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Looking to Improve Patient Experience? Simple Options Can Yield Big Results.

Posted on September 18, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Improving patient experience is a top priority. Instead of grandiose new programs, hospitals and practices would see better results by focusing on simple options that have a big impact – like an eConsent solution. eConsent makes it easier for organizations to treat patients with respect and gets patients involved in their care.

Over the past several years more and more attention has been placed on improving the patient experience. This is partly due to a recognition by healthcare organizations that experiences could euphemistically be called less-than-ideal and partly because of changes to reimbursements that tie $$$ to patient satisfaction (specifically HCAHPS scores). From a patient and patient champion perspective this attention has been a welcome change.

There is a tendency, however, for healthcare organizations to gravitate towards large-scale projects to improve patient experience. Although projects like renovating patient suites and implementing AI chatbots can indeed have a positive impact, these initiatives are resource-intensive and can take a long time to yield results. Instead, hospitals and physician practices should focus on doing small things better and reap the benefits of improved patient experience sooner.

According to a study published by BMJ Open in 2016, positive patient experiences were “closely linked to effective patient-health professional interaction and logistics of the hospital processes”. The authors of the study also found that “positive aspects of the hospital experience were related to feeling well informed and consulted about their care”.

In 2014 a study found that delays in healthcare (wait times) impacted the perceived quality of care received. The longer the delay, the more that confidence in the care provider eroded. Having confidence in the care provider is a key factor in the online ratings patients give to healthcare organizations. Online ratings are the new real-time way to gauge patient satisfaction.

Taken in combination, these studies tie patient satisfaction/experience directly to (1) interactions between patients and their health professionals; and (2) smooth hospital processes.

Interactions with Patients

So what can hospitals do to improve interactions between health professionals and patients? They could implement new communication tools (like real-time chat). They could renovate offices so that patients and clinicians can look at screens together. They could even hire navigators to help patients interact with health professionals. All of these are fantastic initiatives, but all of them will take time and in some cases, a lot of resources.

There are, however, a number of simple things that hospitals could do that do not require significant investments of time or dollars. One would be to train clinicians to ask patients: “Is there anything we have covered today that I can help clarify or that you have questions about” rather than the standard “Do you have any questions?”. Another would be to implement electronic forms during the intake process so that patients only have to enter their information once. There is nothing more annoying than having each department ask for the same information over and over again.

Along these lines, an often overlooked yet quick-hit improvement area, is the informed consent process. The American Medical Association defines it as follows.

“The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. In seeking a patient’s informed consent (or the consent of the patient’s surrogate if the patient lacks decision-making capacity or declines to participate in making decisions), physicians should:

(a) Assess the patient’s ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision.

(b) Present relevant information accurately and sensitively, in keeping with the patient’s preferences for receiving medical information. The physician should include information about:

  • The diagnosis (when known)
  • The nature and purpose of recommended interventions
  • The burdens, risks, and expected benefits of all options, including forgoing treatment

(c) Document the informed consent conversation and the patient’s (or surrogate’s) decision in the medical record in some manner. When the patient/surrogate has provided specific written consent, the consent form should be included in the record.”

The informed consent process is a golden opportunity for hospitals to improve the patient experience. It is a chance for health professionals to engage patients in their care. This engagement has numerous benefits including:

  1. Reducing the anxiety patients have about the upcoming procedure, which in turn helps improve patient outcomes. This study published in the British Journal of Surgery, shows patient who are less anxious have fewer post-procedure wound complications.
  2. Demonstrating that the health professional (and by extension the hospital) care about the patient as a person.
  3. Mitigating the risk of malpractice. Lack of communication and feeling like clinicians didn’t care about them are common reasons cited by patients who decide to sue for malpractice. This New York Times article has an excellent summary of various studies into this phenomenon.

A simple way to improve the informed consent process is to move away from paper-based consent forms, which can be lost and are often confusing to patients, to electronic consent forms (commonly referred to as eConsent).

According to Robin McKee, Director of Clinical Solutions at FormFast, which offers an eConsent solution, “It’s the right time to be having the conversation about the costly risks associated with a paper-based process. Over 500 organizations recently experienced compliance issues due to missing informed consent forms according to the Joint Commission). Adopting an electronic solution is an easy and quick way to offer a better patient experience during the consent process.”

