Capturing the patient voice in #telemednow: PROS & Patient Experience Survey

#TelemedNow Twitter Chat Wednesday, October 21 – 8 PM ET Introduction & Welcome: Helen Burstin (@HelenBurstin) - Moderator Capturing the patience voice in #telemednow: PROS & Patient Experience Survey

Q1: How can we routinely capture the patient experience and satisfaction with #telehealth?

And bonus question: Should we assess clinician experience and satisfaction with telehealth?

A1 Notable Responses: Jamey Edwards (@JameyEdwards) End of visit survey's are a great tracker of satisfaction for patient as well as provider. @CloudbreakHLTH, we use the surveys to track #netpromoter score & for immediate service recovery should someone have a negative experience. Repeat visit #'s also valuable. Ceci Connolly (@CeciConnolly) Satisfaction/experience measures should be built into the tools! Let people react in the moment, the way online customer service portals do. Jamey Edwards (@JameyEdwards) Bonus: Absolutely. #PhysicianBurnout is real & troubling issue. We should make sure #healthcare technology eases burnout & makes it easier for clinicians & patients to connect, communicate & care. #Empathy is 2 way street. Andrew Watson (@arwmd) I agree with Jamey, but is there an easy way to do it on your smart phone? Are used to do it using paper, but then it had to be scanned or faxed. I think we need to do more #provider surveys as well. Ceci Connolly (@CeciConnolly) Big believer in the instant feedback loop but is there a need for reflection sometimes? Don't have a point of view, just curious what others say Jim St. Clair (@jstcliar1) pt engagement should be continuous and provide feedback before after and between tele-engagement Evan Kristel (@EvanKristel) leverage digital tools to ask and ask again! Sam Lippolis (@samiamlip) Patient & provider satisfaction has tracked for 10+ yrs for #telemednow Press Ganey & hcahps have versions of standard questions that cover video I do think we should distinguish btwn phone, video, email, text, in person because they're very different Helen Burstin (@HelenBurstin) That's great to see, @jameyedwardsWe definitely need to assess patient (and clinician) experience. Patient experience is key domain of telehealth effectiveness for public and private payers. Good toolkit @CareInnovations… Ritu Thamman (@iamritu) -need more validated instruments/surveys -need to involve pts in all stages of PRO development Andrew Watson (@arwmd) bonus. Good one @HelenBurstin We were talking as a department today, and are looking to analyze trouble tickets specific to our department. I think there’s a lot to be learned by department and reported IT issues. #TelemedNow. A bit different than a survey... Aditi Joshi (@draditijoshi) we do surveys from jeffconnect to assess patient experience, not so much for teletriage but our ED satisfaction will get comments about it every so often. Surveys obviously are reliant on willingness and time to answer but have gotten some helpful feedback. Janice Tufte (@Hassanah2017) I receive a pressganey survey after every clinic visit #virtual or #inperson. I think it is best to let patients have opportunities to share their experiences, satisfaction or dissatisfaction regarding #TelemedicineVisits in their portal too. #TelemedNow Shereesepubhlth (@Shereesepubhlth) The CLX should always be a consideration as we continue to fight burnout. #PatX can routinely be captured by building more seamless workflows. Patients shouldn't incur more stress from innovation; it's counterintuitive to why we do it. #TelemedNow Aditi Joshi (@draditijoshi) Using data on outcomes/time in ED/need and availability to followup are indirect markers but having the patient voice about these questions would be valuable and a new way to look at it. and yes on clinician experience, they are the other user! #telemednow Matt Sakumoto (@MattSakumoto) For repeat visits, do scores tend to trend up or down? (ie are expectations set high after an initial visit and then drop, or just stay consistently 4.5+?) #telemednow (Emojis) (@dia_trahman) As someone who has done client support for #telemed, setting expectations right and creating AN UI that supports smooth workflow helps patients. #a11y accessibility and digital literacy are key factors to consider #telemednow Ritu Thamman (@iamritu) The ER is a great place to collect PROs #TelemedNow Ongoing development &validation of PROM-ED 1.0, questionnaire enabling the systematic collection of patient reported outcomes after ED care Tricia Guay (@TMG_ACHP) The easier you make it the more likely the patient will actually complete. #TelemedNow Andrew Watson (@arwmd) Good point Shereese. I don’t know when the best time to survey physicians is. After an encounter or maybe too much. After clinic, we’re typically whipped. Anyone have any ideas? I have a good sized clinic coming up tomorrow. Lots of #Telemedicine Irma (@IrmaRaste) Also, is there / how can we communicate value to the #patients for completing the survey? We are all busy, so relying on people’s desires to help an organization might not be enough of the incentive. Of course there is bias with negative feedback too. #TelemedNow Sam Lipolis (@samiamlip) Translators available RIGHT AWAY in 3 way video call for #telemednow NO special 'translator phone/machine'. Straight and clean 3 way video call I've been on a soap box on this one for a while!!! Thanks for asking Aditi Joshi (@draditijoshi) Great question. Reminds me of initial results showed pts didn't care where their doc was. If had stopped there we wouldn't have seen the trend change. Both have value depending on needs - real time intervention for poor outcomes/QA. long term trends for patients needs #telemednow Stacy Hurt (@stacy_hurt) I would be more than willing to provide feedback to my and my son’s medical teams before or after our televisit Salim Saiyed (@SalimCMIO) And close caption in any language, for those that are hard to hear. #telemednow Chad Ellimoottil (@chadellimoottil) To capture PROs after telehealth visits, you could use a text-based chatbot. At a big health system, you can run dozens of A-B implementation experiments to improve patient experience.

