Translation And Health Literacy In Telemedicine

Are we speaking the same language? How telehealth can help

By David Thompson, MD

“Fever” may sound different in other languages, but it means the same thing. Whether a patient says fever, fiebre, or fièvre, it’s the telehealth provider’s job to deliver the correct diagnosis and treatment. Language differences can add complexity to an already confusing situation for patients. Fortunately, healthcare professionals can help bridge this gap using digital health tools to capture symptoms in the patients’ own language.

Language Translation: So, how can healthcare systems reach the broadest patient base possible and ensure telehealth options benefit everyone? One answer is offering an e-visit intake process (rapid medical history) to patients in multiple languages.

Language-specific documentation checklists support healthcare providers by capturing a detailed history of the patient’s symptoms at the beginning of the medical encounter. Language localization also makes it easier for non-English speaking consumers to use e-health tools and applications to ensure greater accuracy when they use virtual care. Language differences can add complexity to an already confusing situation for patients. Click To Tweet

The most recent National Assessment of Adult Literacy (NAAL 2003) found that 89 million Americans have limited health literacy. It’s fair to say a significant percentage of those have English as a second language or speak no English at all. This highlights the need for global health literacy guidelines and healthcare options for all languages. Consider the following reasons to offer multilingual telehealth options.

Improve patient engagement: By using a multilingual telehealth platform, clinicians can help patients of all language backgrounds—even if they, themselves, don’t speak the same language. In addition, more tech-savvy patients can choose their language preference when using e-health applications. The simple ability to communicate health information in their preferred language can improve patient engagement and satisfaction by:

  • Providing easy-to-understand information;
  • Making patients feel they’ve received customized, personal attention;
  • Offering flexibility for individual situations; and
  • Giving patients control over their healthcare, regardless of language.

The bonus is that health systems using flexible telehealth platforms can also see improved retention due to patient engagement and satisfaction.

Support communication along the care continuum: Not only can telehealth technology offer engagement solutions, but it also has the benefit of connecting providers and patients along the care continuum. Patients can see health information in their preferred language, while the telehealth platform provides data coding and translates it into medical terminology. This data can then be shared among medical call center nurses, telemedicine providers, hospitals, and primary care providers. There’s never a need for patients to feel they have less access to quality care because of language barriers.

With advancements in translation technology and digital health platforms, the future of healthcare will be measured by how well organizations and providers appeal to a broad patient audience; capture health information; share data with other providers; and leverage that data to improve medical care, speed up care delivery, and reduce costs.

Consider the case of John Gomez, a twenty-two-year-old, whose primary language is Spanish. John has had knee pain for two days and contacts a telemedicine provider.

Step 1: The initial call: John calls a service representative who works with his doctor. This service representative does not speak Spanish. Using a symptom-checking engine that offers symptom options for “knee pain” in Spanish, she collects information about the patient’s condition. The representative then obtains John’s demographic information, transcribes his chief complaint and helps him complete an online “rapid medical history” for knee pain. The telehealth platform lists recommended care options based on John’s symptoms, his availability, and doctor preferences. The service representative then arranges a telemedicine encounter.

Step 2: The telemedicine encounter: John can speak with a Spanish-speaking doctor or an English-speaking doctor because his information has been transcribed and coded as data in medical terminology. The doctor reviews the medical history, validates the information during the telemedicine encounter and provides treatment recommendations.

Step 3: Follow-up: A nurse in a centralized call center contacts John in two days to make sure he is following treatment recommendations, getting better, and has no further questions.

Serving a broad population: Healthcare is confusing, but fortunately, patients are increasingly becoming more involved in their care. As healthcare and technology continue to evolve, healthcare systems and providers must adapt to serve a broad patient base with consumer-friendly tools and information.

David Thompson, MD, FACEP is CEO and chief medical officer at Health Navigator. A part-time faculty attending in the Northwestern Memorial Hospital Emergency Department, Dr. Thompson also works as an author and partner with Self Care Decisions, LLC and Schmitt-Thompson Clinical Content, LLC. He is board-certified in both internal medicine and emergency medicine, having completed a dual residency at Northwestern Memorial Hospital at Northwestern University. Dr. Thompson is a Fellow in the American College of Emergency Physicians. He can be reached at david.thompson@healthnavigator.com.

Hospital Call Centers



The Vital Ingredient in Clinical Communication

By Kevin Mahoney

 A robust and effective communication system is essential in any hospital, as it forms the backbone of the provision of exceptional patient care. The adaptation and growth of evidence-based medicine have led to growth in multidisciplinary approaches in patient care and increase in research among healthcare professionals.

Multidisciplinary approaches and evidence-based practice, therefore, have necessitated constant and efficient communication among health professionals, especially at the hospital level. The sensitivity of patient care and the fast growth of technology, both clinical and non-clinical, further necessitate a need for balance and maximizing of the right forms of technology for effective clinical communication.

The hospital call center serves as a vital platform in the cog of hospital communications. Often it serves as the patient’s first contact with the hospital. In general, the call center is tasked with providing patients and staff with information pertaining to emergencies, appointments, health monitoring, and the provision of specialist information. It is also a source of patient data and interdepartmental communication. This hospital call center platform, therefore, is multifaceted in its communication functionality. The facets of communications that are related to the hospital call center are patient-to-hospital communications, internal communications, and hospital-to-patient communications.