With an eConsent solution like FormFast’s, hospitals would be able to:

  • Have patients fill out forms on a user-friendly tablet
  • Pre-populate information on the forms with EHR data
  • Link to educational material that explains the procedure and risks in more detail
  • Quickly recall consent forms prior to the procedure by scanning the patient’s wristband
  • Provide a copy of the consent form (and links to the educational material) to patients

Smooth Hospital Processes

Feeling respected as an individual is key to a good patient experience. In fact, a 2015 Consumer Reports Survey found that patients who said they did not feel respected by the medical staff were 2.5 times as likely to experience a medical error versus those who felt they were treated well.  One of the easiest ways to show respect for patients is to value their time and prevent long delays during their hospital stay.

For patients, it is a horrible feeling to show up at the appointed time for a procedure, only to be carted to a waiting area in nothing but a flimsy robe and left to wait with no explanation. Now imagine how it would feel after 20 minutes of waiting to have a member of staff come and ask you to fill out another set of consent forms because your originals had been lost. Of course, while the patient is filling out the form, the staff member must review all the risks and implications of the procedure before you can sign the forms again. I know I would be about as calm as a palm tree in a hurricane.

This situation is referred to as “gurney consent” and is something that many hospitals are trying to eliminate. The National Center for Ethics in Health Care has a special guideline that prohibits gurney consent – VHA Handbook 1004.01 – Informed Consent for Clinical Treatments and Procedures. That handbook states that “Patients must not, as part of the routine practice of obtaining informed consent, be asked to sign consent forms ‘on the gurney’ or after they have been sedated in preparation for a procedure.” This clause was meant to ensure the consent does not occur “so late in the process that the patient feels pressed or forced to consent or is deprived of a meaningful choice because he or she is in a compromised position.”

Sadly, gurney consents are an all too common occurrence in hospitals that use paper-based consent forms. JAMA reports that missing consent forms cause 10% of procedures to be delayed, costing each hospital over $500K each year. This of course does not count the emotional toll it takes on patients.

It would be remiss not to point out that members of staff equally hate the need to have patients re-sign consent forms. It’s not comfortable to be the bearer of bad news and stand there while an upset patient vocalizes their displeasure. After all, the staff member is not the one that lost the form. Medscape’s recent National Physician Burnout & Depression Report found that the top contributor to physician burnout was excessive administrative tasks. Asking for another consent form from a patient certainly qualifies as an excessive administrative task.

“By modernizing document workflows, FormFast gives patients, their family member and clinicians the information they need, when they need it,” says Rob Harding, CEO of FormFast. “Digitizing the informed consent process helps ensure procedures go according to plan – no one is running around trying to find a paper document or asking for forms to be filled out yet again. A frictionless workflow makes for smooth operation which helps both patients and health professionals. eConsent is really a win-win.”

Conclusion

There are a myriad of ways to improve the patient experience. Big, bold initiatives and small, simple changes to existing processes. Although it is not an either-or situation, in the current economic and regulatory environment, hospitals should look for “small wins”, like eConsent, as an affordable and pragmatic way to improve the overall patient experience. As an added bonus, clinicians and administrators will also reap the benefits of lower stress and smoother workflows.

No matter what initiative, a hospital takes, ANY effort made to improve patient experience is a step in the right direction.

FormFast is a proud sponsor of Healthcare Scene.

Hospital Patient Transfers with Optional Protocols

Posted on September 4, 2018 I Written By


The following is a guest blog post by General Devices.

Patient Transfers are business. Serious business for all patients involved; transferring hospitals, transport service, agent and – the patient. They hold the balance to patient care, place and time plus the business side of healthcare. If a patient transfer is initiated and the ED/ EMS staff are unable to follow protocols it could result in not only the breaking of federal law, but also impact outcomes and costs. “Inter-hospital transfers can have negative financial (operational, and liability) implications for the patient, transferring and accepting facilities, and the health care system” (Academic Emergency Medicine: Inter-hospital Transfers from U.S. Emergency Departments; 2013). This article will explain:

  • EMTALA and how it will affect your transfer process
  • The different types of transfers
  • How transfer process and workflow can be made simpler, with less risk, using digital protocols.

