Peer roundtables will share insights and explore solutions, as health systems enter a new era of consumerism.

As patient experience moves center stage at many of the nation’s health systems, leaders responsible for this function are tackling issues related to a maturing discipline. Most have moved far beyond HCAHPS surveys and many are diving into the realm of consumer marketing.

The landscape is rapidly changing as a new generation of tech-savvy millennials is introduced to hospital services through maternity and pediatric needs and as companies such as Amazon, renowned for delivering exceptional consumer experiences, enter the healthcare space.  

On September 19–21, more than two dozen patient experience executives will convene at an invitation-only forum during the 2018 HealthLeaders Media Experience Exchange in Scottsdale, Arizona, to discuss the challenges they face and solutions they’re exploring.

HealthLeaders Media spoke with a number of leaders at institutions across the country as a preview to the conference to gain insight into the commonalities they share and concerns they want to explore.

 

1.  HCAHPS: An Antiquated Approach

The HCAHPS survey—the same instrument that gave rise to the patient experience function at many health systems—presents one of the greatest challenges.

Leaders point to the lag time created by "snail mail," as the primary culprit. To improve the patient experience, it is essential to take real-time action when problems occur. In an era of sophisticated technology, data received sometimes months later does not seem to offer meaningful opportunities for improvement.

"The surveys need revising; they need to meet patients where they are, and they need to ask meaningful questions," says Shannon Connor Phillips, MD, MPH, chief patient safety and experience officer at Intermountain Healthcare in Salt Lake City. "We need to be able to do all of the required surveys electronically and do more real-time, in-the-moment surveys."

Amy Thorson, director of patient and family experience at Dayton Children’s Hospital in Ohio, agrees, pointing out that her primary customers are millennial parents who represent the expectations of a new generation. "Current industry-standard survey tools lag behind what appeals to our millennials," she says.

The existing approach reduces response rates and feedback is not timely, she says.

 

2.  Conquering Ingrained Processes

While HCAHPS surveys are relatively new, there is a tougher nut to crack at most health systems: processes that are deeply embedded in an institution’s history and culture.  

"Many of our processes are built for our convenience—not our patients," says Kevin Gwin, chief patient experience officer at University of Missouri Health Care in Columbia, Missouri.  

"Our processes are built for good reasons, to excel at clinical quality, to be efficient, and to hold down costs, but when we don’t align with our customer’s preferences where we could and it’s appropriate, then that’s where we’re feeling the tension between us and our patient customer," he says.

Piedmont Healthcare, an 11-hospital system based in Atlanta, experiences the same dynamic.

"Some of our larger challenges are adjusting our processes internally to better meet consumer demand and expectations," says Matt Gove, Piedmont’s chief consumer officer.

"Some of our processes have been developed around physician needs, around administrative needs, around EHR needs." While it is crucial to respect those requirements, "when you are trying to refocus everyone on the consumer journey and how to best meet that customer’s needs, it does require a change in mindset," Gove says.

 

3.  Overcoming Administrative Burdens

If patient experience leaders could wave a magic wand and change one thing, many would make administrative burdens on clinicians disappear.

"If we could eliminate the extemporaneous expectations, and [clinicians] could only focus on the quality of the experience, as well as delivering a very personal, very compassionate experience each and every time, that would be ideal," says Rose Glenn, senior vice president, chief communications and experience officer at Henry Ford Health System in Detroit.

"But there are so many things that regulatory agencies and others require, that sometimes being able to deliver that individualized personal experience every single time becomes challenging," Glenn says.

One physician explained that for every hour of clinical time, she spends another two hours on medical record administration.

"They will not be able to keep up that pace," says Glenn. "They want to do the right thing, but the impact of all the changes and the increase in expectations makes it difficult to deliver a consistently exceptional patient experience. Unless we address burnout and help our staff become more resilient, I think that challenge is going to continue."

 

4.  Forging a Human Connection

Administrative burdens diminish the human connection that is essential to a positive patient experience.

