Author Archives: HITC Editor

In 2012, the Department of Defense charged LTC Daniel T. Johnston, MD, MPH, with creating an online wellness platform that would enable the agency to assess, manage and improve the health of active duty Soldiers and Army civilians. Johnston partnered with Sharecare to build ArmyFit: a platform maximizing digital engagement and fostering behavioral change through tailored content and interactive tools. During this presentation, attendees will learn how the Army is utilizing data-driven applications to monitor and improve population health and program effectiveness at the installation level, as well as optimize development of health policy and resource allocation. 

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Session Presentation:
 Dan Johnston, U.S. Army Medical Director Lieutenant Colonel Doctor and Jeff Arnold, CEO, Sharecare | View HD video on demand and download PPT here 

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State CIOs and their HIT leadership teams have an unprecedented opportunity during the implementation of the next phase of the ACA to deliver services to common populations across agency and division lines and to collaborate with providers to improve health outcomes and reduce cost.

View the panel as they discuss the opportunities and challenges of connecting the State enterprise of healthcare and to build the analytical capabilities to support the improved coordination of health and human services, patient centered care delivery models and to eliminate fraud, waste and abuse.

Moderator: 
Chad Grant, Senior Program Analyst, NASCIO
Panelists:
Ron Baldwin, CIO, State of Montana
Rex Plouck, Portfolio Manager, Governor’s Office of Health Transformation, Ohio
Manu Tandon, CIO and HIT Coordinator, EOHHS, Commonwealth of Massachusetts
Tracy Wareing, Executive Director, APHSA 


Session Presentation: Manu Tandon, CIO and HIT Coordinator, EOHHS, Commonwealth of Massachusetts| View HD video on demand and download PPT here

 

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In today’s uncertain healthcare environment it is critical for hospitals, clinics, payers, and other care providers to move past the siloed and fractured care models commonly in place today. The successful care models of tomorrow will have the ability to move with and pro-actively engage patients no matter what the patients are receiving care. Quality and efficiency will be front and center and the successful use of data will be king.
In this presentation Chad will mix his own experience in building an integrated care system along with his vision for the future. Chad will also cover other relevant topics including:

1. How do you get Hospitals and independent physicians engaged and aligned?

2. What role does technology play in an integrated network or ACO?

3. What are the land mines in developing an integrated network?

4. Getting the patient involved in their care experience.

5. What does the future hold? 

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Session Presentation: Chad Johnson, CEO, Children’s Health Network | View HD video on demand and download PPT here

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The rollout of health care reform legislation and Federal innovation grants have set the stage for new approaches to meeting the triple aim of increasing quality of care, lowering costs, and improving population health outcomes for Medicaid populations in some states. These approaches are key to improving patient outcomes and decreasing health care costs nationally. One approach of the health care reform legislation to improve care coordination, ensure quality and safety, and reduce waste is the Accountable Care Organization (ACO). ACOs are provider-based organizations that assume responsibility and accountability for the quality, cost, and comprehensive care of a defined population of patients across the continuum of care. Illinois has embarked on a Medicaid innovation with Accountable Care Entities ACE organizations which hope to fulfill this aim. The panel will explore the assessment of population risk stratification, quality measurements, reporting, care coordination, patient engagement and lessons learned through the use of technology for sharing information. 

Moderator: Tom Lowry, Director Government Sales, InterSystems
Raul Recarey, Executive Director, Illinois Health Information Exchange Authority
Hunt Blair, HIT-enabled Care Transformation SME, ONC/DHHS
Sonia Mehta, CMO, Loretto Hospital Suresh Krishnan, CIO, Loretto Hospital 

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Session Presentation: Raul Recarey, Executive Director, Illinois Health Information Exchange Authority | View HD video on demand and download PPT here

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The move from procedure-based to outcome-based evaluation of care and continued attention to reducing costs require more sophisticated analysis of patients, their behavior, and community. The ability to handle population data, from demographic segmentation to tracking patient actions to predicting the risk of chronic disease, is key to developing effective, cost-containing strategies. Learn about the different approaches, applications and outcomes from our panel of experts.