Patient to Hospital Communications: Call centers at healthcare facilities allow the communication of the patient with the hospital and provide treatment access and patient support. The hospital call center has evolved to be a key primary contact area in the healthcare system.

Treatment access begins with proper scheduling services that taps clinical assessment and triage. This is done to allow the patient to access the right specialized care specific to the individual. For instance, it considers previous admissions, patients’ insurance information, and urgent and emergent situations and classifies patient procedures as either inpatient or outpatient. Hospital call centers play a significant role in any hospital’s clinical communications. Click To Tweet

Patient support goes far beyond initial contact and the initial care received at the hospital. The medical call center has evolved to incorporate preventive and rehabilitative features into the platform. Moreover, call centers now use disease management programs to increase awareness of certain preventable diseases. Furthermore, they help the patient schedule appointments and remind them of screening programs.

The medical call center also helps patients access hotlines suited to their ailments, such as giving patients information about suicide prevention resources. Consequently, these platforms have improved communication features by integrating holistic curative, preventive, and rehabilitative features. This patient communication is an essential part of providing health services by a hospital.

Internal Communications: Additionally, the hospital call center supports clinical communication within the hospital staff. This is evident in environments where there is a centralized web directory. In such instances, the call center acts as the medium for vital information within the hospital. This essential information includes work schedules, contact information, and information about the employees on call. It is a critical component of providing well-coordinated care within the hospital system.

Furthermore, such call centers are tailored to communicate emergency codes and deliver critical messages to clinicians. These critical messages are essential, as they allow patient access to clinicians and contact among clinicians themselves.

A hospital call system, therefore, must be well-coordinated, time sensitive, reliable, and suited to the hospital devices available to the healthcare professionals. Hospital call centers and systems are further being improved upon to allow the tracking and escalation of messages provided to clinicians. This is essential in urgent and emergent service delivery in hospital environments.

Medicine is adopting a multidisciplinary approach to allow more holistic care and treatment to the patient. This requires constant and effective communication among medical professionals. Therefore, the hospital call center is essential, as it acts as a referral point among specialists and a resource for specialists to get access to a client base from the hospital.

Hospital to Patient Communications: Last, call centers allow the communication of the hospital and the patient who is the primary customer of the healthcare facility. The hospital marketing department benefits from the communications between the patient and the call center. The hospital call center is a point of increased patient satisfaction and improved marketing information. Patient satisfaction must be the most important goal and a practice ingrained within the organizational culture.

The hospital, therefore, should aim at optimizing the call experience for the patient. This can be done by cutting down the call waiting time, coordinating points of services, and improving patient registration and billing.

The internet has made it easy to widely disseminate information. A patient can communicate his experiences to a potential customer base. Patient experience, therefore, in the internet age, is an essential form of hospital advertisement. Improving patient experience builds upon the hospital brand and helps set it aside from the competition.

Optimizing patient experience goes beyond a single interaction to anticipate the needs of a patient and tailor services to meet those needs. The increasing need for data within the information age, therefore, cannot be understated. Data from call centers helps the marketing department find effective ways of communicating with the patient.

Each hospital call center must have a means of feedback. This helps identify and document potential issues the client had with the system. There is currently an adaptation of use of proprietary tools such as live metric dashboards and quality assurance and tracking tools. Therefore, most hospitals are collecting data to learn the needs of the patient and tailor their customer care services accordingly. For instance, most call centers now use customized call scripts; this ensures the provider maximizes care support and efficiency.

Optimizing the customer experience has led to call centers evolving as new and exciting forms of hospital income generation. The consequences of effective customer service are based on optimizing the patient experience, which leads to an increase in hospital revenue.

Final Thoughts: Clinical communication is a hugely faceted subject with far reaching consequences that go beyond hospital walls. Hospital call centers play a significant role in any hospital’s clinical communications. This role is expected to continue growing in the coming years as modern technology makes it easier and faster to communicate.

By optimizing communications, a hospital call center can improve patient health outcomes, fill an essential healthcare gap, and serve to improve overall patient care. It is, therefore, imperative that hospitals find effective ways of maximizing call centers, not just as a channel of communication, but also as a huge income-generating department.

1Call, a division of AmtelcoKevin Mahoney is a hospital and healthcare-related account advocate and sales engineer at Amtelco, a manufacturer and supplier of call center solutions. Contact him at kmahoney@amtelco.com.

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Using Telehealth Data to Improve Patient Care

By David Thompson, MD

Understanding what drives patients to seek treatment can help you educate and prepare staff, which improves the patient experience. While you may have a gut instinct as to your patient’s chief complaints, have you ever crunched the numbers? Health Navigator has. We’ve explored approximately 20,000 medical call center patient interactions to identify the top reasons patients called, how urgent their symptoms were, and peak call times.

The analysis included information for patients from all age groups and found the top complaints included: fever, vomiting, stomach pain, cough, and head pain. Patients with the most urgent needs were babies or infants three to twenty-four months old (nearly 35 percent of calls), while the least urgent calls involved children (two to twelve years).

Understanding why and when people contact nurse advice centers allows telemedicine providers to manage staff expectations and prepare for common interactions. This can be accomplished by using a diagnostic telehealth platform that codes the chief complaints. This serves as a starting point to analyze the most common interactions at a hospital or health system.

