3 Ways to Improve Post-Treatment Compliance

text post treatment compliance

According to a study published in the Journal of the Royal Society of Medicine, patients tend to immediately forget 40-80% of information their care providers present to them – or, worse, remember incorrect information about care plans or follow-up care.1  In the era of value-based care, it’s important to find a way to ensure patient compliance with treatments to improve patient outcomes and avoid costly readmissions.

Engaging patients with messages and reminders sent as text messages offers healthcare professionals an opportunity to improve patient treatment compliance when, where, and how it would be most effective.

Treatment Plan Communication

Traditional approaches to care plan compliance include verbal discharge instructions and sending patients home with discharge documents and information. Digital interventions can improve compliance with care plans, including:

  • Providing a digital format of care plan information that can be referred to anytime, anywhere
  • Clear, action-oriented reminders of care plan instructions when and where they are needed during the recovery process. For example, if a patient is to begin an exercise regime on day 3, a reminder can be sent that morning with a link to specific instructions or videos walking patients through the exercise program.
  • Provide timely guidance, tips, or exercise recommendations to support patient self-care

Handling some of this important patient information via text message can support the care plan at precisely the right time while also keeping the lines of communication open so that patients can text back or call in if they have any questions or need further information.

Automated Medication Adherence Reminders

Medication adherence requires that patients fill their prescriptions, understand directions, and take medication on time. Adherence rates for chronic conditions is about 50%, accounting for up to half of treatment failures and 25% of hospitalizations each year.2 Adherence interventions strategies for medication includes directly faxing prescriptions to pharmacies and leveraging reminders and single-response survey questions (“Have you picked up your prescription from the pharmacy?”).

Text messaging doubled the odds of medication and improved overall adherence rates by 17.8%3

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Although there are many digital adherence technologies (DATs) that can automate reminders for medication, it’s important to support ongoing two-way engagement with patients, who may have questions or concerns about side effects, and to have a way to send survey questions to confirm compliance.

Surveys to Improve Compliance and Reduce Readmissions

In a recent survey, Dr. Ethan Basch, M.D., M.Sc., found that nearly half the physical and psychological symptoms of his patients went unreported.4 Improving patient outcomes requires capturing more patient-reported outcomes (PROs) in real-time to provide timely interventions.

After discharge and periodically through recovery, you can leverage automatic procedure-specific diagnostic surveys to assess progress and ensure understanding of the treatment plan. Patient-reported outcomes can be tailored to the condition or procedure in question, assessing general health as well as data specific to symptoms, side effects, or pain levels. For the management of chronic diseases such as diabetes, our own data suggests that securely surveying key health indicators can help improve a1c rates by 0.5 points or more.

Based upon patient responses and your defined rules, PerfectServe’s patient engagement platform will alert care team members if a patient requires follow-up. Based upon the familiarity and simplicity of text messages, the solution has the proven capability to reduce readmissions by as much as 30%.

“We have such a hard time getting some patients to answer a phone call, yet they will respond to assessments delivered by text. PerfectServe saves valuable time for our nurses every day and helps us reach those in need more quickly.” — Karen Loscheider, Manager, Triage Nurse, Park Nicollet Health Services

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In addition to encouraging patient reported outcomes, patient satisfaction insight surveys also help you gather and act upon feedback in time to make a difference on a patient’s overall satisfaction, which can help reduce the risk of patient leakage and improve HCAHPS scores.

PerfectServe’s Patient & Family Communication solution can help you deliver a thoughtful, targeted set of prompts to support post-treatment care to reduce readmissions and improve outcomes. Our solution is proven and is live in more than 10,000 care locations, facilitating more than 42,000 patient interactions every day.

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1 Roy P C Kessels, PhD. “Patients’ memory for medical information,” Journal of the Royal Society of Medicine. 2003.

2 Jennifer Kim, PharmD, BCPS, BCACP, CPP et al, “Medication Adherence: The Elephant in the Room,” US Pharmacist, 2018.

3 Thakkar J, Kurup R, Laba TL, et al. “Mobile telephone text messaging for medication adherence in chronic disease: a meta-analysis.” JAMA Intern Med. 2016

4 Ethan Basch, Md, MSc, et al. “Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment,” JAMA, 2017

The role of secure communications in your clinical integration strategy

If you could take one solution with you on your journey to clinical integration, what would it be?