In 2017, the United States saw 1,391,712 hospital transfers. Faster approved transfers lead to much better outcomes and more lives saved. Transfers can be necessitated by a multitude of reasons which include overcrowding, limited resources, lack of expertise, proper equipment for a specific treatment specializations, and more. A transfer can happen both during initial transport to the hospital or during the patient hospital stay. There are times where an incoming EMS call is immediately deemed transfer necessary, referred to as a diversion. Other times, a patient could be stablizied in the emergency room or during their hospital stay and require a treatment which is better suited for another hospital. Once the need for transfer is confirmed there are certain liabilities and protocols that must be followed.

E M T A L A, the federal law, requires the patient transferred from one hospital to another to be first stabilized and treated. This can include forms that must be completed, pre-transfer stabilization and preparation, as well as communication between the EDs, the transporting staff and transfer centers. EMTALA includes its’ own steps that must be followed during a transfer.

Transfer centers were established in an attempt to better manage the process. The simple fact is, their communication technologies do not allow team collaboration.

How can a configurable mobile telemedicine app help?

During a transfer, timing is one of the most crucial components to ensure effective patient treatment. Having inflexible protocols potentially restrict the ease of transferring a patient when needed. Every hospital, EMS and healthcare environment operate differently and have different needs, which is why a canned set of protocols will not work for everyone. – This is where a configurable mobile telemedicine solution comes in. Whether it’s an intra-hospital, inter-hospital or EMS transfer, a good mobile telemedicine will give you the capabilities you need to ensure the patients best interests. Proper Documentation is a result of a proper MT app and can be used for audit purposes for workflow improvement and investigating the flaws in the patient transfer.

About GD (General Devices)
GD enables smarter patient care by empowering hospitals, EMS, community healthcare, and public safety with the most comprehensive, interactive, configurable, affordable, and integrated FDA listed medical communications and mobile telemedicine solution. The benefits of which are enhanced workflows, minimized risk, reduced costs and improved patient outcomes.

Approaches For Improving Your HCAHPS Score

Posted on June 27, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Improving your HCAHPS scores gets easier if you make smart use of your existing technology infrastructure. To make that work, however, you have to know which areas have the greatest impact on the score.

According to healthcare communications vendor Spok, hospitals can boost their scores by focusing on five particularly important areas which loom large in patient satisfaction. Of course, I’m sure these approaches solve problems addressed by Spok solutions, but I thought they were worth reviewing anyway. These five areas include:

  • Speed up response to the call button
    Relying on the call button itself doesn’t get the job done. If calls go to a central nursing station, it takes several steps to eventually get back to the patient, it’s possible to drop the ball. Instead, hospitals can send requests directly from the call button to the correct caregiver’s mobile device. This works whether providers use s a Wi-Fi phone, smartphone, pager, voice badge or tablet.
  • Lower the noise volume
    Hospitals are aware that noise is an issue, and try everything from taking the squeak out of meal cart wheels to posting signs reminding all to keep the conversations quiet. However, this will only go so far. Spok recommends hospitals take the additional step of integrating the monitoring of equipment alarms with staff assignments systems, and as above, routing nurse call notifications to the appropriate patient care providers mobile device. Fewer overhead notifications means less noise.
  • Address patient pain faster
    To help patients with the pain as quickly as possible, give staff access to your full directory, which allows nurses to quickly locate provider contact information and reach them with requests for pain medication orders. In addition, roll out a secure texting solution which allows nurses to share detailed patient health information safely.
  • Make information sharing simpler
    Look at gaps in getting information to patients and providers, and streamline your communications process. For example, Spok notes, if communication between team members is efficient, the time between a test order and the arrival of the phlebotomist can get shorter, or the time it takes the patient transport team to bring them to the imaging department for a scan can be reduced. One way to do this is to have your technology trigger automatic message to the appropriate party when an order is placed. Also, use the same to approach to automatically notify providers when test results are available.
  • Speed up discharge
    There are many understandable reasons why the patient discharge process can drag out, but patients don’t care what issues hospitals are addressing in the background. One way to speed things up is to set up your EMR to send a message the entire care team’s mobile devices. This makes it easier for providers to coordinate discharge approval and patient instructions. The faster the discharge process, the happier patients usually are.

Of course, addressing the patient care workflow goes well beyond the type of technology hospitals use for coordination and messaging. Getting this part of the process right is a good thing, though.

Yale New Haven Hospital Partners With Epic On Centralized Operations Center

Posted on February 5, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Info, info, all around, and not a place to manage it all. That’s the dilemma faced by most hospitals as they work to leverage the massive data stores they’re accumulating in their health IT systems.