If healthcare professionals and call center staff know what to expect in the average telehealth experience, they can:

  • Prepare a standardized call flow format and follow-up questions for their system’s top complaints.
  • Calmly and consistently handle patient calls and manage expectations.
  • Plan workflow and staffing needs, based on patient prioritization and time of day.

Diagnostic platforms can also provide data healthcare professionals can use to determine the suggested treatment protocol for common complaints and to enhance staff training, such as to:

  • Teach incoming staff the most common chief complaints.
  • Document follow-up protocol and questions to ask.
  • Prepare educational information about recommended treatments.

Consider the patient who contacts a medical call center about a persistent cough. The responding staff member recognizes this as a common chief complaint and asks follow-up questions suggested by the telehealth platform. This allows staff to consistently communicate the most common treatments for a cough and to provide care instructions for the patient. The telehealth platform can also provide easy access to printable aftercare instructions to share with patients.

This more efficient workflow can ultimately create a more effective environment for staff and contribute to patient satisfaction and retention efforts. The needs of a patient population may change over time, but data about common chief complaints can help understand these cycles and market services accordingly throughout the year.

David Thompson, MD, FACEP is CEO and chief medical officer at Health Navigator. A part-time faculty attending in the Northwestern Memorial Hospital Emergency Department, Dr. Thompson also works as an author and partner with Self Care Decisions, LLC and Schmitt-Thompson Clinical Content, LLC. In a collaboration with well-known pediatrician Dr. Barton Schmitt, Dr. Thompson has developed a comprehensive set of telephone triage protocols that are used in medical call centers and doctors’ offices in the United States and internationally. He can be reached at david.thompson@healthnavigator.com.

Using Mobile Apps to Engage Patients


TriageLogic


By Ravi Raheja, MD

Telehealth and mobile applications are changing the way healthcare is delivered. A recent Pew Research study found that about 77 percent of Americans own a smartphone. Smartphone users spend about 1.8 hours every day on their devices, and 89 percent of that mobile media time is on an app.

Anyone who owns a smartphone has come to rely on mobile applications to quickly access anything from their bank accounts to social media pages, even to that game they are addicted to. As the public relies more on technology, the telehealth field has grown and adapted to meet patients’ need to stay connected and in control of their health.

Mobile apps play a huge role in bridging access from the provider to the patient. However, as with all new technology, medical mobile apps face obstacles and the challenge of regulation. In recent years, there has been an explosion of patientcentered apps to aid in health and wellness.

Healthcare Mobile Apps Help Patients With:

  • Connecting to their physician’s office
  • Researching health insurance benefits or claims
  • Looking up reviews on providers
  • Finding nearby urgent care centers and ERs
  • Managing chronic disease
  • Lifestyle management
  • Smoking cessation
  • Diagnosis
  • On-demand doctors and telehealth

The Patient Behavior: A key issue for brickandmortar providers is to ensure their patients receive continuity of care with their health. However, with so many outside options available through mobile apps, doctors have to find ways to stay in touch with their patients and ensure patients come back to them for health issues. Solutions include providing patients with a service, such as a nurse triage on call, to ask questions about their symptoms when the office is closed. In addition, doctors can have their own mobile app to engage customers and improve access to the office for prescriptions and appointments.

Provider Driven Telehealth Apps: There are many times when a provider can use mobile technology on phones or tablets to assist in patient care. Mobile apps can send notifications or events directly to patients, such as reminders for appointments and tests or even reminders to help with antibiotic compliance.

Some mobile apps, such as My24/7HealthcareTM, allow patients to send messages to practices to request appointments and prescription refills. Additionally, some telehealth apps allow providers to virtually extend their hours, by allowing patients to conveniently access the practice and their nurse triage from their mobile app. A quality mobile app for a practice allows providers to increase engagement with patients, improve patient convenience accessing the office, and extend the hours when patients can get questions about their health symptoms answered.

In another use of mobile applications, patients can use telehealth mobile apps to replace in-office visits with their providers. This is most useful for rehabilitation or post-operative care patients and those with chronic conditions, who require regular follow-up care or monitoring. Many of these patients have transportation issues due to their health conditions. With the use of mobile applications, patients are able to chat or send images of their progress or setbacks, saving patients the time and money it would take to go to the physical office.

Finally, mobile health applications have proven especially beneficial to rural areas with limited access to physical medical facilities. Rural locations tend to have a shortage of specialists. Primary care providers can use mobile technology to access specialists from large institutions to virtually assist in the care of their patients. The primary care doctors themselves can save their patients time and effort to drive to their offices by conducting telehealth visits using the mobile application.

Regulation: As with any communication tool with patients, an important consideration is that all communication between patients and providers has to be HIPAA compliant. For example, text messages must be secure and coded to ensure that only the patient and the provider are able to access the information. In addition, when sharing a family account on a telehealth mobile app one must have a way for the patient to determine what is visible and to whom.

Though many states have passed telehealth coverage laws, there are still many issues with service reimbursement. Currently, there is some controversy over telehealth parity laws, which would require reimbursement by health plans for telehealth services at the same or equal rate as those services performed in person.

Since telehealth mobile apps are a relatively new tool, the medical community is still developing ways to regulate this industry in order to evaluate and prevent potential dangers. The US Food and Drug Administration (FDA) has weighed in on which apps require regulatory oversight and which do not.

