Trend Report 5
This Trend Report is part of a series that analyzes the results of the 3rd bi-annual Health IT Survey sponsored by several leading health care organizations.
A key challenge in care management is to fully engage patients (and sometimes their primary care physicians) with a care treatment plan that addresses all of a patient’s co-morbidities. Involving patients throughout the care continuum will strengthen efforts to lower the incidence of chronic, and often preventable, diseases as well as improve general health and wellbeing for all Americans.
Care managers are an integral part of managing a patient’s health, ensuring patients adhere to their care plans, providing advice and information when patients have questions, and helping patients become and remain healthy. However, the positive outcomes associated with proper care management can only be achieved with patients who are committed to the process, which means patient engagement is vital.
Engagement integrates health care information and professional advice with a patient’s personal needs, skills, motivation, preferences and abilities. It focuses on the behaviors of an individual that are critical to health outcomes, rather than the actions of professionals, technology or institutional policies. Knowing what types of technology patients currently use, as well as where IT trends are headed, can help care managers and other health care professionals target their outreach strategies to keep patients engaged.
In a society and culture where Internet and cellphone use are becoming ubiquitous, care managers will benefit significantly by learning how to use these and other emerging technologies to better connect with their patients and engage them in their care plans.
The 2012 Health IT (HIT) Survey, conducted by Schooner Healthcare Services for study sponsors TCS Healthcare Technologies (TCS), the Case Management Society of America (CMSA), and the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP), is the third bi-annual study conducted since 2008. Schooner Healthcare Services and Trajectory Healthcare, LLC assisted in the 2012 analysis, and an advisory panel of volunteers also supervised the administration, analysis and reporting of the survey.
The following analysis compares results of the 2012 survey with the prior two surveys (2008 and 2010) and focuses on which communication methods and sources of health information are most commonly used by patients, and what technology-aided methods are being implemented for patient monitoring.
As indicated in Trend Report #1, responders to the three HIT surveys over the past five years were similar in type of business, size of business, and provider type. The absolute difference in responder characteristics was never more than 10 percentage points.
For the first time since the survey series was launched in 2008, respondents were asked to list the HIT systems they use to make transitions of care easier, describe how technology-enabled processes and tools are improving transitions of care, and specify the aspects of the software systems that support their readmission prevention goals.
The 2012 online survey posed dozens of detailed questions to not only determine how care managers communicate with patients, but also identify HIT trends that can boost patient engagement and positive outcomes. The analysis is broken down into three subcategories – patient communications, medical advice and information, and technology-aided monitoring.
Like past surveys, the 2012 study asked respondents to select the types of patient engagement and communication methods they currently use, as well as predict future use of each type of communication “two years from now.” The survey also collected information regarding patient access to certain types of technology and sources of medical advice and health information. For the first time in the HIT series, the 2012 survey asked about patient monitoring through technology.
This analysis is supported by several figures and tables (see Appendix of this Trend Report):
- Figure 1 displays current patient communication options for the entire respondent pool
- Figure 2 reports on current patient communication options for the care management respondent sub-pools
- Table 5A summarizes patient access to various forms of technology for 2010 and 2012
- Table 5B/Figure 3 compiles patients’ sources of medical advice both in 2010 and 2012
- Table 5C/Figure 4 highlights responses to a new 2012 question regarding the current use of technology for patient monitoring
- Table 5D further breaks down patient monitoring through technology by type of care management program sub-pools
Having a clear understanding of how the use of technology impacts patients is critical for care managers and other providers if they want to effectively engage their patients and improve clinical outcomes. By utilizing technology that patients are already familiar and comfortable with, providers can eliminate potential barriers associated with the use of novel technology, and focus their efforts directly on patient care.
As detailed in Trend Report #2, case managers and providers use a variety of communication platforms and techniques. As shown in Figure 1, traditional communication methods such as telephone (91%), letters (74%), and face-to-face conversations (71%) are still heavily favored as a means of communicating with patients. Among the care manager sub-pool specifically, the most commonly used tools are telephone (96%), letters (87%), email (68%) and face-to-face conversations (67%) (Figure 2).
However, when compared to the 2010 survey results, shifting trends can be seen in the increased use of newer patient communication methods such as text messaging (6%), social networking sites (5%), member/patient portals (3%), wireless monitoring solutions (3%), email (2%) and smartphone applications (2%). In a similar vein, some traditional patient communication methods are decreasing such as facsimiles (-10%), telephone (-2%), and letters (-2%).
While the current percentage of care managers and patients using newer technologies might be smaller than the use of more traditional methods, it is important to note the rapidly increasing trends found in their adoption as such technologies become more common. For example, as predicted in the 2010 survey, social networking site usage such as Facebook and micro-blogging (e.g., Twitter), doubled by 2012, and nearly a two-fold increase also occurred in the use of text messaging. Use of smartphone applications, wireless remote monitoring, online personal health records (PHRs), member/patient portals, and remote monitoring devices also increased, though at a smaller pace.
