In partnership with Allscripts, our Chief Medical Officer, Dr. Tashfeen Ekram, MD, shared some thoughts on the future of patient engagement–how we can modernize the approach to patient communication in order to fill the gaps and get people in front of the care that they need.
Allscripts has recently integrated Luma into its developer program, allowing its practice management users to take advantage of Luma’s mobile engagement solution. In partnership with Allscripts, our Chief Medical Officer, Dr. Tashfeen Ekram, MD, shared some thoughts on the future of patient engagement–how we can modernize the approach to patient communication in order to fill the gaps and get people in front of the care that they need.
Speaker: Dr. Tashfeen Ekram, MD, Chief Medical Officer of Luma Health
Good afternoon everyone, thank you for joining us on this webinar. Let me give a few minutes until the few last people join in, and then we’ll get started.
Alright, I think we can get started. Thank you again for joining us and I’d like to start off by giving thanks to our supporters, Allscripts. They’ve been great in helping us facilitate this, and their platform has really been great for us, them being champions in the world of interoperability, so I give my thanks to them. Today on the webinar, we’re going to be covering the next generation of patient engagement, and filling the gaps in patient communication.
Just starting off with some brief introductions. My name is Tashfeen Ekram. I’m the Chief Medical Officer at Luma Health. By training, I’m a physician and a radiologist, and I split my time between that and, I guess what the term is here is, a healthcare innovator, working with Luma Health. And some of the impetus of me trying to take some time off from practicing medicine, which I’ll kind of discuss as we get through this presentation. With me here is John Ellis, who is our Director of Sales. He’s been working in the field of sales for about 15 years in helping healthcare systems drive patient engagement and patient outcomes. So he’s going to be helping me with the webinar and kind of fielding some of the questions.
So the agenda today will be talking about navigating the patient journey. And in that, we’re going to follow that by driving patient experience and engaging your patients, and those are kind of three problems that I saw in my personal practice. And I’ll be kind of talking about them in a kind of global view, trying to help frame the problem that we’re going to be talking about. And then after that, we’ll briefly talk about what we’re doing at Luma Health. And then hopefully at the end of that, we’ll have 15 minutes or so for questions and answers. Please feel free to send any of your questions; you can use the send privately button to us, so that we can kind of log the questions, and then I’ll try to address as many of them as we can at the end.
So let’s dive in. The first problem when I started practicing medicine that was really bugging me was that I found that our way of communicating with patients was quite outdated. Most of our clients, before they get on-boarded to our platform, use, more or less, two types of communication. They’re either using a manual process by picking up the phone everyday and communicating with the patient, or they’re using a third party service that automates the phone call and uses kind of a robotic voice. And interestingly enough, if you look at the ways in which patients are being communicated with today, it’s almost identical to the way it was done almost 20-30 years ago. And looking at other industries, things have moved a lot in the last 20 or 30 years. So it’s kind of a little bit disappointing to see that we’re still kind of doing a lot of things that we were doing 20, 30 years ago.
Just to put some stats around what happens when you use phone calls; the average American, on any given year, ignores approximately 337 phone calls per year and 67% of Americans admit to avoiding phone calls. So obviously, it’s not the best way to engage patients or try to interact with them. And also, it’s not only frustrating for practices trying to reach out to patients who aren’t picking up their phone, but it’s actually also frustrating for patients when they’re trying to call in. In a paper where they were looking at industry standards between healthcare and other industries, they found that the average patient spends 8.1 minutes per phone call. And comparing it to, for example, the industry standard in the telecom industry or even in the banking industry, it’s an average of three minutes. And what’s even more frustrating about that 8 minutes that the patients are spending per phone call, is that 30% of that is spent just waiting, listening to elevator music. So obviously the patient is having a tough time getting in touch with the clinic, and it’s not an overall optimal experience on both ends.
And just to kind of put it in perspective, what are patients accustomed to communicating? And not only on a personal, social level, but also with businesses that, to put some stats on it, on a daily basis, just in the United States, 20 billion SMS messages are sent. 60 billion messages are sent on WhatsApp and Facebook. So obviously patients obviously still use phones and will communicate using voice, but they’re starting to get accustomed to other ways of communicating.
