The GIAA is made up of three centers: the Center for Clinical Innovation, the Center for Reengineering Healthcare, and the Center for Emerging Technology. The Center for Clinical Innovation is the laboratory for patient engagement pilots that—if they are able to demonstrate better care, cost, and patient satisfaction—are rolled out to GHS.
The Center for Clinical Innovation is where the care gap program was piloted. It gets patients with chronic diseases up to date on their immunizations, routine checkups, and lab tests. That keeps them engaged with the system, both with technology tools that GHS is constantly testing and with providers (because patients have to come into GHS clinics). The data from the pilot showed that from 2010 to 2013 there were not only fewer gaps in patient care, but there was also a $30 million increase in revenue because patients were getting more and necessary care. "That was an unexpected by-product of doing the right thing for the patient," says Moore. "We were focusing on patients with diabetes, hypertension, chronic obstructive pulmonary disease, and figuring out a reliable way to close those gaps in care."
Moore says a care gap is typically identified in the patient's EHR before the patient comes in for the appointment. Depending on the patient's preference, either a phone call, text, or email will outline what to expect, including whether it is time for a foot exam or a vaccine, for example. If it's a foot exam, the patient will be asked to remove shoes in the exam room. It's a small action that reminds the doctor a foot exam is due, though GHS' technology makes the care gap nearly impossible to miss. It is noted in the EHR so that the front desk sees it when the patient checks in, the nurse sees it when rooming the patient, and the physician sees it on the EHR screen in the exam room.
"We've found that the patients themselves are reminding the nurse and alerting their care team," says Moore. "It's about those communications. Everyone is getting information before the visit." The number of gaps that GHS closed during 2010–2013 was 250,000.
Another patient engagement initiative recently rolled out at GHS is the use of OpenNotes, which gives patients and their caregivers access to providers' notes about their care through a secure patient portal. GHS has had a patient portal since 2001. It now has 300,000 registered patients, with a daily log-in rate of 15,000–20,000. The large patient population using the portal made it a natural fit to be one of the first pilot sites for OpenNotes in 2010.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.