Q2 As we work to incorporate patient reported symptoms and PROs into routine care, how can we use the "digital waiting room" to capture these data? A2 Notable Responses: Jamey Edwards (@JameyEdwards) Interactive patient waiting rooms can help reduce perceived waiting time while conveying valuable information to patient or collecting information to speed encounter. Providers can stream videos, images, surveys, & audio to patients while they wait. #TelemedNow Andrew Watson (@arwmd) One nuanced answer, is that remote monitoring also gathers PRO ‘s, but would never have a waiting room. Monitoring does change the equation a bit. But overall, the video platforms typically have a great waiting rooms. #TelemedNow Ceci Connolly (@CeciConnolly) Makes a lot of sense as long as it is relevant, not sales pitch or too preachy. Don't want to turn people off #TelemedNow Janice Tufte (@Hassanah2017) “We are very sorry that there is a approximately XXminute wait, we would appreciate your # 1 to share your symptoms #2 Updates on existing condition or follow up concerns #3 medication concerns or need help with essential needs #4 listen to options again #SDoH #TelemedNow Salim Saiyed (@SalimCMIO) -it has to be engaging and patient need to see the benefit in wanting to respond. #telemednow Andrew Watson (@arwmd) Yes Jamey, and what you point out and Helen is driving at is how do you have a meaningful experience for the patient while they wait. Show them videos? Or have them enter data? #TelemedNow Ritu Thamman (@iamritu) Time to fill out the PROs - ideal if automated - use waiting room time for health literacy education Insufficient time, staff & infrastructure to support routine PRO collection & non‐integrated PROMs in patient electronic medical records may be barriers #TelemedNow @arwmd Matt Sakumoto (@MattSakumoto) But even remote monitoring needs a check-in visit to review trends, etc, so waiting room could be used there. And probably a survey upon device return would be good. Are there any RPM-specific PRO metrics you'd recommend @arwmd? #telemednow Sam Lippolis (@samiamlip) As a patient I dislike waiting for anything. I'm not sure how much I'll really pay attention to things in digital waiting room. I'm likely mindlessly scrolling on another device just.....................waiting Let's set realistic expectations of digital waiting room Ceci Connolly (@CeciConnoly) Splash of cold water here I suppose but am guilty of scrolling on another device so point well taken. Probably need some savvy marketers like @ScottDRippe Shereesepubhlth (@Shereesepubhlth) Digital waiting rooms are great triage solutions when used optimally. The off-site clinician can order labs & tests or develop a Tx plan, which can add to seamlessness by moving the patient through the system faster. Tricia Guay (@TMG_ACHP) Makes sense. This is what happens with in-person visit. You're called back. Nurse asks you these questions before the doctor sees you. Seems like you could use nurse in same manner with #TelemedNow visit. Stacy Hurt (@stacy_hurt) Give us an application that is easy to use and engaging to report our symptoms & utilize #AI to link them to health system (NOT pharma) patient education while we wait #TelemedNow Ritu Thamman (@iamritu) tailored PROMs may ˅ readmissions, ˄ medication adherence, & ˄ better behaviours from patients to support their own health & we should think carefully about why, what, when, & how when collecting PROs so it’s systematic, quantifiable over time #TelemedNow (Emojis) (@dia_trahman) Single queue vs multiple queue systems are worth looking into for virtual care triage Telemedicine 2.0 would be able figuring out the triage system Jamey Edwards (@JameyEdwards) Yes Jamey, and what you point out and Helen is driving at is how do you have a meaningful experience for the patient while they wait. Show them videos? Or have them enter data? Irma (@IrmaRaste) Please let’s not make that “data entry” be what often happens at the in-person provider visit - fill in multiple paper forms We need #HealthyData & personal health record available to #patients & usable in #telemedicine visits! Ritu Thamman (@iamritu) The patients should be involved in all stages of developing the PROM instrument/measure - this is key for pt engagement #TelemedNow Irma (@IrmaRaste) It would be especially useful to #patients if these videos/other educational content were personalized! Facts about their specific medical condition, relevant resources, etc

