Custom Content Augments Technology's Value

Listening to the opening keynote at Monday's HIMSS conference, I was struck by a question posed to the speaker, Warner Thomas, President and Chief Executive Officer of Ochsner Health System: What was Ochsner doing to engage patients?

Now in fairness, what Ochsner has achieved in the six-plus years since Hurricane Katrina is nothing less than breathtaking. For example, the health system has invested in an electronic health record-driven initiative to serve the resurgent city of New Orleans.

But in the best "what-have-you-done-for-us-lately" spirit of HIMSS, the question posed was one Thomas tried to address, but it's clearly among Ochsner's next set of challenges. Thomas emphasized Ochsner's efforts to engage via increasing patient surveys. All good. But to see where the cutting edge of patient engagement is really underway, you need to hop a plane and head over to Alabama.

At Cullman Regional Medical Center, a Tier 1 heart and stroke center, they're engaging with patients using a just-enough-technology approach that points the way to further cost-effective innovation on the patient engagement front.

Post-Discharge Instructions On Demand
Specifically, Cullman has been able to reduce 30-day hospital readmissions by 15 percent by giving nurses iPod Touches with an app that lets them record the post-discharge instructions they are giving to patients, then allowing those patients to retrieve those recordings by phone, Web, or mobile device.

The app works on any iOS device—iPod Touches are just the least expensive ones. "The nurse tells the patient, I'm going to record the instructions that I'm providing for you, so that when you get home, if you have a question, or you forgot something that I covered with you, you or your family can call in and listen to what I'm telling you," says Cheryl Bailey, Cullman CNO and vice president of patient care services.

"Or you can log on to a computer, or your smartphone, and you can not only listen to this actual conversation, but you can also see other information related to your diagnosis."

This simple tech augmentation to discharge helps overcome the impact that a distracted patient can create by not paying close attention to complex discharge instructions, or by not being able to understand the instructions upon just one listen to the instructions, Bailey says.

"When the nurse typically goes into the room to provide the discharge teaching, the patient knows they are on their way out the door, and the nurse is the only thing standing between them and that door," Bailey says.

"When you're focused on that, you're not listening to what the nurse says. So if you're not listening, that sets you up for not following the discharge plan, because you don't remember it, and then you could be readmitted."

In addition, Cullman staff recognize that there is often no one else in the room during the discharge instruction phase. Family caregivers benefit from being able to listen to these instructions, too.

Improved Accountability, Lower Readmissions
Bailey says the tech also improves accountability of both clinicians and patients. Directors and chief nurses can randomly listen to these recordings. "The nurses know that, so they do a better job up front teaching," she says. "[And] when the nurse says, 'Miss Bailey I'm going to record what I'm telling you,' the patient thinks, 'wow, this must be important if they're going to record it, so I better listen.' And so they're doing a better job listening. So both parties are doing a better job."

The 15 percent readmission reduction was based on a six-month trial on a 31-bed "step-down" nursing unit at Cullman where many stroke, pneumonia, and congestive heart failure patients recuperate after the ICU.

"My goal was, if we can make a difference on Four East with those patients, then I can replicate that on any of my other nursing units," Bailey says. In addition, Cullman saw a 62 percent improvement on HCAHPS patient satisfaction scores during the trial.

"We started thinking, okay, where else can we implement this in the hospital that's going to be beneficial? We next rolled it out into maternity," not to reduce readmissions, but to improve education. "This generation is all about technology, so they all have a smartphone, so we created information that the parents can watch videos, can read information on how to bathe the baby, anything they need to know. They can just log on," Bailey says.

Customizing Content for LT Care and Billing
The selection and details of a move into long-term post-acute care are also being targeted to benefit from this technology. "You might have a case manager that goes into the patient's room on Monday, and they talk with the family to ask them which nursing home they would like their father to go to, they choose their nursing home, then the case manager will record that conversation on everything that they need to do," Bailey says.

Last week, Cullman even began using this technology to record conversations with patients about their billing and payment options and make them similarly available after discharge.

And nursing homes are also excited about being able to access these discharge instructions, and will be providing their own content to be customized and packages as part of the post-discharge information available to patients and family.

When you think about it, much of this innovation is about providing ever-more customized content to patients. To me, that's the true power of patient engagement at work. Cullman may be the vanguard of a huge positive development in healthcare IT, one that goes far beyond many of the basic innovations that an electronic health record represents.

And eventually, the EHR will benefit as well. Bailey says the basic technology will be integrated into EHRs so that this custom content becomes part of the medical record. When that happens, watch for a healthcare IT system to be much more than the sum of its parts today.