HealthIMPACT Live Presents: Patients as Partners - Ensuring Your Health System is a Partner Throughout the Patient Journey from Prevention to Recovery at Home
Originally Published: Apr 7, 2022
YouTube Video: https://www.youtube.com/watch?v=l2qxDdZfV8s
The shift to virtual care during the pandemic has created a whole new set of patient experience and engagement challenges. Managing the health of vulnerable patients with chronic illnesses like diabetes virtually was of particular concern. The need for engaging accessible tools has never been greater. In this session a healthcare leader will discuss what works and what doesn't when it comes to supporting, engaging, activating, coaching, and ultimately partnering with patients:
Emily Dumas, Manager of Care Transitions, University of Alabama Birmingham Medical Center
Shahid Shah: Welcome back Health Impact audience. We have talked many times, and especially in our last Health Impact, we had Chris Ross and a number of other CIO's talking about how important it is to really treat the patient as a partner and in which we're not doing things to the patient, but we're doing things with the patient. For that we've got a really, really good speaker and Emily Dumas is going to talk to us a lot a lot about how to make sure that when you're interacting with patients, you often hear us thinking about consumer oriented healthcare or retail oriented healthcare that's absolutely the wrong way to look at things because people are not coming to stores to buy shopping shopping for clothing and that kind of stuff. So how do you actually get patients to believe that they are part of the care and that they are partners with the physicians and the nurses and the administrators. In a hospital setting and in a healthcare delivery setting that's what the emily's gonna talk to us about and after her and presentation i'll ask her a few questions about.
How to actually put a lot of what she's talking about into practice so with that Emily i'd like to have you join us that go ahead and show your presentation, give us a quick intro about you and what you do at The University of Alabama Birmingham medical Center and take it away from there great.
Emily Dumas: Thank you so much i'm are you able to see my screen okay.
Shahid Shah: We do.
Emily Dumas: Wonderful. I'm so like he said so hi all my name is Emily do miss I am the manager of care transitions at UAB hospital located in Birmingham Alabama and say Oh, we talking about patients as partners through my experience utilizing the me program here at UAB and for those who are not familiar with UAB we are the University of Alabama at Birmingham we're located in Birmingham Alabama great Center of our state. So you ab medicine is one of the top academic medical centers in the United States and its also Alabama's largest single site employer. In addition to providing health care services for more than 1.6 million patients annually, we are committed to educating medical professionals and advancing medical science through research, you a medicine is anchored by you any hospital, which has been named one of us news and world. World reports best hospitals were also the number one best large employer for 2121 by Forbes magazine so it's a wonderful place to work and i'm very honored to be speaking on behalf of it.
Okay um I want to give a quick overview about UAB beyond what i've already said so you ab medicine is recognized as a magnet designated organization we're in our fifth year so we're hoping to go for six us we're very proud of that credentialing we're one of only 21 hospitals with worldwide with that designation so we're very proud of our status you'll be missing, this also decimate as a healthcare equity leader by human rights campaign foundation for demonstrating leadership in the LGBT Q, healthcare and employment. So we're at equal rights employer and we hope that our patients employees and everyone you to see that we are excited and doing wonderful work here.
Other claims are listed on the screen, you can see that we have a busy and reward for supply chain excellence. And also, we have over 350 doctors that are rated as the best doctors in America serving us here at UAB so we're very excited about our physicians and we hope to bring the great programs to our patients. So our topic today is how we support engage activate coach and ultimately partner with our patients.The way we achieve these outcomes is through the Multi modal approach to patient engagement and communication we provide technology based communication that are designed to activate and empower our patients oops. Yep so we do this through various modalities and we use phones to collect.
So our topic today is how we support engage activate coach and ultimately partner with our patients.
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Emily Dumas: The way we achieve these outcomes is through a multi modal approach to patient engagement and communication.
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Emily Dumas: We provide technology based communications that are designed to activate and empower our patients and again we do this through multiple modalities.
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Emily Dumas: We use phone calls to collect patient information or to schedule appointments and close gaps in care.
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Emily Dumas: We also use web based programs to educate patients and their family members and caregivers to support those shared decision making and provide a documented report of the patient education Pack.
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Emily Dumas: We also use all these mechanisms to help monitor our patients.
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Emily Dumas: Post discharge to coach them and help them self manage their conditions and to have been identified those at risk, so that we can reduce readmissions, and hopefully less than length of stay in future admissions.
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Emily Dumas: Through our partnership with me, we have deployed the right solutions at key decision points for better experiences and outcomes.
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Emily Dumas: And if not just knowing we're delivering trustworthy content.
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Emily Dumas: With behavior based delivery We also hope to deploy tracking tools and leverage analytics to provide key insights as the patient struggle with decisions during the care process.