Moderator: Lori Evans Bernstein, President, GSI Health
Elizabeth Ennis, CMO, Baptist Health System
Tom Wall, Vice President and Executive Medical Director, Triad HealthCare Network, Medical Director Cone Health

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Session Presentation: Lori Evans Bernstein, President, GSI Health | View HD video on demand and download PPT here

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Healthcare in the past several decades has been marked by consumers seeking healthcare services; visiting a physician, being admitted to a hospital, seeking emergency room care. But achieving positive patient outcomes today will mean taking healthcare to consumers, as well as encouraging them to want that healthcare. A panel of four experts discussed engagement strategies at the HealthCare IT Connect Accountable Care and Healthcare IT Strategies Summit.

One key to understanding engagement is understanding what barriers exist to prevent that engagement, said Gary Capistrant, senior director of public policy at the American Telemedicine Association. “A lot of people are invested in the status quo and they are a barrier. And while the idea of patient engagement is very appealing, it’s useful to think beyond that, to consumer management and consumer direction. What are the tools to get the consumer beyond engagement?” he said.

Telehealth is one avenue of engagement, bringing services to patients from a remote site. But these services currently are only in rural areas, delivered only by physicians and only involve television, largely because of Medicare coverage, Capistrant said. “But urban people may also have problems reaching a doctor,” he said.

But barriers to telehealth also include doctors who don’t want to do telehealth. State to state licensing and practice rules also are barriers. Even “doctor-patient relationships are a way to keep telehealth out by enshrining the relationship,” Capistrant said. “I think a consumers should decide what their relationship is, and how they will deal with a doctor.”

Capistrant pointed to a number of state actions (Arkansas and Mississippi are leaders) in telehealth, as well as bills in Congress on changing Medicare coverage of telehealth.

Customizing the Patient Experience
Vree health provides patient-centered care through customizable configurable patient experience, said Lena Lattanzi, Executive Director of Product Management at Vree Health. “We can organize patient care, aggregate data from EMRs and systems to provide a central location for everyone to have access to information,” she said.

Vree provides care for patients before a physician visit, and even leading up to surgery. When the patient goes home, the company’s services offer patient monitoring and clinical health checks. “We can make sure medications are accessible, patients can get to appointments, have a primary care physician, and are going to the right site for care,” she said. Vree also analyzes its results and compares success with other initiatives.

Today’s organizations largely focus on the highest cost patients (the sickest), totaling 3% of all patients. Vree, however, offers services across the spectrum.

But technology alone is not engaging patients, Lattanzi warns. Most healthcare apps are used for less than a week, largely because the apps are not personalized. “We need to engage patients without engaging them.”

Cost savings from engaging the sickest
Huge differences in monthly healthcare costs exist between the healthiest patients (making up half the patient mix) and the sickest 3%. Costs could run up to $6,000 per month for sickest patients, said Brian Ralston, CMIO Chicago Market for Tenet Healthcare.

Tenet, however, experienced dramatic savings from the sickest patients, using complex case managers, contacting patients constantly and making decisions. “A lot of it was access—they could get information to me quickly and efficiently,” Ralston said. Online tools for analytics, data evaluation and care management also helped get information quickly to those who needed it, and could make a doctor visit more efficient. “It is horrible what’s being dumped into the short patient visit (refills, health maintenance, symptom announcement),” Ralston said.

One challenge of meaningful use is to strategically use online patient portals. While a hospital or health system can introduce a portal, outpatient settings probably already have similar portals, producing too many sources of information.

Engagement at an academic medical center

Northwestern Medicine, an academic medical center north of Chicago, uses a team-based care approach, “and the patient is the most important part of that team,” said Lyle Berkowitz, Associate Chief Medical Officer of Innovation. He noted that a very small percentage of a patient’s life is spent with a healthcare provider. So, how can they provide high quality care, efficiently?

Telehealth—Northwestern has offered these services for years but “in a fee for service environment, it’s better to have patients come in.” But for certain patients, convenience is key. But for certain patients, convenience is important.
Patient portals—a lot of interactions are conducted online. The patients are often happier and more engaged, “but they’ve signed up for the system so they would be. And most physicians find it easier than phone tag,” Berkowitz said.
Remote patient monitoring—Northwest has used monitoring on its own employees, the uninsured and higher risk patients. The healthcare system has been experimenting with these unique groups, including giving them an app monitor every day, and asking them if they felt better compared to the previous day.