I think we’ve got to start looking at this to say, how can we modernize what we’re doing. Some opportunities and what we can do about it. I think the lowest hanging fruit is enabling our practices to be able to send text messages; our patients live on their phones, they’re spending their days and nights texting each other. So the least we can do is help develop a solution and have a solution, a way that patients can communicate with the clinic using text messaging. But it doesn’t suffice just to be able to send a one-off text message, sending a patient a reminder that says, ‘hey, you’ve got an appointment coming up in two days,’ and leaving it at that. Because what we’ve seen, even with our clients, is that when patients receive the text message, they actually don’t realize that the message that’s being sent to them is actually being sent by a computer or a robot, so they’ll actually respond. So being able to carry a real time conversation, and having patients be able to respond and being able to intelligently respond to those messages is really what we want to be able to do.
And the other thing is, if you look at ways that — one of the most frustrating things for a patient is that when they’re calling in and they have to be on hold, and then they have to go through a long process of getting their answered questions. So if we look at the most common reasons why patients call in, we can bucket them into three things. There’s either prescription refills, scheduling issues, and getting test results. What we can try to do is have a streamline for each of those processes for our patients, so that they can get the answer that they need. What we’ve seen some practices do is be able to create, on their website, a place where patients can come in and make requests of those things. So they can make a prescription refill request or they can make a scheduling request or a test result request. And I think what’s nice about this is that for the clinics and the front of staff, what they can do is they can aggregate all of the requests that are coming in for, for example, prescriptions, and process them all at once. So not only does it create a better experience for the patient who can get that prescription refilled or get that test result all at once, the clinic can also process all of these things, all in a streamlined way. So it’s kind of a win/win situation.
So to recap, kind of the first solution that I think, or opportunity, is that we can try to modernize the way we communicate. And just to kind of give you — to draw a parallel, to kind of bring our communication back to where we are today. We can look at the phone conferencing world. Phone conferencing has had a lot of upgrades in even the last 10-15 years; previously, it was quite frustrating to have a phone conversation over conferencing. Everyone would have their own individual number to call into, you’d have to share a pin, and then the first five or ten minutes you’d always spend trying to find that phone number or trying to find that pin. Or the pin wouldn’t work and you have to restart the conference. So even working with the physical hardware of the phone conferencing was challenging. Now, we’ve seen a lot of companies where what you can do is five minutes before the conference, you’ll get a text message which will either contain your pin or will actually remind you of your pin, or will have the actual phone number. It can actually even pre-populate who will be in the conference, so they actually don’t even need a pin, so they can directly call in. So the whole experience has been modernized, and I think this is what we kind of need to think about when we’re looking at ways to modernize the way we communicate with patients.
Jumping to the next slide. I think one of the other major issues that I found when I started practicing medicine was patient satisfaction. I think we are seeing a big move in the way medicine is being practiced and the way medicine is being perceived by our patients, in the form of consumerization. Patients are now seeing themselves as consumers of medicine rather than patients of medicine, and what this really means is that patients are starting to take a more active role, not only in what kind of treatment they get, but who they get it from. So I think in this world where there are a lot more choices and patients are a lot more educated about what they can or cannot do, I think we need to be able to track and understand where patient satisfaction lies, because that is, in turn, an important indicator. People will argue whether patient satisfaction actually correlates with the outcomes, but suffice to say, in order for us to do the best we can to engage patients, we need to be able to assess their patient satisfaction so they can engage in our clinics. And of course, there are a lot of legislative also coming down from CMS and they’re pushing physicians in healthcare to be more transparent on what patient satisfaction levels are. And so they have websites like the physician compare and hospital compare, which will contain patient satisfaction data. The patients will actually be looking at these things before they make a decision on who they’re going to choose.
And now if we look at what currently is out there and what currently we’re doing, it’s a little bit challenging. And again, it’s kind of like what we talked about with the previous problem. What people are doing today on assessing patient satisfaction? Somewhat similar to what we’ve been doing 20-30 years ago, which is basically the patient comes in for an appointment and approximately two weeks afterwards, the patient receives a scantron form in the mail. And the patient then has to kind of recall what happened two weeks ago and will answer questions about how the provider was, did you have sufficient parking. How was the front desk staff, were you disgruntled about anything? And that data is aggregated by these third party providers and then you get it. The challenge with these things is that you get your data that’s usually trailing 3-4 weeks, so the changes you’re going to be making today is hard to understand what impact that’ll have those 3-4 weeks later. And so the feedback loop is very slow.