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Emily Dumas: To that end, i'd like to do a deep dive into three case studies that we have done here at uab to be able to show tangible measurable impacts that we received from me and how our patients experience the process here.
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Emily Dumas: Okay, so documenting which patients receive an influenza vaccine is critical i'm sure anyone in health care or even just having children growing up has experience what it's like to try and get a flu shot for everyone in their families.
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Emily Dumas: But with retail pharmacies in urgent care clinics also offering flu vaccines, it can often be difficult to ensure that a patient's flu vaccine status is reflected in their electronic medical record.
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Emily Dumas: Often, this is because the patient either did not receive a flu in the first place, or they were done somewhere outside of the system so they're not connected.
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Emily Dumas: So at uab we knew that there had to be a better way to manage this process we had over 54,000 patients.
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Emily Dumas: yearly come in, many of whom had not had documentation were having a flu shot but might have stated that they had it in their medical records, so we turned to the me platform and said, what can we do better to try and track these for our patients.
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Emily Dumas: So, with their help, we were able to create a patient engagement program to help educate patients and raise awareness about getting the flu shot where they could get it done.
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Emily Dumas: And then reaching out to those patients to have them confirm whether or not they did or did not receive it so in less than 85 days, we were able to.
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Emily Dumas: update patients vaccine documentation and provide flu status for over 13,000 patients so about 24% of our patients engaged with the calls and let us know.
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Emily Dumas: Where they were at with their flu series so we're really proud of those results it's wonderful to see our engagement do what we wanted it to do, and be able to reach all those patients and make sure that we're providing the best care for them at that point.
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Emily Dumas: Then our second state case study is about our GI group, and so they had an overall goal for the year to reduce GI cancellations.
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Emily Dumas: Okay, so health professionals administer preventive screenings and services to assess and reduce your risk of heart disease and conditions such as colorectal cancer.
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Emily Dumas: In the long run it's more cost effective to take steps to prevent disease and.
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Emily Dumas: then pay for treatments as much as $3.7 billion in medical costs could be saved annually in the United States, it preventive screenings were increased.
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Emily Dumas: According to the US office of surgeon general so poor patient education and understanding leads to poor compliance, which results in cancellations for scheduled colonoscopies.
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Emily Dumas: So you may be challenged me to help them, reduce the cancellation rates for preventative GI procedures.
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Emily Dumas: So using me to help educate our patient populations, about the importance of upper GI endoscopies enter colonoscopy procedures.
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Emily Dumas: um help to improve our patient outcomes so each patient received in me access code and instructions and how to view the education online through either a smart device or tablet.
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Emily Dumas: And for patients who did not have smartphone access or Internet we were able to call them and provide those updates over the phone.
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Emily Dumas: But the overview is that our patients were able to receive education at the right time in the right place in the way that they wish to receive their education to hopefully get them inspired about taking care of themselves and engaged in their own healthcare journeys.
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Emily Dumas: So the results of this were among the 4144 patients who were assigned to the program during this case study.
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Emily Dumas: yep so among the 4144 patients who are signed in me engage program with an appointment for an upper GI.
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Emily Dumas: endoscopy or cold ass could be the results showed that there was those who did not engage how to 12% cancellation rate.
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Emily Dumas: And those who engage had a 3% cancellation rate so patients who engaged with the services were able to decrease that cancellation rate by over 90%, and so we saw.
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Emily Dumas: That more patients, we had a 75% reduction in patients not canceling their appointments.
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Emily Dumas: So, at the end of the study it was determined that patients who engaged with me program were less likely to cancel the dusk be or colonoscopy appointment.
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Emily Dumas: So this is still in utilization today.
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Emily Dumas: We continue this process to make sure that our patients are able to receive their education so they can bring questions back to their doctors would never they have their appointments.
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Emily Dumas: And then we followed them through their actual actual procedure to make sure that if they have any follow up questions were there for them, and we can answer questions out so that the hospital to prevent any unnecessary readmissions.
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Emily Dumas: And then, for our third case study and this one is about scalability and efficiency at uab hospital as a whole.
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Emily Dumas: So i'm discharge patients need to be consistently engaged throughout a career transition order to have the confidence and ability to successfully manage their health at home.
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Emily Dumas: This is critical for managing performance, reducing readmissions, and managing patient throughput.
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Emily Dumas: However, this does require hospitals and health systems to find effective and scalable ways of monitoring and intervening with patients.
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Emily Dumas: in need and empowering those patients to be able to self manage for themselves so uab again challenged me to say what can we do about this, is there a way we can utilize me to help these patients.
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Emily Dumas: So we our goal was to reach patients after discharge to reduce staff time spent connecting with low risk patients and to help discharged patients self manage those chronic conditions.