Yale New Haven Hospital’s solution to the problem is to create a centralized operations center which connects the right people to real-time data analytics. Its Capacity Command Center (nifty alliteration, folks!) was created by YNHH, Epic and the YNHH Clinical Redesign Initiative.

The Command Center project comes five years into YNHH’s long-term High Reliability project, which is designed to prepare the institution for future challenges. These efforts are focused not only on care quality and patient safety but also managing what YNHH says are the highest patient volumes in Connecticut. Its statement also notes that with transfers from other hospitals increasing, the hospital is seeing a growth in patient acuity, which is obviously another challenge it must address.

The Capacity Command Center’s functions are fairly straightforward, though they have to have been a beast to develop.

On the one hand, the Center offers technology which sorts through the flood of operational data generated by and stored in its Epic system, generating dashboards which change in real time and drive process changes. These dashboards present real-time metrics such as bed capacity, delays for procedures and tests and ambulatory utilization, which are made available on Center screens as well as within Epic.

In addition, YNHH has brought representatives from all of the relevant operational areas into a single physical location, including bed management, the Emergency Department, nursing staffing, environmental services and patient transport. Not only is this a good approach overall, it’s particularly helpful when patient admissions levels climb precipitously, the hospital notes.

This model is already having a positive impact on the care process, according to YNHH’s statement. For example, it notes, infection prevention staffers can now identify all patients with Foley catheters and review their charts. With this knowledge in hand, these staffers can discuss whether the patient is ready to have the catheter removed and avoid related urinary tract infections associated with prolonged use.

I don’t know about you, but I was excited to read about this initiative. It sounds like YNHH is doing exactly what it should do to get more out of patient data. For example, I was glad to read that the dashboard offered real-time analytics options rather than one-off projections from old data. Bringing key operational players together in one place makes great sense as well.

Of course, not all hospitals will have the resources to pull something off something like this. YNHH is a 1,541-bed giant which had the cash to take on a command center project. Few community hospitals would have the staff or money to make such a thing happen. Still, it’s good to see somebody at the cutting edge.

Predictive Analytics Will Save Hospitals, Not IT Investment

Posted on October 27, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most hospitals run on very slim operating margins. In fact, not-for-profit hospitals’ mean operating margins fell from 3.4% in fiscal year 2015 to 2.7% in fiscal year 2016, according to Moody’s Investors Service.

To turn this around, many seem to be pinning their hopes on better technology, spending between 25% and 35% of their capital budget on IT infrastructure investment. But that strategy might backfire, suggests an article appearing in the Harvard Business Review.

Author Sanjeev Agrawal, who serves as president of healthcare and chief marketing officer at healthcare predictive analytics company LeanTaaS, argues that throwing more money at IT won’t help hospitals become more profitable. “Healthcare providers can’t keep spending their way out of trouble by investing in more and more infrastructure,” he writes. “Instead, they must optimize the use of the assets currently in place.”

Instead, he suggests, hospitals need to go the way of retail, transportation and airlines, industries which also manage complex operations and work on narrow margins. Those industries have improved their performance by improving their data science capabilities.

“[Hospitals] need to create an operational ‘air traffic control’ for their hospitals — a centralized command-and-control capability that is predictive, learns continually, and uses optimization algorithms and artificial intelligence to deliver prescriptive recommendations throughout the system,” Agrawal says.

Agrawal predicts that hospitals will use predictive analytics to refine their key care-delivery processes, including resource utilization, staff schedules, and patient admits and discharges. If they get it right, they’ll meet many of their goals, including better patient throughput, lower costs and more efficient asset utilization.

For example, he notes, hospitals can optimize OR utilization, which brings in 65% of revenue at most hospitals. Rather than relying on current block-scheduling techniques, which have been proven to be inefficient, hospitals can use predictive analytics and mobile apps to give surgeons more control of OR scheduling.

Another area ripe for process improvements is the emergency department. As Agrawal notes, hospitals can avoid bottlenecks by using analytics to define the most efficient order for ED activities. Not only can this improve hospital finances, it can improve patient satisfaction, he says.

Of course, Agrawal works for a predictive analytics vendor, which makes him more than a little bit biased. But on the other hand, I doubt any of us would disagree that adopting predictive analytics strategies is the next frontier for hospitals.