I think what we need to understand is, how can we make that feedback loop a lot shorter, and then be able to address patients’ concerns a lot faster. And interestingly, if you look up what are the most common reasons patients don’t have a positive experience, it actually does not turn out to be related to the actual health care they’re actually receiving. It ends up being related to other ancillary issues, which are still important, such as scheduling, billing, wait time. So there is a lot of technology that we can try to evaluate to see, how can we address these other issues to help them improve their patient satisfaction.
So, some opportunities. One thing to keep in mind is that if you look at third party websites such as Yelp, Google and others that aggregate patient reviews. And even based on our own — you’ll see that healthcare is actually the third most viewed category. So patients are definitely reviewing hospitals and reviewing doctors and looking at it. What can we do? I think the easiest thing to do is be able to assess patient satisfaction on a real time basis. So looking for solutions, for example, that can send messaging, via text messaging or email, soon after the patient interaction, so that you can start aggregating responses and be able to act on a much faster, much shorter period of time. And what this does for patients also is that it helps them feel like they’re actually having a positive impact in their voices being heard, and it increases patient engagement. And what you can also help with with some of these services, is that you can then drive some of this positive patient interactions to improving your online presence and building a reputation for your practice online.
Going to the next and the last problem that we’ll kind of be discussing today is on engaging patients and how we can use that patient engagement to drive outcomes. There’s a lot of reasons patient engagement has dropped off over the years, but I think there’s a certain low hanging fruit that we can try to address and to drive patient engagement. So some of them are scheduling issues. Some of them are issues that are going to be very difficult to address, like social issues or economic issues. But one of the issues that is kind of a low hanging fruit is health literacy. Now the Institute of Medicine looked at, and there are several other papers that have looked at, is health literacy, which is, how well are patients able to understand the conversations that physicians and health care providers are having with them. And how much understanding do they have after the appointment, so that they can carry through on whatever regimen you’ve prescribed to them. So the numbers vary a little bit [depending] on who you ask, but approximately 45% of Americans are characterized as not having health literacy, which is very high. What that really translates to is that the patient is coming in, you’re prescribing them the regimen, and they’re walking out and half the time, they’re not really understanding what they’re supposed to be doing. Which obviously leads to patient non adherence, which can also lead to poor referrals. It has a lot of implications down the line.
The other thing that we can help with driving patient engagement is trying to reduce what I call the human factor. A lot of the processes in health care are manually driven or are dependent on humans, and there’s definitely a personal touch to that, but the more we rely on humans, there’s also an element of error that can come in. Just as an example to clarify what I’m talking about, if you look at the referral process, a lot of referral processes in most clinics is relatively manual. So for example, a patient comes in, sees a primary care doctor, and they’re coming in with palpitations. So the primary care doctor will decide, for example, to refer the patient to a cardiologist down the street or on the other side of town. The process is relatively manual; the patient will receive a physical prescription that basically describes, ‘hey, you should go see this doctor for such and such concern.’ And then, someone on the primary care provider’s side will fax an order over to the cardiology clinic and then they’ll get that fax. And that point, it’s kind of left up to either the patient to call into the cardiology clinic to make the appointment or possibly even the cardiology clinic reaching out to the patient to book that appointment. Now, we just talked about health literacy; so the patient not even understand why they’re going to that, so they might not understand the importance of following up with it. The clinic on the other end might not have the exact workflow to make sure the patient is called. So there’s a lot of opportunity for the patient to not actually be able to see that cardiologist and get that immediate need met. I think the element of human error is really strong here.
