Krames StayWell White Paper.indd

Beyond the Checkbox:
Using Health Information to Continuously
Engage Patients and Improve the Patient Experience
The U.S. Dept. of Health and Human Services announced in
February 2012 that nearly 2,000 hospitals received incentive
payments under the Centers for Medicare and Medicaid
Services’ EHR Incentive Programs. In addition, 85 percent
of hospitals now report that by 2015 they intend to take
advantage of the incentive payments. With the competitive
inpatient market moving toward critical mass, many hospitals
face the daunting but necessary challenge of meeting Stage
1 Meaningful Use criteria, comprising 14 required core
objectives and five menu set objectives from a list of 10.
Forward-thinking hospitals and health
systems
are
approaching
patient
education beyond checking a box on their
way to qualifying for incentive payments.
Hospitals may choose their five menu set objectives based on
the “low hanging fruit” principle. The objective “to use certified
electronic health record (EHR) technology to identify patientspecific education resources and provide those resources to
the patient if appropriate” appears to be easily attainable.
Forward-thinking hospitals and health systems, however,
are approaching patient education beyond checking a box
on their way to qualifying for incentive payments. They are
strategically leveraging the electronic capability of providing
patient education materials for greater value – to continuously
engage patients after their discharge and improve patient
experience, thus forging a stronger, long-lasting patientprovider relationship.
Beyond Meeting Meaningful Use
Driven largely by the Meaningful Use criteria, New Orleansbased Ochsner Health System wanted to provide consistent
patient education materials based on evidence-based medicine
to its clinicians across its seven hospitals and 40 clinics.
Previously, the health system had a mix of in-house content,
vendor-supplied materials and myriad other sources. “There
was no quality control or way to enforce consistency,” said
Robert Jones, senior systems administrator for Ochsner’s
Academic Division. “We knew we needed to do better.”
Ochsner addressed the quality and consistency issues by
partnering with Krames StayWell, which was chosen because
of its deep history and expertise in the market and its reliance
on evidence-based medicine for its content.
Krames StayWell was also able to meet Ochsner’s
implementation goal of delivering patient education materials
from within its Epic electronic medical record (EMR) system.
Krames StayWell enhanced its export capability so content
can be integrated in the EHR environment and be part of the
clinical workflow. Clinicians can now seamlessly and easily
select, review and print the materials from the EMR at the point
of care, which also enriches communication between patient
and clinician.
In addition, the export capability helps deliver better search
results, according to David Trenti, product development
manager for Krames StayWell. When a clinician opens
a patient record in an EHR system, for example, relevant
documents tied to the patient’s diagnoses codes are
automatically delivered, providing clinicians with targeted and
more granular documents to give to their patients. Indexing
content correctly and tagging content based on diagnoses
codes rather than general keywords not only deliver higherquality search results but higher-quality content, he said.
Ultimately, the provisioning of high-quality patient materials
will help deliver better care and enable better outcomes for
patients, which Jones said is Ochsner’s “real goal.”
Oschner Health System
In addition, the integration allows the EMR to document
the delivery of patient materials. While the audit trail offers
liability protection on the extreme end of the spectrum, it
helps clinicians pinpoint why patients aren’t making progress
with their treatment plan after they have been discharged,
Jones said. Clinicians can see whether patient education
materials have been provided or not. If they have been
distributed, clinicians can then walk through and help their
patients understand the materials. It’s yet another opportunity
for building the patient-clinician relationship as well as drive
compliance, he pointed out.
Enhancing Patient-Centered Communication
In addition to Meaningful Use criteria, hospitals across the
nation are also working to comply with the Joint Commission’s
patient-centered communication standards for hospitals,
which become effective July 1, 2012. With more than
300 languages spoken in the U.S., the Joint Commission
understands the challenges of communicating with patients
and families in their primary tongue. Sara Riegel, manager
of patient and family education and community health for
Swedish Medical Center, a five-hospital, 30-clinic system in
Washington state, reported multi-language capabilities was a
requirement when selecting a system.
The Joint Commission also documented that more than 90
million Americans have low health literacy, i.e., are unable to
adequately understand and use health information. Too much
information can intimidate or fatigue patients, which can lead
to noncompliance. According to Lane Stiles, who has overseen
patient education programs at both Vanderbilt University
Medical Center in Tennessee and Fairview Health Services in
Minnesota, a common thread across the diverse populations
he has worked with in his career is that it is very easy to
quickly overwhelm patients. While at Fairview, Stiles worked
with Krames StayWell, whose content focused on three to five
key messages and provided actionable knowledge to support
compliance initiatives for better outcomes.
Expanding Patient Reach through Multiple
Channels
This patient-centered communication approach is also forward
thinking, noted Stiles, as it will help health systems meet new
requirements of the future in the areas of patient engagement
and satisfaction, which are integral parts of emerging valuebased payment systems. In his current position at Vanderbilt
University Medical Center,
Stiles intends to create
the definitions and build
out metrics for patient
communications, relying on
existing instruments such
as the HCAHPS (Hospital
Consumer Assessment of
Healthcare Providers and
Systems) survey, the first
national, standardized,
publicly reported survey
of patients’ perspectives of
hospital care. By defining
patient communications
metrics, health systems can
Vanderbilt University
Medical Center
then tie them to patient
satisfaction and outcomes,
which in turn can help determine return on investment (ROI) of
patient-education solutions, Stiles said.
Fairview, which comprises seven hospitals, 40-plus primarycare clinics and numerous specialty services, home care and
senior services, was looking for an electronic enterprise-wide
solution that could accommodate its expansion. The regional
integrated health system also wanted to deliver patient
education through its various media – public website, Epic
EMR system, patient portal and intranet – which would allow
it to reach a greater portion of its patient population and its
clinicians through their preferred communication mode. “We
were able to develop a true continuum of care with consistent
messaging across all media,” said Stiles.