Conclusion: Physicians need to acknowledge and embrace telehealth mobile apps or suffer losing patients to those who are able to integrate the needs of the patient. In this on-demand society, it is important for practices to adapt from the traditional model of healthcare.

Telehealth mobile apps have made it easier for the patient to take an active role in their healthcare, while making access to physicians and medical providers more convenient. While mobile technology has changed the way telehealth is practiced, there is still a lot of data that needs to be examined and adjustments made to the different models to figure out the best approach for the future of healthcare.

TriageLogicDr. Ravi Raheja is the medical director of TriageLogic, a URAC accredited, provider of quality triage solutions, serving over 9,000 physicians nationwide. TriageLogic provides software, mobile applications, and nurse triage services. Recently, TriageLogic expanded its offering to provide employee telehealth solutions through Continuwell. For more information contact Amy Smith at 888-TEAMTLC or visit www.triagelogic.com.

Mobile Apps and Telehealth: Another Channel for Reaching Your Audience


LVM Systems

By Sue Altman-Riffel

Healthcare contact centers have acted as the communication and wayfinding hub between their sponsoring organizations and the audiences they serve. In the 1980s, when I started my first hospital call center, there was really just one channel for quick communication: the telephone. It was a landline.

We didn’t give much thought to our audiences’ preferred communication methods back then. The only option of note was whether someone wished to be contacted on his or her home phone or work phone. Later came car phones and cellular phones, more possible options to be considered when collecting callers’ phone numbers.Healthcare contact centers have acted as the communication and wayfinding hub. Click To Tweet

The typical contact center users: patients, parents, plan members, and prospective community members have not changed much through the years, but their communication options have expanded.

Internet availability brought about health organization websites. The primary advantages of the website are 24/7 availability and no waiting on hold, allowing its audience to quickly find information, download forms, browse physicians and facilities. and register for programs and services, whether a call center was available or not. Contact centers (note the change from call center to contact center) continue to add support to a variety of website functions behind the scenes, but a growing list of transactions can be concluded without human support.

Websites continue to be an extremely important digital platform for healthcare today. Studies show that the user’s viewing device (for websites) can change throughout the day: a smartphone in the morning and while the user is commuting or at lunch, desktop use picks up during the workday and tablet use increases in the evening. But for the last ten years, the communication medium that has outpaced all others is the smartphone.

We Love Our Smartphones: Since the smartphone was launched, we humans have fallen in love with its convenience and offerings. We each have our favorite apps. They entertain, keep us connected, act as a platform for sharing our views, provide us with answers, and support telephone and video communication.

In the US, the average adult spends eighty-seven hours per month on their mobile devices, mainly smartphones. We keep them nearby, often in a pocket or purse. Studies show that 75 percent of smartphone users take their phones to bed with them. (I want to smirk at this, but I remember using my white noise app to fall asleep last time I traveled.) Clearly, we’ve incorporated smartphones into nearly all aspects of our lives, including managing our (and our family members’) health.

Each year, more functionality is integrated into smartphones (effectively hand-held mini-computers). The list of functions will look familiar. At present, hospital apps support many do-it-yourself (DIY) services, such as:

  • Locate facilities, with mapping and directions
  • Find physicians: search based upon specialty, insurance, location, language
  • Check symptom acuity, with self-care advice and connection to care locations
  • Connect to a triage nurse or telemedicine provider
  • Browse health information libraries
  • Look-up dosages; track medications
  • Login to patient portals
  • Engage in social media
  • Pay bills
  • Sign up for a class or event
  • Get reminders, encouragement, and education via push notifications

One of the many advantages offered by mobile is one-tap connections to the next services needed. A symptom check is one tap away from calling one’s doctor, finding an open urgent care (with map), scheduling (online or agentassisted), or connecting to a triage nurse or telemedicine provider.

Have Mobile Apps Replaced Talking to a Real Person? No. Although mobile is becoming the organization’s digital front door, it is not the sole communication vehicle. The choice between mobile versus livevoice is influenced by your audience, the service required, and its complexity.

Audience and Age: First, audience adoption of apps differs by age group. Pew Research regularly studies the adoption of technology by population. In 2015, they found that 77 percent of the eighteen to twenty-nine age group has used their smartphone to seek information about a health condition, compared to slightly fewer (68 percent) of 30-49 year olds.

They also explored the shrinking segment of non-users (13 percent for websites; 20+ percent for smartphones). The shared characteristics are highlighted as age 65+, income below the poverty level, low education (high school or less), and rural. If this describes a portion of your audience, then telephone services will continue to be the main medium for supporting them.

General Movement Away From the Telephone: Recent Forrester research “Your Customers Don’t Want To Call You For Support” tells us adults in the US prefer using web or mobile self-service more than speaking with an agent over the phone. This use increased from 67 percent in 2012 to 81 percent in 2015 among US online adults.

Although calling customer service has steadily decreased over the past six years, it is still used for escalation. Customers prefer to resolve straightforward interactions using selfservice (web and mobile), but still reserve complex issues for a telephone call.

For 10 plus years, contact centers have seen the volume of inbound calls decline—especially in the age group of 18-35 years. Creating a mobile app to engage this audience is a way of keeping their loyalty by respecting their self-service preference. They will connect by telephone when their health needs escalate or exceed self-service.