Q3 What special considerations for language and literacy level should be built into online #telehealth patient surveys? A3 Notable Responses: Janice Tufte (@Hassanah2017) Patient surveys should be available in the primary languages of the #PatientPopulations clinics/hospitals serve. 5th grade language and preferably infographics could be used to avoid monotonous surveys #TelemedNow Nadir Bhuiyan (@DrNadirMD) We need to find out what the patient's preferred language is so that we can make sure they receive information in the language they understand most #TelemedNow Jamey Edwards (@JameyEdwards) Survey's can be complex enough when you speak english. When people are looking at survey's in a second language, it can taint the data in big way. Survey's should be offered in patients primary language for best success w/ support via chat/phone. Andrew Watson (@arwmd) And interestingly enough, we have a real need for Nepali here in Pittsburgh. So it can be hard to predict. Aditi Joshi (@draditijoshi) we have preferred language and interpreters called in. This is bare minimum. My concern is how do we get the patients TO US in the first place. Creating account requires language and digital literacy which is a barrier. Do we know how many people we are excluding? Ritu Thamman (@iamritu) Many iterations needed so core concepts are not lost in translation & are culturally sensitive :here’s step-by-step overview of how EuroQol translates PROMs for EQ5D. #EQ5D Salim Saiyed (SalimCMIO) Cultural sensitivity is tough even in person, must work hard to maintain in #telemednow Shereesepubhlth (@Shereesepubhlth) Language is a bigger issue than ever. Languages used in #telehealth should insult, alienate, or devalue, but we're seeing is bias, micro-aggressions, & confusing terms. We can't fix what we don't know. Patients should voice language concerns. #TelemedNow Salim Saiyed (SalimCMIO) Making surveys available in different languages. Though this is a huge loft for most organizations as most digital and portal remain in English #telemednow (Emojis) (@dia_trahman) I have worked with patients who have dementia or could not see properly. Digital literacy, accessibility and language barriers can cause undue stress when ppl are vulnerable Here is a presentation I did at a human factors conference… #TelemedNow Matt Sakumoto (@MattSakumoto) Even pre-COVID I heard our non-English speaking pts avoiding calling bc our front desk staff weren't readily hooked into a translator. We need to offer native language option even before this step. #TelemedNow Helen Burstin (@HelenBurstin) Agree @MattSakumoto. We need to make visits work regardless of language and capture PROs from ALL patients, especially barriers to access goes along with higher disease burden and lower satisfaction #TelemedNow Connie Hwang (@hwangc01) This #telemednow question rightly raises concerns re: the "Digital Divide." Nice perspective piece in JAMA advocating that all telehealth offerings adhere to National Standards for Culturally and Linguistically Appropriate Services (CLAS). @_ACHP