"Patients don’t want a medical transaction, they want a personal interaction," says Gwin. "They want a relationship with their physicians and their nurses, and they want to feel connected to their hospital and their doctor’s offices. If I could change one thing, I would make us better at discernment, at gauging ‘How is this relationship going?' "

"I want us to pick up on those cues that this is going really well, or this is not going well," says Gwin.

Conner Phillips says, "You don’t get great quality if you don’t have a partnership with your patients."

She wants people working in healthcare "to more intentionally see the connection between quality and safety and experience. You can’t have great experience if we fall short in quality and safety . We can give people great outcomes and keep them free from harm, but if we don’t connect with people and [employ] empathy, then we’re not establishing trust and being respectful. It’s not going to feel right to the patient. If it doesn’t feel right to the patient, they’re not going to participate in their treatment plans and keep themselves healthy or improve their chronic disease because they don’t feel connected to us."

Teaching hospitals have an additional challenge in this realm. Cindy Burger, MS, RN, vice president, patient and family experience at Dayton Children’s Hospital, sums up the concerns expressed by other leaders at teaching institutions, explaining that it is difficult to indoctrinate a philosophy when students constantly rotate in and out of the facility.

Students and residents "are part of our culture, but they are not quite as enculturated," Burger says. "Delivering consistency every time during every interaction becomes a challenge."

 

5.  Expanding the Point of View

As health systems become more invested in the patient experience, the scope of work is broadening. Getting healthcare organizations to act like other consumer-oriented industries, however, is not easy.

"You cannot separate brand from experience," says Gove. "Most successful consumer-facing organizations understand that. But for most of its history, healthcare hasn’t even accepted that it’s a consumer-facing industry."

Piedmont is taking a holistic approach and examining every place people interact with the system—digitally, through advertising, and word of mouth, as well as billing and booking appointments. "There is an enormous opportunity for us to rethink what 'experience' means for a healthcare system," he says.

Henry Ford Health System is making similar inroads.

"As experience officers, we need to do a better job of understanding expectations before the consumer ever enters any of our facilities," says Glenn.

While hospitals are now doing a much better job of understanding patient’s preferences while they are in the facility, she questions how systems can proactively understand consumer expectations before they become patients.

"How do we hardwire the processes and the cultural standards that people expect, prior to the person ever coming into one of our medical facilities?" she says. With players like Amazon, Google, and Microsoft entering healthcare, the picture changes dramatically.

"They have a different take on addressing consumer needs. Healthcare organizations have to get up to speed and have that retail-oriented framework in order to deliver an exceptional experience," Glenn says.  

 

6.  Battling the Bottom Line

One final challenge patient experience leaders face is not new for those working in healthcare systems: financial.

"There’s a lot of competition for resources inside a system," says Gove. "As good stewards of the resources that have been entrusted to us by our communities, because we’re a nonprofit health system, how do we continue to convince the system to prioritize [patient experience] work? It does require an investment; technology platforms cost money. How do we keep [patient experience] high in the list of priorities so that we can continue to make the changes needed?"

 

The Experience Exchange

These are just a few of the issues to be explored at the Experience Exchange, along with solutions that are working for participating health systems.

The Experience Exchange is one of six healthcare thought-leadership and networking events that HealthLeaders Media stages annually. While the roundtables are invitation-only, qualified healthcare executives, director-level and above, will be considered. To inquire about the HealthLeaders Exchange program, email us at Exchange@HealthLeadersMedia.com.  

 

Referential matching holds promise to significantly improve claims denials, reduce medical errors and waste, and improve the patient experience.

In a development that holds promise to significantly reduce claims denials, diminish unnecessary repeat tests, and improve the patient experience, Northwell Health has tested a novel approach to reducing patient record duplication, producing results that vastly improved its performance.

The pilot project assessed the effectiveness of referential matching, an innovation developed by Verato. New York State–based Northwell resolved 87% of a sample set of mismatched records after other matching processes were deployed. The 23-hospital system must address 300 mismatched records each day.