These initiatives have generated questions: Will patients actually download it? Will they continue with it? If they continue, will it provide something valuable? Can we act on a problem that arises?

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Healthcare IT Connect sat down with Calvin Togashi, Pharm.D.,M.S., Partner, HealthQEC/formerly with Kaiser Permanente to discuss challenges physicians are faced with today around patient-provider communications and how through advanced improvements best outcomes can achieved.

Healthcare IT Connect: What are some of the challenges facing patient-provider communications?

Calvin Togashi: Time is the biggest challenge. The Center for Disease Control and Prevention estimated 1.2 billion office visits in 2010. For physicians, there just is not enough time in a 10 minute office visit to address current and chronic medical issues. After the office visit, there is even less time available for following up, sharing information and making decisions with patients. Meanwhile, in between office visits, patients often have more questions about their medical issues and treatment.
Lack of integration is another challenge. Physicians know what they want to communicate to patients, but the information is trapped in multiple systems – vital signs, appointments, laboratory results, prescription refills, registries, demographics and contact information. Some electronic medical records have integration between systems. Others are stand-alone islands that require manually pulling together information for each patient. Physicians want integrated system where they can filter diabetic patients for elevated hemoglobin A1c, check for the last oral hypoglycemic prescription refill and send patients encouragement for diet and exercise in just a few clicks.


HITC: Can you describe some of the important messages that physicians may want to send patients?

CT: There is a wide variety of messages including reminders, information messages, notifications and alerts. Reminder messages could be for an upcoming office visit, procedure or imaging appointment while information messages publicize health fairs, blood drives, prescription mail order savings or exercise and nutrition tips. Notifications may cover missed appointments, refills waiting in the pharmacy or pending laboratory order. Finally, alerts require action like a drug recall, poor air quality for asthmatics and appointment changes.

HITC: In a busy physician practice, how can the office staff help deliver these messages?

CT: The method to deliver messages needs to match the patient’s preference. All patients are not technologists! Some patient prefer paper. Other patients prefer phone calls, emails or text messages. Likewise patients may have language preferences. Physician practices that cover a wide geography may also see differences in affluent and less affluent areas.
The office staff need to review current practices for contacting patients. Manual phone calls and letters are very labor intensive. Consideration should be given to changing the delivery workflow and automation of processes to match patient preferences. The goal should be to increase patient satisfaction while decreasing staff effort. Our Prompt Outreach tool can deliver individualized outreach messages by email, pdf letters and text messages.

HITC: Why should physician practices invest in patient-provider communications today?

CT: Patient workloads continue to grow for physicians and office staff. Better communication can reduce manual work, refocus staff on their unique skill sets, organize the flow of information and lead to improved physician, staff and patient satisfaction.

HITC: Where will advances in technology take patient-provider communications?

CT: As health related sensors improve and become ubiquitous, there will be an explosion in individualized data collected continuously. Monitoring of vital signs, physical activity, electrolytes, glucose, hormones and drugs, measurements once available only in the hospital, will be readily available from transdermal, corneal or ingested sensors. The next challenge is to correlate sensor data with individualized patient outcomes and communication between patients and providers how to steer care delivery toward the best outcomes.

Calvin Togashi presented at the 2014 Accountable Care And Health IT Strategies Summit, Chicago IL, September 2014.  The session Patient Portals: Effective Approaches and Future Trends can be viewed on demand, in HD video with accompanying PPT. To subscribe to view the presentation please register here  

Calvin Togashi, Pharm.D.,M.S., Partner, HealthQEC/formerly with Kaiser Permanente
Matt Sarrel, Healthcare Expert; GigaOm Analyst; CEO and Founder of Sarrel Group
Jonathan C. Silverstein, VP Biomedical Research Informatics, NorthShore University Health System
Lauren Sullivan, Director Application Services, Sinai Health System 

Challenges created by the ever-growing demand of patient needs, changes in healthcare delivery as a result of The Affordable Care Act, HIPAA regulations, and the HITECH mandate, physicians and healthcare providers must rapidly adapt to an ever-changing environment. To maximize efficiency, enhanced communication between providers and patients, and provide consistent high quality care to patients, new platforms that integrate medical care and digital technology are being developed and deployed. Communications technology encompassing a broad range of tools such as smartphone applications, outbound messaging, emails, patient portals, telemedicine and more are continuously evolving.