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Emily Dumas: So we developed the me transition program to extend the reach of care team beyond the clinical care setting so we encourage self.
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Emily Dumas: Management we motivated positive behavior and we alerted the cure team of people who may be at risk.
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Emily Dumas: So we currently utilize multiple me transition series to target both the general discharge patients, as well as patients with chronic conditions such as COPD heart failure pneumonia Am I and a few other diagnoses that we want to track outside of the hospital.
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Emily Dumas: So the results of the study so before me uab had nurses, that would call patients after discharge, so we were only able to connect with about 66% of our target population.
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Emily Dumas: So we had multiple nurses calling patients, through their average workday.
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Emily Dumas: And were you i'm sure can imagine that not every single patient engage with the calls too many calls were spent with the nurses, leaving a voicemail or having to list them as a reconnect later.
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Emily Dumas: So, by implementing me transition to scale the care management process more patients for REACH post discharge.
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Emily Dumas: Post me nurses, combined with me connected with 21% more patients reaching 80% of US target population.
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Emily Dumas: And while me is not able not only to connect with more patients but also spend more time on the phone with them, since the calls can continue.
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Emily Dumas: So this has been a great benefit to us because not only does the system, do the heavy lifting for us, but it allows the nurses, that when they need to call patients back they're connecting with the patients who need us most.
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Emily Dumas: So this call series is able to connect with those patients connect with red flags, so if there's something going on, we need to know about it, we can have a real nurse call the patient back either same day or next day to check on those issues and hopefully prevent readmissions.
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Emily Dumas: So not only were nurses able to reach more patients post discharge, but they were also able to provide more immediate interventions for those in need.
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Emily Dumas: Any any transition ask patients certain questions to identify any potential concerns this information is delivered back to the clinical staff alerting care teams of the patients who may be at risk.
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Emily Dumas: So before me 5.2% of nurses calls were made to patients with issues with me transition staff.
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Emily Dumas: resource were allocated to the patients who need it most, and 100% of calls nurses nurses were made were to patients with issues so.
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Emily Dumas: We ultimately saw an increase in nursing satisfaction as well, because they were able to utilize their nursing skills to be talking to patients with every single phone call.
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Emily Dumas: Not just in a tense, this was so successful at uab that we have expanded the use so from September 2015 to June of 2018 the me transition series made over 407,000 phone calls.
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Emily Dumas: That did not result in a red flag so by allowing staff to focus on those follow up calls that had red flags, we were able to save the equivalent of one and a half full time employees.
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Emily Dumas: per year and we've seen that grow even since then, this is probably my favorite program that any is in utilization at uab right now so i'm very excited to hopefully expand this in the future.
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Emily Dumas: Then, many hospitals and healthcare systems struggle with effectively managing the help of the discharge populations.
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Emily Dumas: Managing recovery reinforcing key information and motivating behavior change are essential to apply avoiding complications and readmissions.
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Emily Dumas: The hospital readmission reduction program hrp penalizes hospitals with high readmission rates giving hospitals, a financial incentive to lower their readmission rates.
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Emily Dumas: So me transitions was also associated with better performance in this area.
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Emily Dumas: So medicare patients that did not engage with me transition had a 19.4% readmission rate compared to the 15.1% for those that did engage, so you may be saw a better performance with readmission rate rates.
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Emily Dumas: For patients with chronic conditions such as heart failure and those heart failure patients that not engage had a 24.8% rate compared to the 18.2% that did.
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Emily Dumas: So overall we're seeing across the care continuum that patients with chronic conditions and then just our general discharge patients.
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Emily Dumas: Those who don't have a diagnosis, but discharged from the hospital that we want to be following up with all sorts of patients benefited from these kinds of call series.
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Emily Dumas: So, as you can see, we were able to help me uab meet its goals or me was able to help meet those goals with a scalable solution and optimize the workflow and improved utilization of hospital resources.
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Emily Dumas: And these improvements contributed to the enhancement of patient and staff satisfaction and we're also associated with the reduction in readmission rates.
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Emily Dumas: So these were just three examples of the power of engaging patients at key decision points for a better experience and outcomes, so our goal from population health standpoint is to keep the patient well at home.
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Emily Dumas: and prevent any unnecessary readmissions, we want to meet the patient, where they are where they're at wherever they need it, we want to be the full force for them to follow through and make sure that they have everything they need in their medical journey.
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Emily Dumas: I want to say thank you all for listening today, I appreciate your time I have listed my contact and amy's contact on here she have any questions or wish to have any sort of follow up and i'm open to some questions.
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Shahid Shah: All right, fantastic, so we will be, of course, getting questions in the chat Emily while you're talking up here, so we definitely welcome that, but.
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Shahid Shah: I love this presentation, because it was chock full of data, not a bunch of intentions that you had not a bunch of things where you are going to be making guesses about things, but you know stuff that.