So what can we do here? I think the key point here on how we can solve this is trying to automate as much of the process as possible. So for example, building out custom care plans and messaging. As a radiologist, one of the medications that we prescribe, and one of the only medications we prescribe, is contrast, used for scanning. So patients who are sensitive to contrast will have some sort of allergic reaction. And we will often prescribe to them, prior to their scan and prior to them getting the contrast, a steroid and Benadryl regimen, medication regimen, that will help reduce the risk of them getting an allergic reaction. And this is relatively timed, it needs to be taken at 48 hours and 24 hours prior to their scanning. What we found is that patients were often forgetting and coming in. So what we found as the optimal way is that you’d send a very personalized and timely message, specifically to that patient. For example, two days before saying, ‘hey, you need to take your regimen of steroids that we prescribed.’ And then one day before, ‘you need to take your second dose.’ Of course, we can generalize this, for example, to taking it to a GI clinic. So a patient can, for example — four days prior to the GI — their colonoscopy appointment, they’ll get a message saying, four days from today, ‘we’ll be conducting your colonoscopy. Here is an informative video that can help explain why it’s important that you come in,’ addressing that health literacy issue. Two days prior to the colonoscopy appointment, the patient can get a message saying, ‘hey, you’ll be coming in for your appointment on such and such day, in two days. Why don’t you go ahead and start your colonoscopy prep.’ One day before, the patient can receive a message that says, ‘you need to start your clear diet.’
The point is that there’s a lot of customized messaging. And a lot of this is done manually, the patient being called by the front desk staff and being explained that — however, if we were to automate this and remove that human element, you can drive patient engagement and hopefully, eventually, be able to drive outcomes. What’s even more interesting on this is that for example, you can further personalize the experience by giving them messages. So let’s just say the patient was recently seeing their primary care physician’s office and was diagnosed with diabetes. Now, the typical primary care doctor’s appointment is probably 15 minutes, maybe 30 minutes. When the patient first hears about that diagnosis of diabetes, there’s probably hundreds of questions going through their mind, but also the mere diagnosis of it is quite overwhelming. The patient isn’t able to comprehend or fully understand what that means. The patient goes home and has hundreds of questions and is now, starting to come to terms with the diagnosis and wants to be able to reach out to the doctor, but now, they don’t know.
So this is a prime example of how the messaging can serve as the appropriate content after the appointment to the patient, to be able to address those questions. For example, there can be an automated computer conversation or as we could call it, like a chatbot, where the person could have a conversation. So the patient would get a message saying, ‘you were recently seen in our clinic, we recently diagnosed you with diabetes; do you have any questions?’ And then the patient could actually message back in a secure way, asking questions like, what does it mean to have diabetes? What are the common medications, what are the common side effects of those medications? And those are the questions that a patient would typically have, but because of some of the lack of understanding that might have happened during the actual appointment, and also, just the overwhelming aspect of being given a new diagnosis, the patient is just not able to articulate them at this time. So there’s a lot of opportunity to be able to message the patient, even between episodes of care, to kind of bridge that gap of education.
And then finally, what’s really important in all of this is that we want to be able to drive patient outcomes. So what we also want to do is be able to intelligently find patients who have gaps in their clinical care. So diabetes again is a perfect example. A diabetic, based on the most recent recommendations, should be getting an annual foot exam and an annual eye exam. Now, the patient doesn’t, per se, understand this, or the more savvy patient may understand this, but figuring out who those patients are and making those appointments can be a problem. Now, some of the EMRs have sophisticated ways of looking at billing data and looking at procedural data to say, hey, here are patients that are overdue for their annual exam. Now again, there’s a manual process in that, where the front desk staff would take that list and then start calling the patients. But why not automate all of this so that we can remove that human element, so that a system can look at your EMR data, can look at patients who have fallen short and have not had their annual foot exam or eye exam, and then message them and help them actually book that appointment so that they can come in for that. And again, the whole outcome of this would be to drive patient outcomes.
So those are kind of three problems that were kind of a thorn in my side and that is kind of what really led me to decide to do something and take time apart from my clinical duties and do something about it. And again, was really the impetus for it. What we found was that there was basically a very big break in the patient communication, where providers and patients were having a difficult time communicating. So what we’ve done at Luma Health is tried to automate as much of those touchpoints that happen around the appointment. So what we do is we automate all of those touchpoints to the patient so that way, we kind of take out that human element. Make it seem like, to the patient, that the clinic is readily available to be able to interact with the patient at any given time. And I think what really drives all of this, as the Institute of Medicine talks about the triple aim, which is patient outcome, patient satisfaction and reducing costs. And that’s really what we’re trying to drive here; is that by being able to automate as much [as possible] in the communication cycle, patients can find that — you can start seeing improved patient outcomes, drive patient satisfaction, and then eventually, this will be tied into saving costs.
