More than two years ago, Mass General launched their Ambulatory Practice of the Future, an innovative primary care clinic for employees and adult dependents. Developed as a Patient-Centered Medical home and ACO, today they support 3,000 enrolled patients with three doctors and two nurse practitioners.

This innovative practice was designed for and with patients for a better patient experience. Their experience begins with the initial greeting and extends through ongoing care interactions. There is a strong focus on patient education and empowerment. The care team collaborates to support each patient both in person and online. One of the goals of the practice is to reach patients where they are both physically and with their health.

Designed to Support Shared Decision Making

Once patients enter the welcoming and intimate care setting at The Ambulatory Practice of the Future (APF), they are ready to collaborate with their clinician. Sitting side by side, they review the medical record together and begin the discussion with health goals.

“We actually added a data field to the record called ‘Health and Life Balance Plan’ where we document  mutually agreed upon goal(s) for the coming weeks and months and then it is easily reviewed by the patient via their portal after the visit and in preparation for upcoming follow- up encounters”, explains Dr David Judge, Medical Director, Ambulatory Practice of the Future, Massachusetts General Hospital.

This collaborative approach has helped patients who have not historically been able to get engaged around a goal. Dr Judge shares a story about a 54 year old woman with diabetes who was reluctant to discuss next steps in management due to her fear of taking insulin. After allowing her to shape the goals with a focus on other areas of lifestyle management initially, coaching to realize some success and encouraging patience with the process, she has recently decided to proceed with insulin therapy.

Patient Engagement Tools

APF uses shared decision making videos developed by the Foundation for Informed Medical Decision Making to educate patients about screening tests and in managing specific medical issues such as prostate cancer.

Between their visits, patients can access the portal to view their medical information and communicate securely with their clinician. Although the care team can access the EMR from their mobile devices, APF expects that patients will be able to access their portal and records via mobile devices in the near future.

Patients can currently participate in an online visit with their care team. Dr Judge describes one of the complex patients that they monitor closely with frequent virtual visits.  “Mr. K is struggling with end stage renal failure, congestive heart failure and it has become difficult for him to come for office visits. Between scheduled virtual visits, emails from the patient and his wife and monitoring by visiting RNs, we are able to manage his needs fairly well with rare office visits.  We are on the verge of implementing true remote monitoring technologies but currently the patient or RN need to  report the measures (i.e. blood pressure, weight, blood sugar, PHQ 9 depression score, etc.).”

On the prevention side, several employees are using mobile apps to track their daily lifestyle choices regarding exercise and nutrition and sharing the information with their clinicians during their visits.

Future Path to Patient Engagement

During my panel at the recent Shared Decision Making Conference, Dr Judge spoke about some exciting new ways APF will be leveraging technology to engage their patients.

“We will be piloting the concept of 'apprenticeship' in which patients go through a more formal education process with coaching and demonstration of increased knowledge and skill to push the boundary on self management. We are developing programs tailored to specific medical conditions (i.e. HTN, DM and Depression). Goal setting for each patient helps the team to understand how to customize the program and to identify what specific barriers may be preventing success.”

“As we have done with diabetes, we expect that patients will learn not only to change their  lifestyle and make healthier choices but also adjust medication in the management of multiple chronic diseases. The care team will be able to monitor and assist but patients will truly drive their own care more effectively from day to day”, adds Dr Judge.

APF is starting a pilot soon using a mobile tablet that “allows very easy synchronous communication to transmit monitored blood pressure and to enable the patient and team to collaborate around lifestyle management and medication adjustment”. 

The term “apprenticeship” is being used by Dr. John Moore at MIT Media Lab. Dr Judge explains, “I think it appropriately describes the next step in the evolution of making shared decisions with patients. Beyond that is potentially a mastery of health and the potential for patient - to - patient support to grow.  We are hoping to launch both face- to -face and virtual peer to peer interactions in the near future.”  

Technology plays a vital role in Shared Decision Making. Join me as I lead this dynamic panel session and learn how you can leverage tools for improved patient centered decisions.

