Mobile Patient Engagement: New Ideas Sometimes Clash With Old Technology

Health systems are learning that they need to plan carefully to give consumers access to services on a mobile platform.

Healthcare organizations are finding that an effective patient engagement strategy involves more than just opening a patient portal. A good platform not only gives consumers access to health system services and resources, but allows them to access those services on the device and at the time and place of their choosing—all without overwhelming either the consumer or the provider with unnecessary steps or tasks.

"It has to separate the signal from the noise," says John Lock, chief transformation officer for MedStar Health, which launched a new patient experience platform designed by b.well Connected Health this past January. The Maryland-based health system, he says, has a strategy in place to "get you to the right care at the right time and on the right modality."

That's not as easy as it seems.

"I wish it were as easy as Uber," he jokes.

John Lock, chief transformation officer at MedStar Health. Photo courtesy MedStar Health.

The patient engagement—or patient experience—landscape has changed dramatically over the past few years, in part due to the challenges imposed by the pandemic but also because of the shift to patient-centered healthcare, a philosophy that's been around for about a decade. The advance of mHealth devices and telehealth platforms has created new channels for accessing care and given the consumer more power to choose how and where to get that care. Healthcare executives are finding that they can no longer sit back and wait for the consumer to come to them; they must be proactive, reaching out to the consumer, or that consumer will go somewhere else.

"You need to create a boundary-less experience for the consumer," says Lock, in which MedStar Health has been working on its own technologies and strategies for the past decade through the MedStar Institute for Innovation. "For us, it's part of … being on the path of becoming digital rather than just doing digital."

The challenges posed by being digital, rather than doing digital, lie in the culture shift that this creates within the health system. At healthcare organizations, new ideas and technology aren't always readily and easily embraced. Health systems need support throughout the institution to adopt new services and adapt to new ideas, and those in charge of leading that change need to make sure doctors and nurses are on board.

"Digital transformation is significant," says Lock. "The work that goes into this, when you've been doing something the same way for a long time," is extensive.

Easy to Visualize, But Difficult to Implement

Patient engagement is a tricky term, and one that might mean different things to the consumer and provider. Surveys done by different sources over recent years indicate more than half of all consumers prefer digital tools for such tasks as appointment reminders and follow ups, and about 60% want to share their health data virtually with providers. About half want to communicate with a doctor via digital channels, and 70% say they'd choose providers based on digital access.

Mobile might seem like a cool term that can be added to any service to make it more popular, but the journey from a portal to portability isn't easy.

At Atlantic General Hospital in Berlin, Maryland, Vice President and CIO Jonathan Bauer, CHCIO, said patient engagement through the portal was a top priority at the hospital when he came on board in 2017. But adding mobility to the mix took a lot of time and resources, and in 2019 hospital leadership felt the cost was too much.

Jonathan Bauer, vice president and CIO, Atlantic General Hospital. Photo courtesy Atlantic General Hospital.

COVID-19 changed that strategy. Suddenly mobility was a necessity, as the hospital needed to stay in touch with patients who were staying home. Atlantic General contracted with Allscripts to roll out the FollowMyHealth portal, along with its telehealth platform, and made use of federal grants to expand the service.

Bauer said the pandemic forced the health system to act quickly, but they knew the numbers were there to support mobility.

"Ninety-seven percent of all Americans have a cell phone and 85% have smartphones," he said in an e-mail.  "We knew if we could start relying on sending text messages to patients' cellphones, we would have a better chance to reach them."

"The fact that patients no longer have to sign up or into a portal account to receive reminders, messages, and protected health information [PHI] is a huge win," Bauer added. "We are reaching more patients with less involvement from our staff.  We are able to prioritize those patients who require contact and to make sure we are completing the circle of care."

Like so many other health systems, Atlantic General saw rapid support for messaging and telehealth, but ran into problems when they considered expanding into scheduling.

"The staff was very receptive to most of the deployment until campaigns like online scheduling and waitlist notification started altering their schedules," Bauer said. "This was not well received, and we are still struggling with these two campaigns as of today. We are trying to find that happy medium where the technology lets the user schedule an appointment but does not disrupt the office flow. Our deployment strategy was based on bringing the easier campaigns live first and easing into the more difficult ones."

The challenges underscore an overlooked aspect of being mobile. What's great for consumers might not be that good for providers.

"The first piece of advice would be to make sure [the providers] understand how each office is manipulating its existing schedule," Bauer says. "One of the main reasons online scheduling was not well received is the fact each office was manually manipulating its schedules to meet the provider's preference. Sitting down with each office and documenting their workflow would help understand how online scheduling and waitlists will affect them."

"The next step we are looking to take is to start using the data we are collecting. MPE [mobile patient engagement] collects a tremendous amount of data that can be used to guide decisions about care. One change we are looking at in the short term is expanding the questions that are asked after an appointment. Currently, we are getting a 6% response rate but we are only asking two questions. We want to expand that to four questions to capture more detail about the patient's encounter."

Adding Scheduling to the Patient Portal

MedStar Health has integrated scheduling into its mHealth portal, but the process wasn't easy. One of the bigger challenges, Lock says, was moving from legacy health IT platforms to more nimble tools that have mobility baked into the back end.

Many health systems are facing that challenge now. The newest generation of digital health tools and platforms no longer sits outside the electronic health platform but integrates with existing platforms to create a seamless experience. For hospitals that have used the same platforms for a decade or two, that transition might have a few more seams than expected.

"We are moving toward interoperability," Lock says. "You're lifting data from legacy systems that you need, and you're getting data from all these new [platforms], and you're trying to make them work together."

With scheduling, Lock says the platform MedStar Health is using incorporates AI technology that can match a consumer's healthcare needs to the most appropriate care provider. This ensures not only that the consumer is being matched with the right provider, but that the provider is seeing patients that he or she should be seeing.

The process includes input and buy-in from clinicians, he said, as well as from other departments whose services will be affected. The health system even spent a year talking to patients and consumers about what should be included. Sometimes it takes a while, and a few changes and test runs to make sure the end result meets everyone's expectations.

"The business transformation that goes along with the digital transformation is significant," he says.

MedStar's portal now boasts several features, including access to records and test results, online registration, check-in and appointment scheduling, and medication reminders. It's a step-by-step process, Lock says, and the next step is to integrate specialty care.

"It's more complicated than just creating an entry point," he notes.

The future, Lock says, will lead to a more personalized platform, with itineraries tailored to the specific patient and access to more health and wellness resources. Consumers will be able to pay their bills online, and manage data from wearables and other smart devices. On the other end, clinicians will be able to use the platform to not only communicate, but collaborate with patients on care, rather than waiting for them to pick up the phone or come into the office or hospital.

The whole idea behind using digital technology, Lock says, is to reduce repetitive steps and redundant actions that push people away from healthcare until they show up in a clinic or ER with a critical health issue that needs to be addressed. The technology should be intuitive, guiding consumers directly to the care provider who can best address the issue at hand.

"We wanted to be able to [create a platform] that doesn't just say, 'Call us,' " he says.