Clinical integration is the unification of healthcare data, services and coordination across acute, outpatient and post-acute care. It portrays an environment where waste and inefficiency are all but eliminated from healthcare communications, costs decrease and care improves. It’s the future of medicine.

You wouldn’t be far off course if your first thought was to rely heavily on the EHR to support your clinical integration strategy. While the EHR is a valuable tool for sharing patient information within hospital systems and broader care networks, it lacks a fundamental quality that bridges the gaps between Meaningful Use and true clinical integration.

Fully realized clinical integration can only occur when the barriers of communication have been broken down, and interdisciplinary clinicians can accurately and reliably coordinate care in real time across organizational and geographical boundaries. As with most things related to healthcare communication and the sharing of information across disparate networks, securing those communications has been and will continue to be a primary focus for healthcare IT leaders. In an environment where healthcare organizations are driving toward an end-goal of clinical integration, enabling secure communications alone just isn’t enough.

To achieve clinical integration, clinicians need a solution that enables immediate, accurate, reliable and secure communications.

Immediacy in healthcare communication

Real-time communication is a crucial element of delivering high-value care. In the most critical emergencies, every second counts. The time that clinicians waste identifying the right on-call care team member to contact, and then trying to reach that person, can quite literally be the difference between life and death. Even in non-emergent situations, early detection and treatment are well-known effective preventers of worsening conditions.

Yet it’s all too common for inefficient and broken communication workflows to create time-consuming hurdles for clinicians to clear—sometimes even to just begin the conversation.

Clinically integrated settings approach clinician-to-clinician communication with a sense of real-time urgency. That’s not to say that every message should be sent with an emergency status, just that the process of identifying the provider you need to connect to and the delivery of that message should be seamless and immediate.

Reaching the right care team member on the first attempt should be an important metric for all hospital systems. To keep performance numbers high in this area, you must ensure clinicians always know exactly whom to contact for any given medical issue.

However, most clinicians today initiate time-sensitive contact to the broader care team by thumbing through a lengthy paper-based on-call schedule, making a call, and then waiting to receive a response.

Real-time clinical communication and collaboration tools immediately deliver secure communications, and even allow the clinician initiating the communication to see in real time when messages are delivered and read.

Contact accuracy

Reaching providers on the first attempt is important, but it’s just as important to reach the right provider—the one who can act on the medical issue at that moment—via his or her preferred method of contact.

It’s not uncommon for providers to have a different preferred contact medium for every variance of their schedule. And it’s not uncommon for those schedules to change at a moment’s notice. Yet many hospitals, in both small and large systems, only print the schedule and patient assignment lists once per day.

Clinicians in this setting have no way of knowing if they are accurately reaching out to the right providers via the right contact method. Manually producing a list of whom to contact and how is a process riddled with opportunity for inefficiency and inaccuracy.

Dynamic Intelligent Routing™ eliminates those opportunities for communication breakdown. A distinct capability of PerfectServe, Dynamic Intelligent Routing analyzes workflows, call schedules and contact preferences, enabling clinicians to reach the right person at the right time with just the tap of a button.

Reliable communication workflows

If your clinicians depend on inaccurate call schedules or outdated, cumbersome processes to drive clinical communications, your communication workflow isn’t reliable.

When clinicians can immediately contact the care team member they need via that provider’s preferred contact method, communication workflows become reliable and trustworthy, which leads to high adoption and improved patient care, no matter the care setting.

From improved care coordination to reduced costs

Inefficient communication workflows not only interfere with the realization of clinical integration, but also they inflate healthcare costs. For example, if a radiologist identifies a critical result in an outpatient test, the radiologist needs to contact the patient’s PCP so action can be taken right away. If the communication is not immediate, accurate or reliable, the process breaks down and the delay could result in medical complications for the patient that end up costing more to treat.

Moving a patient safely through the admissions, treatment, discharge and post-acute care processes requires a tremendous amount of coordination, good communication and a sound clinical integration strategy. The tools you use to support that communication and collaboration will play an important role in your success.