• Piloting and evaluating SDM tools in the Patient Centered Medical Home to drive physician- patient collaboration for better outcomes
• Leveraging a mobile decision support tool to effectively educate consumers and enable them to evaluate their care options anywhere, anytime
• Discovering and defining a Shared Decision Making opportunity to empower and engage seniors and their families

Moderator:

Sherri Dorfman, MBA
CEO, Consumer eHealth Engagement Specialist, Stepping Stone Partners

Panelists:

> Kyra Bobinet, MD, MPH, Head of Senior Care Solutions, Aetna Emerging Business Group

> David C. Judge, MD, Medical Director, Ambulatory Practice of the Future, Massachusetts General Hospital

> Zev Lavon, MBA, PhD, Director, Enterprise Solution Architecture, CareFirst BlueCross BlueShield

Join me and my panelists at the World Congress Shared Decision Making Conference. 

In 2008, Cisco launched their LifeConnection’s onsite health center which uses a Patient- Centered Medical Home model. Today, it supports over 42,000 employees and their families at Cisco’s corporate campus in San Jose, CA.

Cisco’s LifeConnections' Center offers primary and pediatric care integrated with care services including disease/condition management, health coaching, mental health, pharmacy, physical therapy and chiropractic as well as acupuncture services.

Cisco now has two physical LifeConnections' Health Centers, one at their headquarters and a second location at the Cisco Bangalore, India campus.  In addition, they operate a telehealth location in the Raleigh-Durham area of North Carolina.

Employees access LifeConnections’ services online for health management. “Within our Cisco LifeConnections' portal, our employees and their families can schedule appointments in real-time, view their medical records, communicate securely with their physicians and even send their doctor an attached document such as a food or exercise log”, explains Katelyn Johnson, Manager, Integrated Health at Cisco Systems. 

Cisco’s approach supports the findings from a recent Accenture Connected Health Pulse Survey which found that most patients (90%) want to use technology to self-manage which includes accessing their medical information, booking their doctor’s appointments and refilling their medications. The survey also revealed that patients do not want to give up the interaction with their doctor. 

Technology Transforms the Patient Experience

Working closely with employees and families, Cisco designed the LifeConnections’ Health Center to bring convenience, better care and transparency to the consumer.

Through ongoing interviews with patients, Cisco has heard feedback from consumers who:

     “Do not want to be burdened by the administration of healthcare”

     “Want technology to take away what I don’t like to do (i.e. clip board,

          discharge payment)”

     “Want to spend more time with my physician”

Cisco has used this insight to determine ways to leverage technology within the LifeConnections’ Health Center to increase patient satisfaction including:

Kiosk: Patients come into the Health Center and use a tablet to have a “paperless, self-service, check in” including verifying demographic information, paying co-pays and signing consent forms, taking less than five minutes of their time. 

Flat Screen Monitors in Care Suite: Within the patient-centric care suites, the patient and physician sit side by side to view and discuss health information projected on the flat screen such as the medical record with the latest vitals and lab results, x-rays and educational content about the patient’s condition. Cisco emphasizes the importance of providing transparency to the patient by showing them their medical record, in real time, during the visit. 

HealthPresence in Care Suite: Cisco has recently partnered with Stanford Hospital and Clinics to enable patients to access specialty care (tele-dermatology) through the use of Cisco’s own telemedicine solution called HealthPresence. A nurse assists the patient in the LifeConnections’ Health Center while the Dermatologist connects from the Stanford Outpatient center.  Cisco has found that connecting specialists with patients using this solution offers greater access to specialty care, reduces appointment wait times, and improves patient satisfaction. 

Matching Technology to the Employee Profile

Cisco has put healthcare technology in place to meet the needs and profile of their employees and families.

 “We are a high technology company and our many of our employees are engineers who literally live on-line.  Their average age is 42 years. Our employees expect our healthcare experience to mirror the way they work – which is surrounded by technology.  Specifically, they want technology to help enable care, remove access barriers and overall enhance their experience as a patient.” shares Sharon M. Gibson, Director Healthcare Business Transformation at Cisco.  “Not only do they want to see more information about their health status but they want to see trending data for themselves to better understand how their health stats change over time and how their behavior impacts those results.”

