Michael O’Neil, Chief Executive Officer, GetWellNetwork

Patients and their families have choices when it comes to their health care. And just like any other consumer, they’re shopping for the best prices, the best service and, more importantly, a provider they can trust and return to again and again.

As more individuals and families have high-deductible health plans and pay more out-of-pocket expenses, they demand a better experience. Chains of urgent care centers and retail stores have entered the provider market and now compete against long-standing hospitals and physician practices. Value, convenience and quality remain critical but it’s time to think bigger. We need to understand how each of these core elements of care contributes to the overall experience a patient has when interacting with our health systems.

In addition to delivering quality care and outcomes for the patients and families they serve, providers are increasingly expected to optimize their patients’ entire experience. I believe we can turn to our everyday retail and consumer experiences for guidance because health care providers are competing for loyalty with the same comprehensiveness, consistency and flexibility of services and options that businesses like Amazon, Starbucks and Uber promise.

Danielle Miller, RNC, PhD (c)

Elizabeth Meyers, RN, PhD(c), CPHIMSS

Every day, millions of nurses report to hospitals across the globe. They assume responsibility for the care of patients across their healthcare continuum. The responsibilities of the nurse is multifaceted. They care for the patients and often times their families all while continually updating the physician on the patient’s progress. This is in addition to continually documenting both.

In a study of 767 medical-surgical nurses, it was discovered that less than 20 percent of their time is spent on direct patient care activities. And surprisingly, more than 22 percent of nurses’ time is devoted to non-clinical tasks. Paying nurses to perform non-nurse activities drives substantial cost and burden in the healthcare inpatient setting. Efficiency on the front lines makes a difference to patients and the bottom line.

How can we as nurse reclaim our workday to focus more on patient care?

John Santa, MD, MPH, Director of Dissemination, OpenNotes

I was privileged to work at Consumer Reports for seven years as the Director of the Health Ratings Center. As a doctor I thought I already knew a lot about patients and what mattered to them, but my time at Consumer Reports taught me a lot. When I had the chance to hear from medical consumers, especially the ones who had been activated by clinical outcome or economic inequities, I realized I had only heard and lived one side of the story.

What Consumer Reports is really good at is sharing reliable information in a way that empowers people to make informed decisions in the marketplace. My job in health ratings was no different – I analyzed data and translated well-organized reviews of science into meaningful comparisons to help people make important decisions about their health.

Throughout the past 75 years Consumer Reports has worked hard to reduce information inequality across the mass market. However, at the individual level, there’s some catching up to do. A major reason health markets don’t work as well as they could is that most patients don’t have easy access to their personal health information. Instead they rely primarily on their doctors, nurses and pharmacists to guide their health care decisions. And that often means confusion.

Apryl Allen, Author, ‘A Tango with Cancer: My Perilous Dance with Healthcare and Healing’

October is the month for celebrating breast cancer (oops, scratch that) Breast Cancer Awareness month! I can assure you, not all breast cancer patients are interested in donning the pink attire to walk or run miles to a finish line. Why? Because their experience with breast cancer was infuriating or worse, torturous. And what about those individuals who are diagnosed with metastatic breast cancer? They’ll have no victory.

In 2013 I was diagnosed with breast cancer. As shocking as it was, I was determined to get through the protocol of treatments and return to the life I adore. The reality? It wasn’t that straightforward and although I was willing to fight cancer, I wasn’t prepared to fight for my sanity, and the ability to heal.

Exactly what are these foundations for anyhow? Finding the cure only? Or are they there to support those who’ve been diagnosed with the disease? Could be both, but it’s still unclear to me. I never attempted to contact them because I couldn’t bare another horror story. I heard more than my share from a patient advocate, who took it upon herself to diagnose me – I hadn’t met with a doctor yet – but thankfully her assumptions were incorrect. Then there was a nurse navigator who detailed her experience of the absolute worst case scenario she personally was going through – not once, but twice! I aptly named her the Nightmare Navigator. All of this because I inquired about what types of specialists I’d require, what their titles meant and was there anything I’ve possibly overlooked.

Many of the healthcare industry’s patient engagement strategies have come from leveraging IT solutions. That approach has been as basic as a text message appointment reminder to making more involved decisions relative to cultivating electronic health records to deliver patient education. The common issue behind all of these interventions is that they are tools, not necessarily the solutions for much of anything. Patient portals, for example, are really just blank slates and they can only deliver positive results if we make the right design decisions during their inceptions. Unfortunately, recent studies suggest that our current approaches to patient portals are not helping certain patient populations, usually those patients in the most need of quality healthcare.

In our first conversation, Michael S. Wolf Ph.D outlined his team’s research, which describes how portals are pushing certain patient populations away from the opportunity of taking charge of their own healthcare management. As a follow-up to that interview, we asked Wolf how healthcare ought to reconsider the mission and function of patient portals so that they may enable a wider population to benefit from the emerging technology’s growing number of applications and features. 

(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article. )

Michael S. Wolf Ph.D. is a health services researcher and a Professor of Medicine at the Feinberg School of Medicine at Northwestern University. Most of his research focuses on health system complexity and the methods patients have available to access and use healthcare systems to support their personal health. He and his team spend a great deal of time focused upon patients who have more chronic care needs and how the healthcare system is helping, or not helping, these patients stay engaged in their self-care.

In terms of healthcare IT, Wolf’s work focuses upon how patients today are gaining the opportunity to utilize a variety of consumer health technologies to stay engaged with their healthcare system whether it be a portal or using mobile apps. His work has found that a lot of these tools have not been well designed in terms of patient engagement and that they are even pushing away the patients who are in the most need of assistance. 

(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article. This interview is part one of a two part series. Part two of the series will be published September 9, 2015.)

Free: Let’s talk about the research you’ve conducted relative to patient engagement and portals. Your findings outline how certain patient populations are not only not getting the information that is available to help them engage in their care, but portals may actually be pushing them away from their healthcare information. Is that correct?

Michael S Wolf, PhD/MPH Professor in Medicine-General Internal Medicine and Geriatrics, Center for Healthcare Studies – Institute for Public Health and Medicine and Department of Medical Social Sciences

Wolf: Yes, that’s correct.

To be clear, most of our research is focused on what we are calling lower health-literate patients. These patients, whether it be through a lack of health knowledge or access to good health information, show a concerning disparity in terms of the efficacy of patient portals. People who may have more limited health literacy skills, or limited capacity to properly engage health information, and use it to their advantage and make informed decisions, that tends to be a group that often times represents a number of disparities. Those who are older. Those who are more social economically disadvantaged. Those who belong to more racial-ethnic minority groups.

When we went into the study, we were asking the question: How would this specific population access information through a patient portal? To do so, you have to have computer literacy. You have to engage and remember your password. Then you have to have the knowledge necessary to find some functionality in the portal. We found that these issues are creating disparities within patient populations who may not have such technical capabilities.

As we went deeper into the study, we looked at two things. One, who has really enrolled in their patient portal? Two, if they were enrolled, among those who were enrolled, how are they using it? Was it a text or email to their provider to get information, did they look at lab values, etc.?