After all, having spent many billions collectively to implement EMRs, hospitals have created enormous data stores, and few would argue that it’s high time to leverage them. For example, if they want to adopt population health management – and it’s a question of when, not if — they’ve got to use these tools to reduce outcome variations and improve quality of cost across populations. Also, while the deep-pocketed hospitals are doing it first, it seems likely that over time, virtually every hospital will use EMR data to streamline operations as well.

The question is, will vendors like LeanTaaS take a leading role in this transition, or will hospital IT leaders know what they want to do?  At this stage, it’s anyone’s guess.

E-Patient Update: When EMRs Make A Bad Process Worse

Posted on August 14, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Last week, I wrote an item reflecting on a video interview John did with career CIO Drex DeFord. During the video, which focused on patient engagement and care coordination, DeFord argued that it’s best to make sure your processes are as efficient as they can get before you institutionalize them with big technology investments.

As I noted in the piece, it’d be nice if hospitals did the work of paring down processes to perfection before they embed those processes in their overall EMR workflow, but that as far as I know this seldom happens

Unfortunately, I’ve just gotten a taste of what can go wrong under these circumstances. During the rollout of its enterprise EMR, a health system with an otherwise impeccable reputation dropped the ball in a way which may have harmed my brother permanently.

An unusual day

My brother Joey, who’s in his late 40s, has Down’s Syndrome. He’s had a rocky health history, including heart problems that go with the condition and some others of his own. He lives with my parents in the suburbs of a large northeastern city about an hour by air from my home.

Not long ago, when I was staying with them, my brother had a very serious medical problem. One morning, I walked into the living room to find him wavering in and out of consciousness, and it became clear that he was in trouble. I woke my parents and called 911. As it turned out, his heart was starting and stopping which, unless perhaps you’re an emergency physician, was even scarier to watch than you might think.

Even for a sister who’d watched her younger brother go through countless health troubles, this is was a pretty scary day.  Sadly, the really upsetting stuff happened at the hospital.

Common sense notions

When we got Joey to the ED at this Fancy Northeastern Hospital, the staff couldn’t have been more helpful and considerate. (The nurses even took Joe’s outrageous flirting in stride.)  Within an hour or two, the clinical team had recommended implanting him with a pacemaker. But things went downhill from there.

Because he arrived on Friday afternoon, staff prepared for the implantation right away, as the procedure apparently wasn’t available Saturday and Sunday and he needed help immediately. (The lack of weekend coverage strikes me as ludicrous, but it’s a topic for another column.)

As part of the prep, staff let my mother know that the procedure was typically done without general anesthesia. At the time, my mother made clear that while Joey was calm now, he might very well get too anxious to proceed without being knocked out. She thought the hospital team understood and were planning accordingly.

Apparently, though, the common-sense notion that some people freak out and need to be medicated during this kind of procedure never entered their mind, didn’t fit with their processes or both. Even brother’s obvious impairment doesn’t seem to have raised any red flags.

“I don’t have his records!”

I wasn’t there for the rest of the story, but my mother filled me in later. When Joey arrived in the procedure room, staff had no idea that he might need special accommodations and canceled the implantation when he wouldn’t hold still. Mom tells me one doctor yelled: “But I don’t have his records!” Because the procedure didn’t go down that day, he didn’t get his implant until Monday.

This kind of fumbling isn’t appropriate under any circumstances, but it’s even worse when it’s predictable.  Apparently, my brother had the misfortune to show up on the first day of the hospital’s EMR go-live process, and clinicians were sweating it. Not only were they overtaxed, and rushing, they were struggling to keep up with the information flow.

Of course, I understand that going live on an EMR can be stressful and difficult. But in this case, and probably many others, things wouldn’t have fallen apart if their process worked in the first place prior to the implementation. Shouldn’t they have had protocols in place for road bumps like skittish patients or missing chart information even before the EMR was switched on?

Not the same

Within days of getting Joey back home, my mom saw that things were not the same with him. He no longer pulls his soda can from the fridge or dresses himself independently. He won’t even go to the bathroom on his own anymore. My mother tells me that there’s the old Joe (sweet and funny) and the new Joe (often combative and confused).  Within weeks of the pacemaker implantation, he had a seizure.

Neither my parents nor I know whether the delay in getting the pacemaker put in led to his loss of functioning. We’re aware that the episode he had at home prior to treatment could’ve led to injuries that affect his functioning today.  We also know that adults with Down’s Syndrome slip into dementia at a far younger age than is typical for people without the condition. But these new deficits only seemed to set in after he came home.