Safeguarding security: 4 tactics for secure clinical communication and collaboration

I had the honor of speaking at the 2016 Becker’s Hospital Review Annual CIO/HIT + Revenue Cycle Summit, discussing the elements needed to truly secure clinical communications with some of the best minds in the healthcare world. With a number of recent high profile news stories announcing ransomware attacks in hospitals and health systems, security and the ability to secure clinical information is top of mind for many.

Those who oversee organizational data and IT systems recognize the importance of securing communication channels containing ePHI as they build a unified communications strategy. While security and regulatory mandates are essential elements of a clinical communication strategy, to create a truly successful strategy, the needs of those who provide care: physicians, nurses, therapists and others on the care team – in any setting – at any time – must be addressed flawlessly and securely.

To do so, there a few tactics to keep in mind:

Understand what the HIPAA Security Rule actually states

There’s been a lot of confusion in the industry when it comes to HIPAA compliance and communication. I often notice that many organizations think this is all about secure text messaging, which is incomplete. The Security Rule never speaks to a particular technology or communications modality, application or device. It is technology neutral.

HIPAA compliance is about the system of physical, administrative and technical safeguards that your organization puts in place to to ensure the confidentiality, integrity and availability of all ePHI it creates, receives, maintains or transmits. Because of this, there is no such thing as a HIPAA-compliant app.

Understand care team dynamics 

Care team members are mobile and they employ workflows to receive communication based upon situational variables such as origin, purpose, urgency, day, time, call schedules, patient and more. The variables determine who should be contacted and how to do so for every communications event.

For this reason, third parties (hospital switchboards and answering services) and disparate technologies are used in organizations’ clinical communication processes. Understanding this variety of technologies and actors is key to accurately assessing your organization’s compliance risk. And, coming up with strategies to effectively address that risk is key.

Secure text messaging is essential, but it’s not sufficient

While secure messaging is an essential component of your overall strategy, it’s not sufficient because:

  1. it requires the sender to always know who it is they need to reach—by name.
  2. it requires the recipient to always be available to other care team members 24/7.

These requirements are inconsistent with the complexity inherent in communication workflows that enable time-sensitive care delivery processes, because they don’t address the situational variables I described above.

Secure messaging is only one piece of what should be a much larger communications strategy—one that should address clinician workflows and multi-modal communications channels for all care team members.

Your goal should be to enable more effective care team collaboration 

Organizations often focus on achieving HIPAA-compliance. This is a flawed objective. The focus should be on achieving more effective care team collaboration. If this is done effectively, achieving HIPAA-compliance will come along for the ride.

Six essential capabilities 

An effective secure clinical communications and collaboration strategy will include the following six elements.

  1. It will facilitate communication-driven workflows that enable time-sensitive care delivery processes. An example of a communications-driven workflow is stroke diagnosis and treatment. When a patient with stroke symptoms presents in the ED, one of the first things the ED physician does is initiate a communications workflow to contact the neurologist covering that ED at that moment in time, while simultaneously notifying and mobilizing a stroke team to complete a CT scan to determine if it is safe to administer tPA, the drug that arrests the stroke. Time is critical. Healthcare is chock full of these kinds of workflows, executed every day in every hospital by the hundreds and thousands.
  1. It will provide technology that automatically identifies and provides an immediate connection to the right care team member for any given clinical situation—this is nursing’s greatest need! Your strategy should be to bypass third parties and eliminate all the manual tools and processes used to figure out who’s in what role right now given the situation at hand. Ignoring this need means you won’t achieve adoption, which means your organization will still be at risk.
  1. It should extend beyond any department and the four walls of the hospital. It should enable cross-organizational communication workflows. This is increasingly important under value-based care where care team members must collaborate across interdependent organizations to deliver better care.
  1. It should secure the creation, transmission and access of ePHI across all communication modalities—not just text messaging. Enough said!
  1. It should integrate with your other clinical systems to leverage the data within those systems to facilitate new communication workflows. This is key to enabling “real-time healthcare.”
  1. It should provide analytics to monitor your communication processes and continuously improve those processes over time.

With these capabilities in place, secure clinical communication simply becomes another positive result of implementing a broader care team collaboration strategy, designed to address clinical efficiency and improve patient care delivery.

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