The Pop Health Forum, a conference put on by the Healthcare Information and Management Systems Society (HIMSS) in Chicago this week, was as much about patient engagement as it was about population health.
This makes sense, because it’s difficult to manage populations without reaching out — engaging — members of those populations.
Jeffrey Springer, a vice president at Princeton, New Jersey-based health IT vendor and consulting firm CitiusTech, said that getting to population health means checking all nine squares on a 3-by-3 matrix. The X axis covers acute, ambulatory and whole-patient care, while the Y axis is about execution on clinical, financial and operational metrics.
Patient engagement falls under all three care rows and at least two of the execution columns. Yes, financial performance has elements of patient engagement.
At University of Chicago Medicine, about nine miles south of the downtown conference site, the annual operating plan for fiscal year 2017 has patient experience as one of the five pillars of the plan, along with people, quality/safety, finance and long-term strategic positioning. Debra Albert, chief nursing officer and vice president of patient care services at U. of C. showed this slide during her presentation:
(Click here for a larger version.)
“We’re really trying to drive a consistent patient experience across all of our platforms [of care],” Albert said.
In fact, patient experience is part of what Albert called the “value-based core” of the academic health system’s goals for 2017. In her view, value equals quality — including the patient experience, proper resource utilization and clinical outcomes — divided by cost.
University of Chicago Medicine hasn’t reached true value-based care delivery yet. However, the goal is so important to the organization that the chief medical officer is in charge of implementing the core of enhancing collaboration, promoting telemedicine and selling faculty members on the concept of value-based healthcare, Albert explained.
Indeed, clinicians are empowered as much as the health system aspires to empower patients.
About three years ago, U. of C. instituted what Chief Experience and Innovation Officer Sue Murphy called “leader rounding.” At the time, rounding on inpatient wards and in the emergency department was paper-based. “We had no way of knowing what was going on,” Murphy said.
The organization standardized inpatient and ED nurse rounding on iPads, consulting unit leaders and rank-and-file staff on redesigning rounding processes. U. of C. created a system of alerts and accountability, analyzing rounding trends and rewarding nurses for good work.
Initially, Murphy and other executives didn’t realize that every nurse leader had a different comfort level with the iPads and with technology in general. Patients also had varying reactions to the presence of a tablet with each nurse who stopped in the room. “We came up with some keywords to say to patients,” Murphy said, to help reassure those who saw the iPad as an intrusion on the patient-clinician relationship.
Individual nursing leaders also have been given autonomy to make process improvements within their departments and wards. “We strongly believe that the leader of a unit is kind of the mayor of that unit,” Murphy said.
According to Press Ganey surveys of University of Chicago Medicine, 81.9 percent of inpatients in August 2015 reported that a nurse manager checked in on them daily. That number rose to 93.8 percent in July 2016.
Overall hospital ratings, as reported to the Centers for Medicare and Medicaid Services, jumped from about 60 percent in 2011 to nearly 75 percent in the reporting period that ended in the second quarter of 2016. There was a sharp increase in 2013, the year the health system started rethinking nurse rounding.
“Those many patients were touched,” Murphy said, gesturing to data on a PowerPoint slide. “They were touched by a kind word, by technology, by a caring nurse.”
But the research community has been able to pull in information from Fitbits and other connected, wearable devices for four years with the help of a research platform called Fitabase.
This week, Fitbit announced that Fitabase, made by San Diego-based startup Small Steps Labs, has now collected more than 2 billion minutes of Fitbit data for research purposes. Fitabase also has supported more than 200 research projects since its 2012 founding, the company also disclosed.
“What we’ve built is kind of the missing piece for research,” said Fitabase CEO Aaron Coleman. The platform collects and de-identifies data from Fitbit users and offers data pools to academic researchers, including many in healthcare. “This removes a lot of privacy concerns,” including those around HIPAA, Coleman said.
“This is a technology that bridges a consumer device like Fitbit with the needs of research,” Coleman said. “Researchers are loving this new paradigm of research.”
That’s important because millions have purchased and regularly use activity trackers. The data these wearables collect provide insights about movement, heart rate and sleep patterns that previously had not been available, plus people actually enjoy wearing their Fitbits.
“It was really difficult to get people to use pedometers,” Coleman noted. That made it tough for researchers and clinicians alike to collect good data and, more importantly, improve health.
“Devices help people better tailor their activities and their health,” Coleman said. “Interventions shouldn’t be the same for everyone.”
For example, Fitabit is helping researchers determine how quickly people regain their previous level of activity following surgery. “They can tailor interventions to people who need it most,” Coleman said.
So what about the “2 billion minutes” of Fitbit data? “We provide the researcher with de-identified data at the minute level,” Coleman explained. Each person’s activity levels can vary at different times in the day. Having this insight allows researchers — and, ultimately, healthcare professionals and caregivers — to schedule interventions when they are most likely to be effective, according to Coleman.
Coleman pointed to a research project at Arizona State University, where Eric Hekler, director of the school’s Designing Health Lab, is applying engineering strategies to study what Hekler calls “precision behavior change,” a complement to precision medicine. Hekler and research partner Daniel Rivera, director of the ASU Control Systems Engineering Laboratory, are testing “health interventions that are adaptive and individualized, versus static and generalized,” according to a Fitbit statement.
Coleman himself also has applied individual Fitbit data to control the level of difficulty in an app called Tappy Fit, a Flappy Birds-like mobile fitness game.
Photos: Fitabase, Fitbit
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