Applying this to healthcare contact centers, communication preferences are situational. One example is symptom checking (described as self-triage). Young parents may use an app or website to check their child’s symptoms. It will help them understand what action is appropriate: ER, office visit ,or manage at home for now, and offer step-by-step advice for managing symptoms.

But what if the parent has additional questions? A great solution is offering the symptom-checker user an option (within the app) to connect to a triage nurse or request a call back. In many instances, self-service may satisfy users’ needs. But self-service can escalate to a nurse if the situation turns out to be more complex.

Scheduling: Not all desired services can be completed quickly via mobile. Appointment requests are still largely facilitated through voicetovoice communication. In many cases,

  1. the office (or hospital department) needs more information about the patient than can easily be completed using a web or mobile form, or
  2. the back and forth of choosing an appointment time that suits both schedules can be done faster via telephone.

There are exceptions. Many health systems are piloting self-scheduling for certain types of appointments through their patient portal or through apps such as ZocDoc. It appeals to the self-service enthusiasts and rates highly for fulfillment of instant-gettification.

Mobile apps can be a conduit for connecting the user to your organization for appointments. Placing a “request appointment” button (within the symptom checker or the physician finder) in logical areas can funnel new patients to your scheduling center.

Mobile is Another Channel: At its simplest, mobile represents another change. Since the first healthcare call centers, there have been cycles of invention and change:

  • pilot a service based upon a health system objective or unmet audience need
  • fine-tune the process to reduce variation
  • make it more efficient using software or automation
  • reinvest any time saved into growth or starting another service

Communication and wayfinding services will continue to be multi-channel: telephone, video, website, patient portal, and mobile applications. As the mobile experience is demanded by a growing audience, more services will be supported by it. It will interface with additional software and applications, putting more self-service at your audience’s fingertips.

Mobile may connect your organization with a new set of customers: the 18-29 age group who only use their smartphone to place a call as a last resort.

There is an opportunity to leverage mobile to off-load low challenge or low acuity calls. This creates the chance to take on additional business, improve service levels, or shift staff to support new opportunities. Mobile is just another cycle of (re)invention and change.

Sue Altman-Riffel worked as a manager and consultant in the telehealth industry for 28 years. She currently serves as the CEO for two digital companies: Self Care Decisions and AppCatalyst, which support more than 200 healthcare organizations with self-triage and mobile application design and development.

Vendor Spotlight: TriageLogic Expands Telehealth’s Reach to Help Your Employees


TriageLogic


TriageLogic® believes no one should delay care because physicians are unavailable or the ER is too expensive. That is why earlier this year, TriageLogic launched a new product, Continuwell®, to provide telehealth services to a wider market. With Continuwell, TriageLogic tackled the big question that many organizations face: How do they keep healthcare costs down and employees healthy?

This new telehealth product was created to help businesses and organizations decrease employee healthcare expenses and reduce employee absenteeism by providing free, 24/7 access to a qualified, objective registered nurse. It also allows companies to engage employees by placing all services in one platform and send push notifications and messages.

A recent Pew Research study found that 77 percent of Americans own a smartphone. TriageLogic realizes the connection people have with their phones and their desire to be better connected with more aspects of their life.Continuwell nurses provide the necessary care without the need of a doctor in 3 out of 4 cases. Click To Tweet

The American Hospital Association found that:

  • 74 percent of U.S. consumers would use telehealth services.
  • 76 percent of patients prioritize access to care over the need for human interactions with their healthcare providers.
  • 70 percent of patients are comfortable communicating with their healthcare providers via text, email, or video, in lieu of seeing them in person.
  • 30 percent of patients already use computers or mobile devices to check for medical or diagnostic information.

Continuwell is a telephone healthcare service with a network of experienced registered nurses. Continuwell provides nurses on demand to evaluate employees and their family members to determine the appropriate care for their symptoms. Continuwell differentiates itself with its nurse-first model, where nurses use doctorwritten protocols to evaluate callers and determine the care to resolve their symptoms.

Continuwell nurses provide the necessary care without the need of a doctor in three out of four cases, saving the cost of a telehealth doctor visit and making the system affordable for employers and employees.

The Service

Step 1: A member enters their symptoms using a mobile application (app) or website portal.

Step 2: A registered nurse calls back within minutes.

Step 3: The nurse evaluates their symptoms and helps them with the next steps.

The team at TriageLogic has spent years developing a mobile app that would be user friendly, to increase utilization, as well as customizable, to allow employers or brokers to modify content to fit their specific needs. They recognized the challenge of getting employees to download, register, and then remember the benefits available to them through their employer.

The Continuwell platform allows organizations to select the services they want to include and creates a custom mobile app for their employees, where they get access to all of their services in one place. The app even has single sign-on capability to make it even more convenient. The platform is flexible enough that services can be added or removed on demand.

You take care of your patients, but who takes care of your staff? Why not extend a confidential and independent triage service for your staff by making Continuwell part of your employee benefits package? Continuwell is always available to help your staff get back on their feet, no matter the symptom.

Benefits

  • Easy to use, easy to access.
  • Customized with your logo and your own buttons.
  • Single sign-on ability means your employees can seamlessly navigate through all of your services.
  • Announcements and events calendar make it easy to keep information coordinated with all your employees, through push notifications.

Continuwell can place all wellness and health options in one, easy-to-access spot. With so many options available to employees, it is easy for a company’s benefits and programs to get lost. The customizable mobile application places the company’s benefits in employees’ hands, making it easy for them to find the resources they need, when they need them.