Just so you can see what kind of impact we’ve had, these are some statistics that we’ve pulled from various clinics. But overall, we’ve been able to help clinics kind of reduce their no-shows, be able to drive increased capacity utilization, which is basically saying that we’re able to keep the schedules more full. And clinics are seeing a wide variety of return on their investments and we’ve been able to do this across a variety of different specialities, for primary care, dermatology, gastroenterology and ophthalmology.
At this point, I will open up to questions but before I do that, if anybody is interested, we’d, of course, be happy to show you a more in-depth dive into what our product offers and what we can do for you, so feel free to check out our website at lumahealth.io, or feel free to email either myself or john. So now, we’ll move onto our questions.
So the first question we have is, we know that you’re partnered with AllScripts, who else are you partnered with? What other EMR, PM systems do you integrate with?
So we have spent the last 2.5 to 3 years building a very robust integration engine, and I think we can probably say that we integrate with probably more EMR and practice management solutions out there, than almost any other provider out there. What’s unique about our way of integrating is that we actually have two-way integration, which is actually quite rare. So for example, for scheduling data, we’re able to pull out the data, which is the first step in trying to be able to communicate with patients. The second step is also, which again, trying to automate the whole entire communication lifecycle is being able to write back in the majority of EMRs that we do integrate with, so that we can also write back. So for example, if you’re a clinic that’s managing a lot of incoming referrals, we can create those new appointments for you in EMR. Or if you’re using a reminder service, we can ask patients to confirm their appointment and we can also go ahead and confirm that appointment. We also have a waitlist feature too, where if you have a cancellation at the last second and would like to fill that appointment, we start messaging patients to fill that appointment. If there’s a patient that does fulfill that criteria and does accept the offer, then we can actually go ahead and write that appointment right back in EMR. Again, taking out that human element and trying to create almost a streamlined experience; not only for the front desk staff, but more importantly, for patients. So the answer is, yes, we do integrate with several different EMRs out there, and feel free to reach out to us if you have any questions particularly on if your EMR works with our system or not.
Going onto the next question is, how effective is this with my older patients? They don’t text at all.
So this is actually a really interesting question. I think the majority of patients that do use text messaging, and I think we can anecdotally say that the younger patients are the greater penetration we have with mobile and smartphones, but believe it or not, there is a significant number of patients over the age of 65 who have text enabled or smartphones that do text. What we’ve seen is we’ve seen our response rates and our engagement rates are relatively stable, regardless of the patient’s age. So if the patient does — even if they are older — if the patient does have a phone that can accept text messaging, patients will respond. We also support other communication channels, so even if you, for example, do have a patient that doesn’t have a phone that’s [text] enabled, then we do support email and we do support phone. So our system is able to intelligently identify the difference between those phones that can accept text messaging or not, and then we channel our communication over the appropriate channel.
The next question is, you’ve talked a lot about automating communications to patients. What about the personal touch?
Yeah, this is actually interesting. There were a lot of papers that were written to see what kind of, for example, appointment reminders are better. Are they better done over the phone manually, by the front desk staff, which is obviously very personal? Or done through a robotic call or some message. If you look at it, in some studies, the personal touch does win out just a little bit, but I think there are a few important considerations. One is the workflow impact you can have by automating the process. So you can save a lot of office hours and staffs’ time by, of course, letting a computer or a robot be able to automate it. Which, then, can help the front desk focus on the patients directly in front of them. The other thing is actually, if you start messaging patients on text messaging rather than phone, it’s actually relatively close to what you’d see in a personal touch.
And believe it or not, if you’re able to find a vendor that can message patients in a relative, personalized way, patients don’t actually even perceive that the message they’re receiving is not — that it’s from a robot. They actually assume that the message they’re receiving is actually from a human. And we see this all the time when patients respond with all sorts of messages about a lot of different issues, and then start to have a conversation with our service, as if they’re having a conversation with a real human being. So I think there is some value into the personal touch, but I think if you find an appropriate vendor that has an intelligent ability to be able to respond to conversations, you can actually mimic a lot of that personal touch. So really what you end up doing, is you end up sort of scaling your front desk staff and being able to help them do a lot more stuff, without actually having to spend the time to do it.