My mother still simmers over the weekend he spent without much-needed care, seemingly due to a procedural roadblock that just about anyone could’ve anticipated. She thinks about the time spent between Friday and Monday, during which she assumes his heart was struggling to work “His heart was starting and stopping, Anne,” she said. “Starting and stopping. All because they couldn’t get it right the first time.”

The Evolution of Forms in Healthcare – Working to Empower the Patient

Posted on July 31, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently had a chance to see a demo of the new FormFast Connect product which empowers the patient to complete all their healthcare forms at home or wherever they may be.  Talking with FormFast was really informative since they are the experts at healthcare forms with over 1100 customers using their technology to handle the sometimes messy job of healthcare forms management.

It’s worth taking a second to look at the evolution of forms in healthcare.  Everyone remembers the stack of pre-printed forms at registration and the nursing station.  Then, over time, FormFast and others started creating bar coded forms that could easily be scanned and integrated into your IT systems using document workflow management software.  Shortly after that we started to see forms generated on demand with patient information printed dynamically.  Then, we moved to electronic forms and eSignature capabilities which converted the analog paper form model into a digital one.  The natural next step in the evolution of forms is to push the forms out to the patient outside of the four walls of the hospital.  That’s what FormFast Connect does and is a great evolution of the FormFast product.

We all know that filling out forms in the doctor’s office or hospital registration area is suboptimal.  Many patients don’t have the information with them to fill the forms out completely and the waiting room or registration desk often create a rushed environment to complete the forms.  In fact, many organizations have resorted to making time consuming, expensive phone calls to patients in order to collect the pre-registration paper work they need from the patient.

This is why an online form solution, like FormFast Connect, that is completed by the patient before the visit is going to be an important tool for every hospital.  The reality is that patients are starting to expect the same kind of online conveniences they experience in their normal life in healthcare.  Filling out forms electronically before a patient visit is one area where healthcare can provide a much improved online experience that mirrors the conveniences provided by other industries.

The real question is why has it taken so long for healthcare to create and adopt these solutions?  Many EHR vendors offer some half baked form options in their patient portal, but that’s exactly the problem.  A half baked form option in your patient portal doesn’t really address the issue.  Forms management is a challenging problem and most EHR vendors have been too busy worrying about regulations and other requirements that they haven’t created a high quality forms management solution.

For example, we know that the majority of patients now have some sort of cell phone or mobile device that they would like to use when filling out pre-registration forms.  Any form solution that pushes to the patient outside of the hospital needs to provide a mobile optimized option for the patient or it will likely fail to engage the patient in completing the forms.  Most EHR vendor forms aren’t mobile optimized and thus fail to achieve the desired outcome.  Plus, it’s not enough for the form to be mobile optimized for the patient.  The form must also create an output that is legally structured for the provider and the legal medical record.  Sounds easy, but I assure you it is not and EHR vendors haven’t executed across all these areas in the forms they offer.

One exciting part of a mobile optimized form solution is it opens up a number of opportunities that were a challenge previously.  For example, mobile devices can easily snap a picture of the patient’s insurance card as part of the form completion process.  The same goes for an electronic signature which is easily captured on a mobile device thanks to all the great touch screen technology found in all our mobile devices these days.  I’m also interested to see how smart form technology continues to evolve and improve as data becomes more liquid in healthcare and certain portions of the form can auto complete for you.

It’s great that we’re finally pushing form completion out to the patient where they can do it in a convenient, comfortable environment.  This is valuable to the patient who enjoys a better experience and for the hospital who receives better quality information.  Plus, even if the patient elects not to fill out the forms before the visit, this is one more opportunity for the hospital to build a relationship with the patient outside of the hospital.  That relationship is going to be key in the new world of value based reimbursement.

FormFast is a proud sponsor of Healthcare Scene. 

With 25 years exclusively focused on healthcare needs and over 1100 hospital clients, FormFast is recognized as the industry leader in electronic forms and document workflow technology. FormFast’s enterprise software platform integrates with EHRs and other core systems to automate required documents, capturing data and accelerating workflows associated with them. By using FormFast, healthcare organizations achieve new levels of standardization and operational efficiency, allowing them to focus on their core mission – delivering quality care. Learn more about FormFast at formfast.com.