The Continuwell mobile app extends the reach of telehealth service to more people and puts them in control of their health. As telemedicine becomes more prevalent, TriageLogic is committed to providing hospitals and practices with the technological tools to meet the needs of their patients and staff. TriageLogic is also committed to helping its clients ensure high-quality care, while decreasing costs and improving patient satisfaction.

TriageLogicFounded in 2006, TriageLogic is a URAC accredited, physician-led provider of high-quality services and software for telehealth. TriageLogic is a leading provider of top-quality triage technology, mobile applications, and call center solutions. The TriageLogic group serves over 9,000 physicians and covers over 18 million lives nationwide. Visit www.triagelogic.com for more information

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Medical Apps and their “Application” in the Clinical Contact or Monitoring Center


LVM Systems


By Traci Haynes, MSN, RN, BA, CEN

Mobile technology is growing exponentially. Hardly a day goes by when there isn’t information on a new medical app for mobile devices. Clinicians use them in their practice to increase efficiency in providing patient care and to effectively explain information to their patients. And individuals use them to learn more about their conditions, and then often to monitor their health status. They are also used as a way in which healthcare providers and patients communicate or interact.Hardly a day goes by when there isn’t information on a new medical app for mobile devices. Click To Tweet

The 2016 HIMSS Connected Health Survey reported that more than 50 percent of respondents indicated their hospitals currently use three or more connected health technologies, which positively affect their ability to communicate with patients and to deliver a higher standard of care. The Technology Marketing Corporation (TMC) reports that the global wearable medical devices market valued at $3.7 billion in 2015 is expected to reach $13.5 billion in 2022.

The advancement in technology in electronics and sensors has permitted devices to capture and present data from the number of steps walked to an EKG. Then it transmits that data to the user or healthcare provider by means of remote or wireless communication. TMC reports wearable medical devices are segmented into diagnostic (such as vital signs, sleep, activity, and fetal and obstetric monitors) and therapeutic (which includes pain management, insulin monitoring, respiratory therapy, and rehabilitation devices). Wearables have different sites of application including head strap, wrist, handheld, and shoe sensors.

Remote monitoring programs primarily focus on serious, chronic conditions that can result in repeated hospitalizations. Several studies have been done on pilot programs with discharged patients and their efforts to reduce avoidable readmissions and maintain medical stability. These individuals, based on their diagnosis, were outfitted at home with devices such as a digital scale, blood pressure monitor, EKG recorder, or pulse oximeter, along with a telestation that wirelessly sends measurements taken in the patient’s home to a monitoring center where the information is viewed.

If the patient data is outside the predefined parameters, appropriate interventions can be pplied, such as a medication change, dietary modification, home visit, or physician appointment. Another example is a sensor on an asthma controller inhaler and an emergency inhaler that sends a signal to a cellphone, which then transmits the information to a monitoring center to let them know whether the inhaler is being used as prescribed.

The innovations in technology and remote monitoring continue to expand. BAM Labs developed an FDA-approved sensor mat, to function as a smart bed, that is placed under a mattress to monitor presence, sleep pattern, and heart and breathing rates. The collected data is transmitted to an app viewable on an internetconnected device.

Other examples include eNeighbor developed by Healthsense, which uses sensors placed on the patient and throughout the home to detect falls, wandering, and medication adherence. Independa created a system for monitoring that can include gathering clinical measurements as well as sensors that monitor motion, toilet flushing, and door opening. The data is then reported via an online app.

Some experts say patient monitoring is necessary for hospitals and physicians to evaluate their business. And monitoring programs are tools to help achieve the triple aim: improve access, raise outcomes, and make the healthcare systems more cost effective.

Challenges have included funding, reimbursement, and patient engagement. Some individuals may have to be reminded or persuaded to use the apps, as unfamiliarity with technology can add an additional encumbrance. Other challenges include staffing needs, filtering the important biometric data and integrating it into the EHR, and questions of medical and legal liability.

Is there a return for the health systems that have implemented a remote monitoring program? The answer is “Yes.” An article in Medical Economics written by John Morrissey, published in 2014, indicated improvements in the bottom line over time. Gains were realized from decreased hospital admissions and reduced use of emergency services. Beyond costs savings, the patients benefitted from the assurance they were being monitored, which improved self-management skills, enhanced quality of life, and enjoyed increased satisfaction.

LVM SystemsTraci Haynes, MSN, RN, BA, CEN is the director of clinical services at LVM Systems, Inc

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Health Navigator Partners With ERatHome

Expands access to care and medical information for retail clinics and home-based urgent care services

Health Navigator announced it has partnered with ERatHome, a network of retail clinics and home-based urgent care services, to expand access to providers and control the flow of medical information between patients and clinicians. As part of the collaboration, Health Navigator will support ERatHome’s Hive application, which is designed to share medical records and treatment history among care teams, provide patients with 24/7 access to doctors, facilitate appointment scheduling, send automated reminders and alerts, and share patient education resources.

“ERatHome provides a valuable opportunity to expand access for patients and providers through its Hive application. This partnership will introduce consumers to a new level of care convenience that includes valuable aftercare instructions and resources,” said Patty Maynard, senior vice president of business development, Health Navigator. “Health Navigator aims to enhance the patient experience with easy-to-understand clinical information in plain language, which makes the Hive application an ideal match.”