» What is your organization currently doing, or what have you seen other organizations doing, regarding patient portals?
». Patient portals can provide a host of benefits: streamlining, provider workflow, improving patient-provider communications, improving quality of care, etc. From the implementations that you’ve seen, what are their strong points and where could they be improved?
» For those organizations without a patient portal, what are some other ways to enhance and streamline Patient-Provider communication?
» There are many interesting innovations and new technologies enhancing Patient-Provider communication? What are some of the more successful case studies or use cases have you seen and what are the factors that lead to their success?

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Guest editorial contributor: Matthew D. Sarrel, MPH, CISSP

Online patient portals are used by healthcare organizations to support critical activities such as enrollment, reporting, claims management, and outreach communication with patients. A prominent goal of such systems is to facilitate the provision of better care while lowering the costs associated with that care. While a patient portal must meet the needs of the healthcare organization developing it, it must, above all, meet the needs of the patients who are going to use it. Patients require easy and rapid access to the information they need about providers and services.

Patient portals can be used to provide a variety of services. Typical uses for a patient portal include scheduling doctor visits, obtaining lab results, and accessing health and wellness information. Patient portals serve as a vital link between healthcare organizations and patients. In many cases, patients can exchange secure messages with their health care teams. A successful patient portal enhances patient-provider communication, empowers patients, supports care and prevention between visits, and, most importantly, improves patient health.

NEC’s InfoFrame Elastic Relational Store (IERS) provides leading edge database technologies that serve as a powerful foundation for a patient portal. IERS relies on technologies developed by NEC to provide high scalability and performance. IERS’ scale-out architecture transparently expands the system without downtime as demand and data volume increase; two things that a successful patient portal is sure to experience.

IERS automatically allocates resources in order to balance the data processing load among transaction servers in order to provide a reliable high-performance database environment. Data is also protected using security mechanisms and distributed across multiple servers for improved reliability. They system automatically load balances itself and overcomes system failures to enable business continuity without service interruption. The result is a speedy data-driven patient portal that stays up and running to provide the online services patients need the most.

IERS has already been used to develop high volume patient portals. HealthQEC, a healthcare analytical and information technology consulting firm, selected IERS as the database behind their Prompt Outreach patient portal. Prompt Outreach is a cloud-based communication system that provides a cost effective way for healthcare organizations to contact and share information with patients using email, SMS, phone, and a variety of other methods. “We chose IERS because of its advanced scaling capability (elastic scale-out and scale-in mechanism) to meet the high volume requirements of a SaaS model. We were also drawn to IERS because of its high performance, reliability and availability for mission critical applications,” says Rafique Khan, Director of IT for HealthQEC.

In addition to exceling as a database for patient portals, IERS is a great choice for the following uses in a healthcare setting.  IERS is well-suited to be deployed as a:

  • Logging system for insurance claims processing
  • Central repository tracking data from diagnostic devices
  • Patient treatment and outcomes analytics database
  • Research driven predictive analytics database

NEC’s IERS is an elastically scalable high-performance database with many uses in healthcare. More information on the platform can be found on the NEC website and the NECtoday blog.

 

Matthew D. Sarrel is a healthcare IT expert, GigaOm Analyst, PCMag.com Contributing Editor, and Internet.com Frequent Contributor. He is also CEO and Founder of Sarrel Group, a consulting firm based in New York City and San Francisco. He has been designing and building big data solutions in healthcare and medical research settings for over 15 years. Follow him on Twitter at @msarrel.

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Delivering value-based care so vital for healthcare reform will depend on culture as much as new data analytics. A keynote panel at Healthcare IT Connect’s Accountable Care and IT Strategies Summit discussed how these two factors intertwine.

Platforms that associate data are important, but each vendor platform is different, requiring some comparison shopping by providers and healthcare systems, warned Jeremy Orr, Chief Medical Officer of Optum Analytics.

Healthcare systems often have a lot of data on people with advanced disease, but what’s needed are data on people who don’t have advanced disorders and don’t see providers as often. Optum aggregates from EMR databases, claims, and socio-demographic data from public databases, and matches these at the patient level to give patient centric view at all levels of care.