“Our employees are busy and always on the move.  They want to take care of their health in an efficient way.  Soon, we will also offer patients the option of e-visits with their doctors through WebEx, for example”, explains Sharon. “Online or e-visits would help engage employees in their health, whether from home or even remote sites, and bring the convenience that they demand”. 

CareFirst BCBS Medical Home SDM Tool

Over two years ago, I led a panel on patient decision support tools for a large interested crowd in Boston, despite the very snowy day.

Since then, I have noticed a few key changes. Physicians are now prescribing information to patients, using the EMR to send emails with links to health resources. And innovative health plans are playing a role in bringing shared decision making tools to engage and empower their members. Health Plans have a big cost saving incentive when these tools educate their members about less invasive and less expensive options.

3 Key Engagement Drivers With Shared Decision Making Tools

While evaluating technologies for my panel on “Evolving Web & Mobile Tools to Engage Consumers in the Shared Decision Process”, I identified how three key drivers of consumer engagement are being utilized:

1. Education

These tools show the consumer what the treatment entails and share patient stories which tell them what to expect.  This education reduces anxiety by putting the consumer in control to understand their health issues and presenting options to address them.

2. Evaluation

Shared Decision Making tools are ideally designed for “preference sensitive conditions” where there are multiple clinical options (For information about target conditions, see the recent report on the Dartmouth Atlas Project which was developed with The Foundation for Informed Medical Decision Making). The most effective tools offer alternatives, capture preferences and guide the consumer through the process while documenting their decisions. This helps set expectations for their experience and supports the discussion with their doctor or care coach. 

3. Collaboration

As the patient and clinician/coach review the SDM summary document together, they can discuss questions, concerns and comments to make the best decision.

Health Plans Leverage Shared Decision Tools

During the panel, health plans described using Shared Decision Making tools to engage members in two key areas:

• Medical Home

Panelist Zev Lavon, PHD, Director Solution Architecture, CareFirst BCBS emphasized “the story of the patient is not their last doc visit or lab test”.  CareFirst launched their Primary Care Medical Home initiative across a panel of physicians deploying communication tools to push information to patients to support the management of their chronic conditions.

•   Wellness Coaching

According to Mark L. Robitaille, MBA, Head of Care Management Support & Engagement, Aetna puts these tools into the hands of their health coaches to send emails with resources links to members or use the tools to look up information for the members without internet access.

Independent Health panelist, James J. Mis, MBA, Communications Manager, Health Care Services, described their interactive voice response campaign to inform members about viewing a shared decision making video (from Emmi Solutions) selected for their specific health interest.

Emerging Mobile SDM Tools 

With a high penetration of smart phones and strong usage across minorities, health care organizations are realizing the tremendous opportunity to deploy mobile applications to engage consumers. To date, most health mobile health applications have been focused on wellness with educational information and tracking.

Panelist Changrong Ji, Senior Solutions Architect, CareFirst BCBS described the opportunity for mobile shared decision making tools. In the future, she envisions that sensors will capture the context of the consumer’s daily life, database analytics will identify patterns and machine learning will be used to help identify relevant mobile messages to send back to the consumer.

Healthwise’s View on Patient Response

During the Shared Decision Making Summit, the chairperson, Don Kemper, Healthwise’s CEO discussed the opportunity for shared decision making tools to give a “voice to the patient”.  After the physician prescribes health information, the tool gathers patient’s preferences to document them in the medical record. I strongly agree with Don as he explains “there is no better way to engage the patient than to assure them that their voice will be heard in treatment and care plan decisions”.

Shared Decision Making Tools for Your Consumers

What are you doing to bring Shared Decision Making Tools to your consumers to motivate engagement in their health and wellness?  I can help guide you through the process of identifing, evaluating and piloting these technologies to deliver better outcomes and a better experience for your consumers.