According to Drew Diskin, independent digital engagement
strategist, being transparent and capable of providing
relevant, timely and valuable information is critical to
delivering on the ease, speed and convenience that consumers
want. “When you look at how people understand information
that is given to them, meaningful use is better served with
supporting information, support and an ongoing approach of
checking in with the patient or the patient’s loved ones,” he
said. Diskin noted studies have shown that ongoing support,
human contact and provisioning that are timely and relevant
increase compliance exponentially, alter behavior, and help
create a bond between patients and their healthcare providers
in a relational way as continuity of care is shaped by their
changing needs.
Continuously engaging patients once they leave the inpatient
setting requires reaching out to them through various
communication channels. Communications providers such
as Krames StayWell often allow content to be distributed in
multiple formats such as HTML and PDF and through multiple
channels such as mobile devices, e-mail, and patient portals.
Krames On-Demand (KOD) enables innovators and designers
to customize content to their needs and export and deploy
it into their application or workflow. “We’re always looking
for new channels for content to be consumed based on our
relationship with EMR vendors and customers,” Trenti said.
By defining patient
communications
m e t rics,
health
systems can then
tie them to patient
satisfaction
and
outcomes, which
in turn can help
determine
return
on investment (ROI) of patient-education
solutions.
Lane Stiles
Director of Patient Education
Vanderbilt University Medical Center
In similar fashion, Ochsner wants to engage its patients outside
of the healthcare setting via an easily accessible electronic
forum. Through its MyChart, patients can retrieve education
materials, lab tests, general wellness information and other
materials that will help them be better informed and therefore
help them better manage their health long after their inpatient
stay. “We will always continue to build the cohort of patients
who use that resource and continually enrich that resource
so there’s always something good for them to use when they
return to the website,” Jones said.
“All things being equal, the most
informed patient is most likely to
have the best outcomes. ”
Robert Jones
Senior Systems Administrator, Academic Division
Ochsner Health System
Correlating Patient Education with Quality of Care,
Better Outcomes
Ochsner believes that providing its patients more information
at every opportunity – to help them understand their medical
condition, alternatives, the choices made by the health system
in terms of treatment algorithms – improves patient satisfaction
and empowerment. Patient knowledge about their medical
condition is “extremely important” in helping them manage
their condition at home, which can help reduce such events
as hospital readmissions, Jones pointed out. “All things being
equal, the most informed patient is most likely to have the best
outcomes,” he said.
While such results are emerging, studies have shown a
correlation between patient education and patient satisfaction
and improved outcomes. The May/June 1998 issue of the
Congestive Heart Failure Journal published a study measuring
the impact of patient-education interventions on readmissions.
In the Our Heart Failure Outcome Study, over a 12-week
period Columbia San Jose Medical Center in California sent
out four mailings comprising a video and booklets. The test
group that received the patient education intervention materials
had a 51 percent reduction in readmissions compared to the
control group, which resulted in a net savings of approximately
$173,000 to the medical center – an eight-to-one ROI.
From 2005 to 2008, Del Sol Medical Center in Texas
participated in the Robert Wood Johnson Foundation
Expecting Success: Excellence and Cardiac Care program. A
Heart Failure Center was established and staffed by a nurse
practitioner who monitored patient progress from admission
through follow-up visits after discharge. The program, whose
patient-education component included implementation of KOD
to deliver information to patients in both English and Spanish,
saw readmission rates for study participants drop from 16
percent to 7 percent.
In terms of the impact of patient education on satisfaction
scores, The Journal of PeriAnesthesiology Nursing published
in 2009 a study that examined the impact of providing
diagnostic-specific discharge instructions on patient
satisfaction. Using KOD to deliver the content, the Regional
Medical Center of San Jose in California realized an
improvement in eight of nine measures of patient satisfaction in
the test population.
Transforming Healthcare through Patient Education
As more hospitals and health systems tie patient education
to improved patient satisfaction and outcomes, they should
be emboldened by the results of the National eHealth
Collaborative’s 2012 Stakeholder Survey, which was released
in February 2012. Of the 185 respondents who participated
in the online survey, 77 percent said patient and consumer
engagement is “very important” to transforming healthcare
and 18 percent said it is “important.” Furthermore, when
respondents were asked to define patient engagement, 64
percent said it is “best reflected” as online resources and
education materials to inform patients about health and health
conditions, and 59 percent said it was patients using tools and
online resources for managing their health records and other
data.
“The big opportunity here is for organizations to be relational
versus transactional in care provision,” Diskin emphasized.
“If the information is easier to work with and has common
threads based on attributes and not a hierarchy of information,
correlations could be made, diagnoses can be revealed and
proactive care can be administered – and then all of this to
say: Meaningful use can be achieved when it has meaning.”
Diskin calls on all stakeholders in the healthcare ecosystem
to approach health information not as a checklist but as a
transformative way of doing business.
About Krames StayWell
Krames StayWell is the largest provider of patient education, consumer health information, and population health management communications in the country.
Combining extensive technology and content assets with vast consumer insights and a strategic approach, Krames StayWell is uniquely qualified to engage
consumers across the entire spectrum of their health care experience. Our best-in-class health communication solutions integrate print, interactive, and mobile
formats at multiple touch points to attract and retain consumers, improve health outcomes, and lower costs. We deliver measurable results for hospitals, health
care professionals, health plans, employers, retail pharmacies, government agencies, and association clients with world-class design, commitment to health
literacy principles, and a focus on custom development. For more information, please visit www.kramesstaywell.com.
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