Some of the most valuable data is the hardest to work with, however: the patient history. Narrative patient histories are not structured datastreams, and even structured entries can be wildly wrong. While more than half of data in EMRs is unstructured, it is quite valuable for predictions, benchmarking and other value estimates.

Use data to capture the rotation of money
In the tradition to value-based care, it’s important to collect data not just for your EHR but also your community at large, including emergency room visits and appoints with outside providers, said Shashi Tripathi, CIO for the 28-location Springfield Clinic in Illinois.
For value based care, there’s going to be rotation of money, Tripathi said. For example, 28% of inpatient cost will move somewhere. Why not move it to outpatient care to improve quality and reduce costs? He asked. “The same procedure in an outpatient facility is half the cost of inpatient care,” he said. Analytics point to these cost savings.

Another issue with value based care is complexity. Springfield includes Southern Illinois University’s school of medicine, and the Clinic will host EHRs on the same platform, totaling 900 providers on the same platform. “Eventually, we will get data in real time, even with institutions that arte in competition with each other,” he said.

Focusing on care gaps and hospitalization prevention has also helped prod reluctant providers. “Providers don’t want to move to value based care. Our proposition is that if you fill these care gaps, you’ll get more patients and in the long term your patients will be more healthy,” he said.

The New England perspective
The Dartmouth-Hitchcock Healthcare System has had an online patient portal for a long time, and a data warehouse since 1980, said Barbara Walters, executive director of Dartmouth-Hitchcock and CEO of OneCare Vermont. “But the ACO experience begins our data story. We were part of the CMS Demonstration Project,” she said.
“Data’s fun, but this is really about delivery and execution,” she said. Data can become a source of resistance, as the search for the perfect model and report causes delays. At Dartmouth-Hitchcock, the center:

  • Uses the primary care medical home as building block.
  • All RNs are care coordinators at this point, instead of triage points.
  • Specialists are in charge of appropriateness and unit costs, and should only be taking care of patients who actually need whatever care it is.
  • Clinical partners must be willing and ready to participate.
  • System administrators are dedicated to giving providers accountable and timely data.

    “Our motto is “First do no harm to the doctors” because they need to spend time with patients, establishing relationships and finding out what’s wrong with patients. It takes a laser-like focus to do this,” Walters said.

Taming wild west healthcare in Montana

To meet healthcare IT needs in the Billings Clinic in Montana, “we needed to have a common EMR platform,” said former CMIO Karen Cabell. Their new platform launched in 2004, and the clinic provides to systems in small towns throughout the vast, sparsely populated state.
Using a common EMR platform “means we don’t’ always go with the ‘best in breed,” so we can have an integrated solution on a common platform, she said. The Billing Clinic culture has helped introduce value added care. It has a very heavy physician leadership in the organization that coordinates tightly with the clinic’s administration, including IT. “We’ve had an explicit partnership with IT and quality, and that’s helped us as well.”

At the clinic, all physician and operational data goes into an enterprise data warehouse. But the clinic doesn’t allow anybody to get to data without feeding the data through the clinic’s cloud first, to verify sources and protect data.

Today, nurses get lists of sickest 5% of population. There are a variety of disease specific navigation tools to identify gaps or transitions in care. In addition, a palliative care team uses automated EMR tools to “find” patients and suggest consults. Value-based care and analytics have reduced readmission rates from 30% to high teens, while a pain management team finds patients electronically and arranges consultations. “We even found ways to avoid skilled nursing consultation—one extra day in the hospital saved a lot on post-acute care.”

View the keynote panel from  the 2014 Accountable Care And Health IT Strategies Summit, Chicago IL, September 2014,  in HD video with accompanying PPT. To subscribe to view the presentation please register here 

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Healthcare IT Connect sat down with Calvin Togashi, Pharm.D.,M.S., Partner, HealthQEC/formerly with Kaiser Permanente to discuss challenges physicians are faced with today around patient-provider communications and how through advanced improvements best outcomes can achieved.

Healthcare IT Connect: What are some of the challenges facing patient-provider communications?

