from bidirectional conversations among participants – Learn about experiences that may not be severe enough for emergency treatment – Impact on behaviors
    31. 31. Extending to Mobile: Texting • 90% of text messages are read within 3 minutes* • Secure, encrypted, protected, traceable texting apps for physicians, nurses and other staff communications • Bandwidth: 1-minute call = 800 text messages** • Text 911 now available in some markets • Preferred by young, minorities & Medicaid beneficiaries 31
    32. 32. Text Message–Based mHealth in Emergency Department Patients With Diabetes Adults with diabetic issues who visited an urban, public ED received two diabetes-related text messages daily during a 6 month period – Motivational messages daily; – Medication reminders three times per week; – Healthy living challenges twice per week; and – Trivia questions twice per week.
    33. 33. TExT-MED Results • blood glucose levels fell by 1.05% and self-reported medication adherence increased from 4.5 to 5.4 on an eight-point scale in the intervention group • 35.9% of patients who received such text messages visited the ED, compared with 51.6% of those who did not receive such messages • effect on medication adherence & disease control was higher among Spanish-speaking individuals • Overall, 93.6% of patients who were sent text messages said they enjoyed receiving them
    34. 34. Partners Healthcare – Texting • Several studies and findings include: – Patients feel better connected to care team and received higher quality of care – Improved adherence to care plans – Decrease in “no show” rates – Sustained behavior changes • What’s next? Support and feedback improving weight lost and diabetics outcomes 34
    35. 35. Results: Sunscreen Use Center for Connected Health
    36. 36. MANAGING THREATS & RISK 36
    37. 37. What languages does your community speak?
    38. 38. Social Media Learning & Influencing • Identify attitudes, perception and behavior about brand and trends • Social intelligence – listening posts across the spectrum of social media outlets (today’s newspaper clipping service) • Social customer relationship management (CRM) • Word of “mouth” promotions
    39. 39. 39
    40. 40. What patients share…. • “Inefficient process, long wait” • “…Bring something to do while you wait” • “Losing your parking stub is a pain in the ass – don’t do it.” • “Dr. xxx is a miracle worker” • “Free Wi-Fi!” • YouTube Video of staff brushing hair
    41. 41. Push Content & LISTEN
    42. 42. Related Patient-Centered Technologies • Mobile: extend the reach of care and stay connected with patient populations • Enterprise portals: single sign-on, proxy access • Personalization: Contextually relevant information and education
    43. 43. Patient Experience Improvement Process Monitor Performance Collect Information Build Strategy & Roadmap Engage Top Down & Bottom Up Establish Shared Vision
    44. 44. Best Positioned Hospitals • • • • Offer social engagement opportunities User-centered designs Benefit from resulting patient perceptions Leverage social media as a care coordination platform • Change the way care is provided – esp. post-discharge • Use social intelligence and directed networks to advance goals
    45. 45. Christina Thielst, FACHE Vice President, Social Media thielst.typepad.com @TowerStrategies @cthielst cthielst@towerstrategies.com Christina@cthielst.com 805 845-2450

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