Patients in the ERatHome network can use the Hive app to call or schedule a virtual visit with a doctor. Doctors use patient information to make a preliminary diagnosis based on symptoms and suggest the next steps to take. Health Navigator provides a diagnostic decision-support platform that features clinical codes, symptom checking intelligence, and process analysis for clinicians. By integrating Health Navigator’s comprehensive set of codes and analytics, ERatHome provides a more accurate, efficient diagnostic process, which can produce improved outcomes.

Moving From “Sick Care” to “Health Care”


LVM Systems


By Mark Dwyer

In 2012 our government enacted legislature that mandated U.S. hospitals reduce re-admissions by emergency departments (ED) admits for the first thirty days post discharge. To force this change in behavior, rather than waiting for hospitals to choose to proactively address the overall health of their communities, the government began penalizing hospitals who had higher than average readmission rates through a deduction in their reimbursed Medicare payments.

This was a radical change in American healthcare as it put the onus of keeping patients well on the hospitals and providers who treated them. No longer could hospitals simply wait for individuals to require hospital care, rather it became their responsibility to proactively manage ED admitted patients for at least the first thirty days post discharge. If they were unsuccessful in providing the patient with the tools and help needed to keep them from re-admitting, they bore the weight of a financial penalty.

Initially, the penalty amounted to 1 percent of the hospital’s total annual Medicare reimbursement. It was tied to three specific DRGs (diagnosis related groups): acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Each hospital was scored against its neighboring hospitals to determine which ones had readmission rates in the highest twenty-fifth percentile of their surrounding hospitals. If a patient who had been admitted via the ED due to one of these three DRGs required readmission within thirty days post discharge, and the hospital’s readmission rate was in the highest twenty-fifth percentile of hospitals in the area, the hospital’s overall annual Medicare reimbursement was reduced by 1 percent. Although 1 percent may not seem like a lot, when it was applied against the hospital’s entire Medicare reimbursement dollars it was significant—especially for hospitals operating with only 2-3 percent profit margins.

But the government didn’t stop there. In year two of the program, the percentage of Medicare reduction was increased to 2 percent of the hospital’s total annual Medicare reimbursement amount. Then in year three, not only was the percentage again increased to 3 percent of the hospital’s overall Medicare reimbursement, but three additional DRGs were added: elective knee replacement, elective hip replacement, and chronic obstructive pulmonary disease (COPD).

At this point many hospitals began paying attention, especially when over 2,200 U.S. hospitals were penalized for failing to reduce their readmission rates. To address this ever-increasing reimbursement reduction, hospitals had to implement programs to manage Medicare patients post discharge for at least the first thirty days. To do so, many home grown programs were introduced with varying success.Healthcare software vendors have programs to help educate and manage the patients post discharge. Click To Tweet

A number of healthcare software vendors also began developing and marketing programs to help educate and manage the patients post discharge. Some of these programs involved on-site care management visits, phone calls, reminder texts, and emails. Some also involved extensive motivational programs designed to not only assist the patient in remaining proactive in their care but also the patient’s caregiver. Too often the Medicare patient’s primary caregiver is their elderly spouse who is also battling a litany of health issues. Assisting them and other familial caregivers was determined to play a critical role in the process.

But what about the many patients who suffer from more than one chronic disease? Some vendors realized that many Medicare patients suffer from co-morbidities. It is not unlikely for an individual with diabetes to also be obese or someone with HF to have been admitted with an AMI DRG. Initially, since these various disease states were defined as separate care plans, patients suffering from co-morbidities experienced multiple interactions post discharge to manage all conditions that could possibly result in a costly readmission.

To motivate patients and their caregivers to follow post-discharge instructions regarding medications, to make and attend post-discharge provider appointments, and to integrate with the hospital’s care management or medical call centers, vendors have begun collaborating with leading content developers. By adding patient educational and motivational training content to their software programs, post-discharge programs can enable the nurse or care coordinator conducting follow-up calls to select the specific information needed to address each of the patient’s multiple issues. This co-morbidity program approach eliminates the need for redundant calls to address each of the patient’s healthcare issues. Instead it enables the nurse or care coordinator to select the content, surveys, motivational scripts, and other resources needed to meet all of the patient’s unique needs across a wide array of health conditions.

Future thinking hospitals and providers who see the need for follow-up beyond the initial thirty days post discharge are beginning to take a stand for long-term health management by using customizable co-morbidity programs. This is a real step in the direction of healthcare management. Imagine a future where healthcare generates greater revenues from having empty beds, keeping area residents healthy and at home.

LVM SystemsMark Dwyer is the COO of LVM Systems, Inc. For more information about LVM’s Co-morbidity Care Management Program (CCMP), contact LVM Systems sales at 480-633-8200 x223 or info@lvmsystems.com.

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The Contact Center’s Role in Reducing Readmissions

LVM Systems


By Traci Haynes MSN, RN, BA, CEN

reducing-readmissions-2

Reducing hospital readmissions has been a focus of the healthcare environment for many years. Steven Jencks MD, dubbed by many as the father of readmission research, along with Mark Williams MD and Eric Coleman MD, analyzed medical claims data from 2003-2004 to describe the patterns of rehospitalization and its relationship to demographic characteristics of hospitals.