Q4 How can we ensure that patient-reported data gets incorporated into patient EHRs? A4 Notable Responses: Janice Tufte (@Hassanah2017) In the near future I expect #RecordedMedicalTranscripts might be smart enough through AI or Machine Learning to record #PRO data and #PROMS> Patients recording their own experiences and symptoms also. #TelemedNow Jamey Edwards (@JameyEdwards) Patients need more control of their own data & PRO helps us begin walking down that path. Need more studies on its relevance & effectiveness & easier ways to upload to EMR via portals & mobile. Stacy Hurt (@stacy_hurt) “(Patient-reported data) should be easy for #patients to complete through apps, web-based tools, or even kiosks in drug stores” I’m still filling out a bunch of forms, so before we integrate data, let’s find a tech patient friendly way to capture it #TelemedNow #RPM #PROs Andrew Watson (@arwmd) Ah, the bane of #EHRs and #Telemedicine #TelemedNow. Meaningful #interoperabiltiy. It all starts with #EMPI / #GUID imo. And really good HL7 modeling. Ritu Thamman (@iamritu) PROMS should be considered as quality metrics for benchmarking- not just 30d mortality, readmissions etc - Our recent (report/pencil emoji) on US adults w/o CVD, ideal CV health associat w/ better PRO s; improving patient satisfaction & experience may save $$ #TelemedNow Helen Burstin (@HelenBurstin) Totally agree, @stacy_hurt. The beauty of some PROs is that you can do them when it works for you. I'm a bit fan of PROMIS since it's embedded into multiple EHRs @theNCI @roxejensen Matt Sakumoto (@MattSakumoto) PROMIS measures are great for standardization. Big plug for the @CAPriCORN_CDRN doing great work with PROs in the Chiagoland area #telemednow Salim Saiyed (@SalimCMIO) - Define the data #doctors find meaningful for care delivery - Find discreet ways to pull into clinician #ehr workflow - ok to filter data, & pull in only relevant fileds to keep #ehr data curated - differentiate between nice to have and must haves (Emojis) (@dia_trahman) Reviews left by patients are used as SEOs and social proof to scale telemedicine. I havent see patient reported data being integrated for making product decisions as of yet. @adahealthis a great example of a product that checks in for patient/user's symptoms #TelemedNow

Q5 Do we need to develop new patient experience tools for telehealth or should we use same tools to allow for comparisons to in-person care? A5 Notable Responses: Andrew Watson (@arwmd) At the very least an entirely new operational model. One that does not replace face to face with #telemedicine, the one that rethinks how we see patients at the most fundamental level. #TelemedNow Jamey Edwards (@JameyEdwards) We should always design around patient & provider experience so tools developed are best for situation regardless of modality. Some existing methods may work great in 1 arena & not another. #Innovate 4 appropriate situation! Janice Tufte (@Hassanh2017) I think many of us patients suffer from #surveyfatigue, I do receive #pressganey surveys post #telemedNow visits and do fill them out, not sure of return rates? #TelemedNow Sam Lippolis (@samiamlip) Until we have a new care model that includes digital tools. I want to compare against in person or people will continue to say 'it's not the same because not even clinicians compare #telemednow to in person" Aditi Joshi (@draditijoshi) Find out what patients need at home for successful encounters would help esp as we go toward more home based healthcare. I.e do we need to train carepartners/family in physical exam/devices? Clinical markers will be the same as the medicine isn't different. #TelemedNow Matt Sakumoto (@MattSakumoto) 100 new tools. Virtual Care should open new models and not just be a brick-and-mortar care replacement. "What could you do NEW in a virtual care world?" not "What old things do you want to recapitulate?" Ritu Thamman (@iamritu) need more validated surveys for #telehealth w IRL comparison: PRO assessments that uses a validated set of questions with standardized scoring on each & every assessment (Emojis) (@dia_trahman) New tools under asynchronous vs synchronous communication will shape up for telemedicine. Depending on the type of consult, asynchronous communication is wanted and preferred by patients #TelemedNow Closing Note: Helen Burstin (@HelenBurstin) Thanks everyone! We have #TelemedNow panel at @CMSSmed meeting next week with @draditijoshi @iamritu @translatedmed and @chadellimoottil. Please join us: #DigitalMed2020 Happy to offer complimentary registration for patients!

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