The next question is, what does the patient engagement space look like right now, and how do you fit into that?
I think I would classify us as a mobile communication platform. I think what we’ve built through the last two or three years is a communication pipeline, where we are better able to connect the patient to the provider. And currently down this pipeline, what we’ve been pushing down is more or less workflow type of messaging. So we help patients connect to their providers, helping them schedule their appointments, helping them complete referrals. But I think what’s interesting about creating such a pipeline is that we can start putting down clinical messages, and I think that’s where it gets really interesting, in that we can drive patient engagement. So I think where we see us different from all of the other patient engagement platforms is that we are more of a messaging platform. We try to help scale the doctors and health care providers and front desk staff, to accomplish some of those repetitive tasks, so that way, they can focus on more important issues. So I’d say that as a patient engagement platform, we are more of a clinic and a provider enabling platform for messaging.
Another question we have is, my EMR has some texting functionality; how are you different?
I’d say that a lot of EMRs do support text messaging, though I think the advantage we offer is that our solution is a lot more customizable and our solution is able to take an input of wider variety than some of the other solutions. A lot of the baked-in solutions in the EMRs are one-off text messaging; they don’t really accept incoming messages, and often times, they will not write back to your EMR. So they’ll basically send a message telling the patient, hey, you have an appointment, and that’s kind of it. We try to have a more personalized conversation with the patient, where the patient can respond. We’ll take their response and be able to update their appointment if need be, we’ll cancel the appointment if need be, whatever is deemed appropriate. So I think there is definitely some overlap with what EMRs offer; however, I think our functionality goes a little bit beyond what other EMRs offer, in terms of being able to give a more personalized and engaging experience to the patients.
Next question is, how do you see the healthcare industry changing, with big players like Amazon and Apple, specifically in the personal health records, entering the space?
Yeah, I’m sure a lot of people have come across some of the recent news, Amazon entering the health care space. I think it’s hard to say which way — those companies that have big pockets, which way they’re going to be handling all of this. I think Apple has definitely taken a more customer-centric approach, or a patient-centric approach, in helping mobilize some of the patient data that exists in the data silos of different health care systems. And being able to give you access to it through a patient facing app, or an app that lives on their phone. Amazon is trying to address a more global issue of our healthcare system being broken and costs running wild, but I think in either case, it still remains unseen what will happen. A lot of other large companies in the technology space, like Microsoft and Google, have also given their play at the personal health care record space, and to limited success. So it’s a complicated space and we’ll see which way they end up.
And the final question that it looks like we have, at least up until now is, I don’t understand how your product impacts MACRA performance; does your product help with reporting MACRA and/or MIPS?
So I think a lot of the quality improvement measures in MACRA are outcome driven and as much as the average health care provider doesn’t like the MACRA, I think they’re probably here to stay, at least for the next few years or the new future. So I think there are definitely different ways that our product can help you address them. One of them that we discussed, for example, if you have a significant volume of diabetic patients, the government will reward you, based on the percentage of patients that get their annual diabetic foot exam or eye exam. Our service can, for example, help identify those patient gaps. Amongst the different data elements that we pull and we integrate with your EMR is looking at procedural and billing data. So we can help you identify, for one, who are those patients who had their annual eye exam or annual foot exam. And then, what we can do is we can actually start messaging those patients, telling them, educating them not only about how important it is to come in for their annual appointment, but also, to help them book that appointment. What we can do is we can start driving that score up, of the percentage of patients that need to get their annual exam, without you actually even having to lift a finger. Now, on the reporting side, we actually don’t — we’re not a CMS registry, so we don’t actually do any of that reporting. We can definitely generate reports for you, that you can use to upload, if you’d like to directly upload. But we’ve also partnered with companies that can help on the reporting side. So if need be, we’d definitely be able to help extract the data and be able to get that to them, and help them facilitate that reporting part of it.
That is all the questions I see, I’ll leave it open for a few more seconds. Okay, looks like I don’t see any more questions. I just wanted to thank everyone for participating and look forward to engaging everyone again. And again, if you guys have any questions, feel free to email me and reach out to our website, lumahealth.io. And if you have any sales questions or anything, please don’t hesitate to ask. Thanks.