As in past years, the 2012 HIT Survey also examined patient access to various technologies to access information. In both 2010 and 2012, respondents estimated that more than eight out of 10 patients have access to a mobile phone (see Table 5A). However, a 4% decrease was observed between the two surveys (i.e., 86% in 2010 and 82% in 2012). Similarly, there was a slight decrease in access to a personal health record (-6%) and use of a computer at home (-2%).
Though these results may appear counterintuitive, the downward trends may be explained in a couple of different ways. For instance, the reduction in cell phone use could be the result of expanded use of mobile “smart” devices including iPhones and Android-based phones. According to a June 2013 Nielsen survey, three out of five mobile subscribers in the U.S. have owned a smartphone within the past three months (March-May 2013).
The reduction of desktops and personal health records could be due to the increased use of mobile devices such as tablets, smart phones and other applications that run off newer technology. In fact, technology experts now predict that half of all Internet traffic is coming through mobile devices. Therefore, the slight trend differences might be based on some question bias (due to the rapidly changing IT field) and/or just random variation in the two survey populations.
Nonetheless, the majority of patients appear to have access to a mobile phone, which seems to be one of the best methods for care managers to communicate with their patients.
Medical Advice and Information
In addition to understanding the most commonly used communication methods, care managers and other medical professionals need to be cognizant of where patients usually turn for medical advice.
In both 2010 and 2012, the five most popular survey responses to “What sources of health information do most of your clients/patients typically rely on?” remained consistent (see Table 5B and Figure 3). Advice from primary care physician (86%) was the most common source of health information in 2012, up another 7% from 2010. In both years, advice from a specialist physician (70%) and advice from a care manager (69%) ranked second and third, with both categories increasing 5% since 2010. Advice from family or friends was the fourth most common response, with nearly 60% of respondents selecting this option in 2012.
Perhaps the accelerated information exchange among providers, friends and family has been spurred by the increasing number of communication options – from traditional phone conversations to emails, texting, blogging and tweeting. Regarding the social media platforms, many providers have been more open to communicating protected health information (PHI) if the patient gives permission to disclose such PHI through unsecure channels.
Interestingly, the use of health websites (still the fifth most used resource) such as WebMD dropped from 45% in 2010 to 39% in 2012. This may suggest that patients are now more likely to consult resources from a health care “smart” application versus a traditional online portal.
As may be expected from a society that is becoming increasingly digitized, the use of print media as a source of medical advice dropped dramatically from 40% in 2010 to only 25% in 2012. To ensure public health information has the greatest impact on its intended audience, care managers and other health care professionals may want to consider publishing medical advice articles online rather than in a printed format. Also, the importance of direct advice from trusted health care professionals such as primary care physicians, specialist physicians and care managers should not be underestimated. As the survey indicates, this type of advice is still the most popular source of information.
For the first time in the HIT survey series, respondents were asked about the use of new technology to aid with patient monitoring, including patient medication and treatment adherence. An overwhelming majority of respondents (64%) reported using phone calls for patient monitoring, as shown in Table 5C.
It appears other patient monitoring technologies are not used as frequently. For example, the second most used patient monitoring technology is health stats monitoring through devices such as heart rate/blood pressure monitoring devices (28%), followed by lifestyle monitoring devices such as pedometers or meal trackers (19%), and medication reminder IT solution (19%).
Although recent research shows consumers are using smart phone applications regularly in the marketplace, most case managers and responders are not taking advantage of smart phone applications with their patients – only 6% utilize this type of remote monitoring IT solution. Similarly, only 8% of the respondents use text messaging and 3% video conferencing.
Across the care management sub-pools, the use of telephones to aid with patient medication and treatment adherence significantly outweighs all of the other patient monitoring options (Table 5F). The case management and disease management sub-pool groups note utilization rates higher than the large pool group for all technologies except health stats monitoring. Utilization percentages are much higher (e.g., in between 30-40%) for health stats monitoring, lifestyle monitoring and medication reminder technology for the Nurse Triage, IRO, PBM and behavioral health sub-pools, suggesting these groups may be at the forefront of incorporating these emerging technologies into their line of work.
Another notable statistic relates to use of text messaging to monitor patients – only 8% of the large pool report using text messaging while 21% of IRO respondents report using this application. Across the board, the sub-pool groups are using video conferencing the least to assist with patient medication and treatment adherence.
Knowing the types of technology patients currently use, as well as where IT trends are headed, can help providers, care managers and other health care professionals target their outreach strategies to get and keep patients engaged.