Northwell has 5 million records in its system and treats more than 2 million patients annually; typically, hospitals experience a 10% duplication rate, according to the American Health Information Management Association (AHIMA).

Following full implementation of the solution in June, this reduction will considerably lower the case load of records that staff specialists must manually address in a labor-intensive process.

"Duplicate medical records are the nature of the business," says Northwell's IT director Keely Aarnes, "but it has implications that run throughout the healthcare system."

Besides the cost of claims denials, which are time-consuming to rectify, consequences include potential medical errors because a patient's complete record is not available, unnecessary repeat testing when records can't be located, and reputational damage due to poor patient and clinician experiences. 

Complex Challenge; Simple Technology

For nearly two decades, health systems have primarily relied upon probabilistic matching to resolve patient record duplication. This approach compares patient records and assesses the probability of whether they belong to the same person.

This method is now built into many EMR solutions, and health systems also can implement third-party technologies, known as Enterprise Master Patient Index, or EMPI, products that also employ the same logic.

"Probabilistic matching has done as good a job as it could possibly do," says Mark LaRow, CEO of Verato, "but there's a basic mathematical limitation to this algorithmic approach."

The technology behind referential matching is surprisingly simple. It involves comparing a patient record to Verato's propriety reference database of roughly 350 million people.

The company combines publicly and commercially available information containing all known names, addresses, phone numbers, and other data for individuals spanning back three decades, providing a comprehensive view into the identity of most people living in the United States.

"We see the full range of both the correct and incorrect versions of a person as they represent themselves [over time]," says LaRow. Depending on the quality of data and the population's characteristics, these automated matches average 92% without human intervention, and can be as high as high as 98%.

Why Health Leaders Should Care

Duplicate medical records are a growing problem due to several factors:

• The situation has been exacerbated as hospital systems consolidate and records from different organizations are combined.
• More departments now access the EMPI. As the number of access points increases, more decisions are made based on the data available, and additional patient identities are contributed to the system. These variables increase the probability that something will go wrong.
• As patients begin directly interacting with their records, more opportunities for problems will occur, including privacy concerns.

This issue creates financial havoc for health systems. In addition to labor costs and resources required to address this challenge, according to a study conducted by Black Book Market Research and reported in an April 10, 2018, news release:

• Thirty-three percent of all denied claims result from inaccurate patient identification or information. In 2017, this cost the average hospital $1.5 million, totaling $6 billion annually for the U.S. healthcare system.
• The cost of repeated medical care related to this duplicate records averages $1,950 per patient for inpatient stays and more than $800 for emergency department visits.

 

Northwell's Eye on the Future

Two years ago, Northwell began an aggressive program to reduce duplicate records. At that time, it had about 700 duplicate records daily and a backlog of more than 200,000 potential duplicates.

An outside company was contracted to manually address the bottleneck, and Northwell began using InterSystems' HealthShare Patient Index EMPI product to reduce duplicate records through probabilistic matching to attain its current rate of 300 tasks each day.

"It's a significant improvement, but not quite where we want to be," says Aarnes. Northwell then added Verato to the mix because it was offering referential matching in the healthcare sector, and it features a cloud-based solution, which Aarnes says will further reduce complications and administrative time. 

The potential for the future is what excites Aarnes most.

"We are getting really good at resolving potential duplicates," says Northwell's IT director, "but we want to prevent them from even happening."

As staff members are freed from duties related to resolving duplicate records, their responsibilities have shifted to training more than 2,000 registration personnel about how to properly create records and prevent problems. But Northwell has an even bigger vision in mind.

Another pilot program is underway in six of the system's practices, testing a biometric patient registration process that involves scanning the iris. Northwell and Verato are joining forces with RightPatient in this venture.

If successful, "that will be our matching mechanism to be able to link to the right patient," says Aarnes. It also could reduce the need for patients to constantly fill out forms.

"It's all part of our digital transformation," says Aarnes. "Patient matching and patient identification are critical to that success. These two initiatives go very much hand-in-hand."