E-Patient Update: Before You Call Me A “Frequent Flier,” Check Your EMR

Posted on April 28, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While there’s some debate about what constitutes an emergency, there’s no doubt I’ve had a bunch of ambiguous, potentially symptoms lately that needed to be addressed promptly. Unfortunately, that’s exposed me to providers brainwashed to believe that anyone who comes to the emergency department regularly is a problem.

Not only is that irritating, and sometimes intimidating, it’s easy to fix. If medical providers were to just dig a bit further into my existing records – or ideally, do a sophisticated analysis of my health history – they’d understand my behavior, and perhaps even provide more effective care.

If they looked at the context their big ‘ol EMR could provide, they wouldn’t waste time wondering whether I’m overreacting or wasting their time.

As I see it, slapping the “frequent flier” label on patients is particularly inappropriate when they have enough data on hand to know better. (Actually, the American College of Emergency Physicians notes that a very small number of frequent ED visitors are actually homeless, drug seekers or mentally ill, all of which is in play when you show up a bit often. But that’s a topic for another time.)

Taking no chances

The truth is, I’ve only been hitting the ED of late because I’ve been responding to issues that are truly concerning, or doing what my primary doctor or HMO nurse line suggests.

For example, my primary care doctor routed me straight to the local emergency department for a Doppler when my calves swelled abruptly, as I had a DVT episode and subsequent pulmonary embolism just six months ago.

More recently, when I had a sudden right-sided facial droop, I wasn’t going to wait around and see if it was caused by a stroke. It turns out that I probably had an atypical onset of Bell’s Palsy, but there was no way I was going to try and sort that out on my own.

And given that I have a very strong history of family members dropping dead of MI, I wasn’t going to fool around when I felt breathless, my heart was racing and I my chest ached. Panic attack, you’re thinking? No, as it turned out that like my mother, I had aFib. Once again, I don’t have a lab or imaging equipment in my apartment – and my PCP doesn’t either – so I think I did the right thing.

The truth is, in each case I’d probably have been OK, but I erred on the side of caution. You know what? I don’t want to die needlessly or sustain major injuries to prove I’m no wimp.

The whole picture

Nonetheless, having been to the ED pretty regularly of late, I still encounter clinicians that wonder if I’m a malingerer, an attention seeker or a hypochondriac. I pick up just a hint of condescension, a sense of being delicately patronized from both clinicians and staffer who think I’m nuts. It’s subtle, but I know it’s there.

Now, if these folks kept up with their industry, they might have read the following, from Health Affairs. The article in question notes that “the overwhelming majority of frequent [ED} users have only episodic periods of high ED use, instead of consistent use over multiple years.” Yup, that’s me.

If they weren’t so prone to judging me and my choices – OK, not everyone but certainly some – it might occur to them to leverage my data. Hey, if I’m being screened but in no deep distress, why not ask what my wearable or health app data has told me of late? More importantly, why haven’t the IT folks at this otherwise excellent hospital equipped providers with even basic filters the ED treatment team can use to spot larger patterns? (Yeah, bringing big data analytics into today’s mix might be a stretch, but still, where are they?)

Don’t get me wrong. I understand that it’s hard to break long-established patterns, change attitudes and integrate any form of analytics into the extremely complex ED workflow. But as I see it, there’s no excuse to just ignore these problems. Soon, the day will come when on-the-spot analytics is the minimum professional requirement for treating ED patients, so confront the problem now.

Oh, and by the way, treat me with more respect, OK?

EMRs Can Improve Outcomes For Weekend Hospital Surgeries

Posted on April 7, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Unfortunately, it’s well documented that people often have worse outcomes when they’re treated in hospitals over the weekend. For example, one recent study from the Association of Academic Physiatrists found that older adults admitted with head trauma over the weekend have a 14 percent increased risk of dying versus those admitted on a weekday.

But if a hospital makes good use of its EMR, these grim stats can be improved, according to a new study published in JAMA Surgery. In the study, researchers found that use of EMRs can significantly improve outcomes for hospital patients who have surgeries over the weekend.

To conduct the study, which was done by Loyola Medicine, a group of researchers identified some EMR characteristics which they felt could overcome the “weekend effect.” The factors they chose included using electronic systems designed to schedule surgeries seamlessly as well as move patients in and out of hospital rooms efficiently.