While traditional communication methods such as phone and face-to-face advice from physicians and care managers still dominate the field, the use of new HIT applications and solutions, including smartphones, social networking and text messaging, is quickly increasing. The widespread acceptance of email communication is a perfect example of how care managers can adopt new technologies that patients are comfortable with, thereby avoiding potential barriers associated with new technology, and focus their efforts directly on patient guidance and engagement.
The use of print media seems to be decreasing rapidly, so care managers and other health care professionals may want to consider shifting to online and mobile technology resources in order to communicate with their patients most effectively. In the field of technology-aided monitoring, phone calls remain the dominant method of patient engagement. However, it will be interesting to watch and see if other methods such as health stats monitoring, lifestyle monitoring, medication reminder technology and smartphone applications gain more acceptance in coming years.
In an increasingly mobile and technology-driven society, providers and their patients now have the ability to utilize tools that were previously unavailable or underutilized in order to open a two-way line of communication with their patients, thereby creating a deeper level of engagement that allows patients to become more meaningfully involved in their own care.
The 2012 Health IT Survey was conducted by TCS Healthcare Technologies (TCS), the Case Management Society of America (CMSA), the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) and Trajectory Healthcare LLC. These organizations teamed together for the third time to sponsor the survey, which examines how various health IT applications are changing the care management field. Schooner Healthcare Services and Trajectory Healthcare, LLC also assisted in the 2012 analysis. An advisory panel of volunteers supervised the administration, analysis and reporting of the survey. In addition to the peer review committee that is highlighted in Trend Report #1, we want to extend special thanks to the following individuals who provided substantive edits to this Trend Report, including: Joel Brill, MD, Garry Carneal, JD, MA, Rob Pock, Pat Stricker, RN, Med, and Teresa M. Treiger, RN-BC, MA, CHCQM-CM/TOC, CCM.
TABLE 5A: PATIENT TECHNOLOGY ACCESS - OVERVIEW
Do most of your patients have access to or use the following items?
(Respondents could select more than one option) 20102012ChangeUse a computer at home?58%56%-2Have an email account?47%49%+2Have access to a personal health record?29%23%-6Own a cell phone?86%82%-4Own a smart phone/tablet with Internet access?NA14%NAHave a home phone or landline?NA72%NANote: This table also is listed in Table 2X
TABLE 5B: SOURCES OF MEDICAL ADVICE
What sources of health information do most of your clients/patients typically rely on?
(Respondents could select more than one option) 20102012Absolute ChangeAdvice from primary care physician79%86%+7Advice from specialist physician65%70%+5Advice from case manager64%69%+5Advice from family or friends56%59%+3Health websites (e.g., WebMD)45%39%-6Advice from other caregiverNA36%NAElectronic media (e.g., television, radio)35%34%-1Advice from health planNA28%NAPrint media (e.g., magazines, books)40%25%-15Social networking (e.g., Facebook)NA10%NAAdvice from professional organization
(e.g. American Academy of Family Practice)NA7%NAOnline video (e.g., YouTube)6%6%0Not applicable/Not sure12%6%-6Other, please specify3%6%+3
TABLE 5C: PATIENT MONITORING THROUGH TECHNOLOGY
Please select all technologies your company uses to aid with patient
medication and treatment adherence. Answer Options2012Health Stats Monitoring (e.g., Heart rate/blood pressure monitoring devices)28%Lifestyle monitoring (e.g., Pedometers, meal trackers, etc.)19%Medication reminder technology /solution19%Phone calls64%Smartphone applications6%Text messaging8%Video conferencing3%None at this time13%Not applicable/Not sure17%Other, please specify7%
TABLE 5D: PATIENT MONITORING THROUGH TECHNOLOGY (SUB-POOLS)
Please select all technologies your company uses to aid with patient
medication and treatment adherence. 2012 Large PoolCMDMUMNurse TriageIROPBMBehavioralHealth Stats Monitoring
(e.g., Heart rate/blood pressure monitoring devices)28%25%29%26%40%39%40%36%Lifestyle monitoring (e.g., Pedometers, meal trackers, etc.)19%22%30%28%38%36%43%36%Medication reminder
technology /solution19%21%25%28%30%36%43%32%Phone calls64%74%83%74%83%79%87%79%Smartphone applications6%8%8%8%5%14%10%13%Text messaging8%12%12%12%18%21%17%14%Video conferencing3%5%4%5%8%7%7%2%None at this time13%8%10%10%5%4%-9%Not applicable/Not sure17%13%6%10%8%14%7%11%Other, please specify7%9%10%10%18%4%13%11%
©2013 All rights reserved by TCS Healthcare Technologies (TCS), the Case Management Society of America (CMSA),
the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP),
Trajectory Healthcare, LLC (Trajectory) and Schooner Healthcare Services, LLC (Schooner).