Calvin Togashi: Time is the biggest challenge. The Center for Disease Control and Prevention estimated 1.2 billion office visits in 2010. For physicians, there just is not enough time in a 10 minute office visit to address current and chronic medical issues. After the office visit, there is even less time available for following up, sharing information and making decisions with patients. Meanwhile, in between office visits, patients often have more questions about their medical issues and treatment.
Lack of integration is another challenge. Physicians know what they want to communicate to patients, but the information is trapped in multiple systems – vital signs, appointments, laboratory results, prescription refills, registries, demographics and contact information. Some electronic medical records have integration between systems. Others are stand-alone islands that require manually pulling together information for each patient. Physicians want integrated system where they can filter diabetic patients for elevated hemoglobin A1c, check for the last oral hypoglycemic prescription refill and send patients encouragement for diet and exercise in just a few clicks.


HIT: Can you describe some of the important messages that physicians may want to send patients?

CT: There is a wide variety of messages including reminders, information messages, notifications and alerts. Reminder messages could be for an upcoming office visit, procedure or imaging appointment while information messages publicize health fairs, blood drives, prescription mail order savings or exercise and nutrition tips. Notifications may cover missed appointments, refills waiting in the pharmacy or pending laboratory order. Finally, alerts require action like a drug recall, poor air quality for asthmatics and appointment changes.

HIT: In a busy physician practice, how can the office staff help deliver these messages?

CT: The method to deliver messages needs to match the patient’s preference. All patients are not technologists! Some patient prefer paper. Other patients prefer phone calls, emails or text messages. Likewise patients may have language preferences. Physician practices that cover a wide geography may also see differences in affluent and less affluent areas.
The office staff need to review current practices for contacting patients. Manual phone calls and letters are very labor intensive. Consideration should be given to changing the delivery workflow and automation of processes to match patient preferences. The goal should be to increase patient satisfaction while decreasing staff effort. Our Prompt Outreach tool can deliver individualized outreach messages by email, pdf letters and text messages.

HIT: Why should physician practices invest in patient-provider communications today?

CT: Patient workloads continue to grow for physicians and office staff. Better communication can reduce manual work, refocus staff on their unique skill sets, organize the flow of information and lead to improved physician, staff and patient satisfaction.

HIT: Where will advances in technology take patient-provider communications?

CT: As health related sensors improve and become ubiquitous, there will be an explosion in individualized data collected continuously. Monitoring of vital signs, physical activity, electrolytes, glucose, hormones and drugs, measurements once available only in the hospital, will be readily available from transdermal, corneal or ingested sensors. The next challenge is to correlate sensor data with individualized patient outcomes and communication between patients and providers how to steer care delivery toward the best outcomes.

Calvin Togashi presented at the 2014 Accountable Care And Health IT Strategies Summit, Chicago IL, September 2014.  The session Patient Portals: Effective Approaches and Future Trends can be viewed on demand, in HD video with accompanying PPT. To subscribe to view the presentation please register here  

Calvin Togashi, Pharm.D.,M.S., Partner, HealthQEC/formerly with Kaiser Permanente
Matt Sarrel, Healthcare Expert; GigaOm Analyst; CEO and Founder of Sarrel Group
Jonathan C. Silverstein, VP Biomedical Research Informatics, NorthShore University Health System
Lauren Sullivan, Director Application Services, Sinai Health System  

Challenges created by the ever-growing demand of patient needs, changes in healthcare delivery as a result of The Affordable Care Act, HIPAA regulations, and the HITECH mandate, physicians and healthcare providers must rapidly adapt to an ever-changing environment. To maximize efficiency, enhanced communication between providers and patients, and provide consistent high quality care to patients, new platforms that integrate medical care and digital technology are being developed and deployed. Communications technology encompassing a broad range of tools such as smartphone applications, outbound messaging, emails, patient portals, telemedicine and more are continuously evolving.

» What is your organization currently doing, or what have you seen other organizations doing, regarding patient portals?
». Patient portals can provide a host of benefits: streamlining, provider workflow, improving patient-provider communications, improving quality of care, etc. From the implementations that you’ve seen, what are their strong points and where could they be improved?
» For those organizations without a patient portal, what are some other ways to enhance and streamline Patient-Provider communication?/br> » There are many interesting innovations and new technologies enhancing Patient-Provider communication? What are some of the more successful case studies or use cases have you seen and what are the factors that lead to their success?
» Any parting words of wisdom for our audience?

View Now and Download PPT

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