Their theories were based on existing research suggesting that patients at hospitals with electronic operating room scheduling were 33 percent less likely to experience a weekend effect than hospitals using paper-based scheduling. In addition, studies concluded patients at hospitals with electronic bed-management systems were 35 percent less likely to experience the weekend effect.

To learn more about the weekend effect, researchers analyzed the records provided by the AHRQ’s Healthcare Cost and Utilization Project State Inpatient Database.  Researchers looked at treatment and outcomes for 2,979 patients admitted to Florida hospitals for appendectomies, acute hernia repairs and gallbladder removals.

The research team found that 32 percent (946) of patients experienced the weekend effect, which they defined as having longer hospital stays than expected. Meanwhile, it concluded that patients at hospitals with high-speed EMR connectivity, EMR in the operating room, electronic operating room scheduling, CPOE systems and electronic bed management did better. (The analysis was conducted with the help of Loyola’s predictive analytics program.)

Their research follows on a 2015 Loyola study, published in Annals of Surgery, which named five factors that reduced the impact of the weekend effect. These included full adoption of electronic medical records, home health programs, pain management programs, increased registered nurse-to-bed ratios and inpatient physical rehabilitation.

Generally speaking, the study results offer good news, as they fulfill some the key hopes hospitals had when installing their EMR in the first place. But I was left wondering whether the study conflated cause and effect. Specifically, I found myself wondering whether hospitals with these various systems boosted their outcomes with technology, or whether hospitals that invested in these technologies could afford to provide better overall care.

It’s also worth noting that several of the improvement factors cited in the 2015 study did not involve technology at all. Even if a hospital has excellent IT systems in place, putting home health, pain management and physical rehabilitation in place – not to mention higher nurse-to-patient ratios – calls for different thinking and a different source of funding.

Still, it’s always good to know that health IT can generate beneficial results, especially high-ticket items like EMRs. Even incremental progress is still progress.

Emergency Department Information Systems Market Fueled By Growing Patient Flow

Posted on March 20, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new research report has concluded that the size of the emergency department information systems market is expanding, driven by increasing patient flows. This dovetails with a report focused on 2016 data which also sees EDIS upgrades underway, though it points out that some hospital buyers don’t have the management support or a large enough budget to support the upgrade.

The more recent report, by Transparency Market Research, notes that ED traffic is being boosted by increases in the geriatric population, an increasing rate of accidents and overall population growth. In part to cope with this increase in patient flow, emergency departments are beginning to choose specialized, best-of-breed EDISs rather than less-differentiated electronic medical records systems, Transparency concludes.

Its analysis is supported by Black Book Research, whose 2016 report found that 69% of hospitals upgrading their existing EDIS are moving from enterprise EMR emergency models to freestanding platforms. Meanwhile, growing spending on healthcare and healthcare infrastructure is making the funds available to purchase EDIS platforms.

These factors are helping to fuel the emergence of robust EDIS market growth, according to Black Book. Its 2016 research, predicted that 35% of hospitals over 150 beds would replace their EDIS that year. Spurred by this spending, the US EDIS market should hit $420M, Black Book projects.

The most-popular EDIS features identified by Black Book include ease of use, reporting improvements, interoperability, physician productivity improvements, diagnosis enhancements and patient satisfaction, its research concluded.

All that being said, not all hospital leaders are well-informed about EDIS implementation and usability, which is holding growth back in some sectors. Also, high costs pose a barrier to adoption of these systems, according to Transparency.

Not only that, some hospital leaders don’t feel that it’s necessary to invest in an EDIS in addition to their enterprise EMR,. Black Book found. Thirty-nine percent of respondents to the 2016 study said that they were moderately or highly dissatisfied with their current EDIS, but 90% of the dissatisfied said they were being forced to rely on generic hospital-wide EMRs.

While all of this is interesting, it’s worth noting that EDIS investment is far from the biggest concern for hospital IT departments. According to a HIMSS survey on 2017 hospitals’ IT plans, top investment priorities include pharmacy technologies and EMR components.

Still, it appears that considering EDIS enhancements may be worth the trouble. For example, seventy-six percent of Black Book respondents implementing a replacement EDIS in Q2 2014 to Q1 2015 saw improved customer service outcomes attributed to the platform.

Also, 44% of hospitals over 200 beds implementing a replacement EDIS over the same period said that it reduced visit costs between 4% and 12%, the research firm found.