They learned that almost one-fifth (19.6 percent) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within thirty days. They also found that 34.0 percent were rehospitalized within ninety days; and that 67.1 percent of patients who had been discharged with medical conditions and 51.5 percent of those discharged after a surgical procedure were rehospitalized or died within the first year after discharge.

Furthermore, of the 50.2 percent of patients rehospitalized within thirty days post medical discharge to the community, there was no bill for a visit to a physician’s office between the time of discharge and rehospitalization. Additionally the average length of stay (LOS) of rehospitalized patients was 0.6 days longer than that of patients in the same DRG (diagnosis-related group) whose most recent hospitalization had been at least six months prior. The cost to Medicare for rehospitalizations in 2004 was $17.4 billion (Jencks, S.F., Williams, M.V. & Coleman, E.A., 2011).

In 2007, the Medicare Payment Advisory Commission (MedPAC) reported to congress that 13 percent of patients rehospitalized within thirty days of discharge in 2005 were for reasons potentially preventable. These readmissions accounted for $12 billion in Medicare spending.

As a result, the Patient Protection and Affordable Care Act (PPACA) of 2010 mandated that the Centers for Medicare and Medicaid Services (CMS) implement a program in which hospitals with higher-than-expected readmission rates for certain designated conditions experience reductions (penalties) in their Medicare payments. Beginning in October, 2012, the hospital readmission reduction program (HRRP) began adjusting hospital payments based on excess readmissions within thirty days of Medicare patients following myocardial infarction (MI), heart failure (HF), and pneumonia hospitalizations.

The maximum penalty at that time was 1 percent of a hospital’s base Medicare reimbursement rate per discharged patient. Beginning October, 2013 the penalty increased to 2 percent and then to 3 percent the following year (2014). The first year more than 2,200 hospitals were penalized for failing to meet standards, with 8 percent incurring the maximum penalty. In addition to the MI, HF, and pneumonia penalties, readmission penalties now include elective knee and hip replacements and chronic obstructive pulmonary disease (COPD).

The healthcare reform mandate required addressing a long-time quality issue. According to Bisognano and Boutwell, the primary reasons for readmission were no physician follow-up visit, medication discrepancies, and communication failure during transitions of care (Bisognano, M. & Boutwell, A., 2009). Eric Coleman MD and others identified poor information transfer, poor patient and caregiver preparation, and limited empowerment to assert preferences as the primary reasons for readmission. Contributing factors include nurses not having time to thoroughly address the needs of both the patients and caregivers upon discharge, the hospital setting not being conducive to education that will drive behavior change before discharge, and the care continuum breakdown between hospital discharge and the hand-off to primary care (Coleman, E.A., Parry, C., Chalmers, S., & Sung-joon, M., 2006).

The uneven impact of the penalties has been a significant concern for hospitals that care for a larger number of low-income patients. They claim it is more difficult for their patients to adhere to post-hospital instructions including payment for medications, dietary modifications, and transportation to follow-up appointments.

To address these challenges some hospitals have implemented measures including discharging patients with medications, home-visits, and follow-up calls. Other interventions include hiring specialty care coordinators and transition coaches to provide follow-up care for patients with multiple comorbidities, providing patients with extensive teach-back for multiple days prior to discharge so they’ll better know what to do once they are discharged. In addition, many include comprehensive medication reviews with a clinical pharmacist.The contact center can be an integral team player in reducing avoidable readmissions. Click To Tweet

The contact center can be an integral team player in reducing avoidable readmissions by enhancing the quality of care in the hospital-to-home transition through the combined capabilities of technology and human interaction. While discharge planning should begin upon admission to the hospital and include arranging for durable medical equipment (DME), transfer to step-down as appropriate, home health care, transportation needs, communications with primary care providers (PCPs), and discussions with caregivers, the extended care team which includes the PCP, caregivers, pharmacist, and other members of the interdisciplinary team can be greatly improved by the services of the contact center in helping to comprehensively coordinate the patient’s care.

The patient and their caregivers will also benefit from the reinforcement of information provided, teach-back, appointment reminders, and coordination of services including transportation, as well as medication reconciliation and symptom assessment resulting in earlier interventions and improved outcomes. Extending the contacts beyond the thirty-day penalty period will bring even greater benefits to patients and caregivers that may prolong readmissions indefinitely.

What readmission reduction activities are occurring within your organization? What is your contact center’s role in reducing readmissions? What level of service do you or can you offer?

Some contact centers make one post-discharge call to review the patient’s diagnosis, instructions, medications, education materials, and ensure the patient has scheduled their follow-up appointment with positive results. Others make several outbound calls to the discharged patient including a call within the first twenty-four to forty-eight hours post-discharge.

In addition the call center staff or care coordinator may reach out to the patient again after their first appointment, which ideally occurs within seven days post-discharge. This call typically is used to review the follow-up appointment instructions, any changes in medications, assist in referrals and scheduling with additional providers or resources, and communicate to the interdisciplinary team as appropriate. During this contact, biometric monitoring may also be tracked through technology or as self-reported by patients or caregivers.

Whatever level of service provided, it’s a win-win for the patients, their caregivers, and the organization. Utilizing the contact center to identify and implement communication strategies that effectively engage the patient and their caregivers adds value to the organization and the opportunity of better outcomes for their patients.

LVM SystemsTraci Haynes, MSN, RN, BA, CEN is director, clinical services at LVM Systems, Inc.

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