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Shahid Shah: really is not only working but but has evidence of working so let's start with maybe one of the hardest questions, and that is.
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Shahid Shah: Which are the patients do you think Emily that are the hardest to activate regardless of whether you have digital or not, because what we're seeing is especially that number that you showed from 60% 80% or 8080 plus percent engagement.
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Shahid Shah: There is still, you know the north of the 80% that are still not going to get engaged somehow so let's start there who are the hardest ones, and why, in those cases, do you think that they're hard to activate even digitally Thank you.
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Emily Dumas: I think that's a good question um, so I think it varies, I think we have to look at it.
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Emily Dumas: The way the world is advancing now with technology and how many things are thrown at patients across their care continuum and then just in their own real lives.
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Emily Dumas: You might have a patient who gives us their work phone number but they're only at work eight to five.
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Emily Dumas: You might have someone that gave us a cell phone number that's no longer in use or they moved and forgot to update their phone number with us, or maybe we had a human or computer error, where we might have missed typed the person's information when we put it in.
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Emily Dumas: So there's always definitely different pieces, I think one of the most exciting things about as we move forward with me and other processes in place at uab is expanding to text messaging.
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Emily Dumas: So I hope that, through offering email phone calls and text messaging that we're able to reach greater beyond that 80% of patients.
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Emily Dumas: But I think meeting the patient, where they're at in the way that they want to be met in a way that's not overwhelming is kind of the key to utilizing this process is you don't want to send them.
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Emily Dumas: You know, five text messages a day you want, maybe one a week so really identifying what is the appropriate amount that a patient wants to receive information from their health care provider is the important piece.
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Shahid Shah: yeah and it sounds like what you're suggesting is based on the fact that, whether you go out with them with texture any others, it seems like the.
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Shahid Shah: requirement of making sure you have a proper phone number of proper email, etc, which we all try to do.
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Shahid Shah: But don't always end up prioritizing so it sounds like one key lesson here, especially that you're sharing with us is hey everybody before you go spend a lot of money on.
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Shahid Shah: A whole bunch of digital and other things, how about just do some simple blocking and tackling and making sure that your contact information is up to date and then what's interesting is you know Wolters Kluwer, of course, as as a.
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Shahid Shah: group that builds me for you guys could also be used for helping to maintain and update those contacts, so it looks like these are.
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Shahid Shah: orthogonal issues, but if you can get the contact information updated seems like me and these other products will do much better as well, I also found it interesting Emily you mentioned that.
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Shahid Shah: You saw a lot fewer cancellations using I mean, I think it was a case study number two I found that interesting because I wouldn't have connected cancellations with engagement right.
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Shahid Shah: tell it tell us a little bit about was that a surprise to you guys or how did you feel the engagement mattered in terms of cancellations.
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Emily Dumas: Right, I think it was actually a very pleasant surprise i'm not sure we expected to see that with quite so much significance.
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Emily Dumas: But it is wonderful to know that reaching out to patients and saying hey this is what's happening in your healthcare journey.
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Emily Dumas: This is what you can expect these might be some good questions to ask your doctor really getting the patients by and how they can engage with their own providers to take back to themselves.
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Emily Dumas: And, especially in being able to expand, not just to the patient, but to their caregiver and loved ones.
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Emily Dumas: really can inspire them to engage their own self care journey we want the patient to think about why is this good for me, why are they sending this to me.
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Emily Dumas: We don't want them to feel overwhelmed but in the example with endoscopies and colonoscopies everyone, you know you probably think oh I probably need a colonoscopy at some point.
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Emily Dumas: But these gentle reminders are a good way to say hey your doctor has recommended this for you or you've reached an age where it's recommended overall that you might need something like this it's something to be thinking about.
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Emily Dumas: And I think in getting patients thinking about what their medical journey needs to look like right now really inspires them to continue looking at to ask those big questions and saying is this right for me is this something I need to do now.
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Emily Dumas: But um with that having all that information out there, I think, patients have more buy in, and with that by and they say okay i'm ready to do this.
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Emily Dumas: let's knock it out all my questions have been answered, I feel, educated about the process i'm ready to come back to uab and have whatever procedure done.
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Shahid Shah: yeah and it sounds like the couple of key learnings here are that by staying in contact with the patient.
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Shahid Shah: Now we you didn't mention the cost savings associated with that.
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Shahid Shah: Cancellation reduction but it's significant right dex whether it's a fee for service or just rescheduling everything.
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Shahid Shah: and making sure that proper utilization gets maintain its substantial and so we're talking about easily hundreds of thousands of dollars potentially in cost savings.
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Shahid Shah: But more important than that is the increase in the trust that the patients now have with uab so talk about that a little bit is, if you get this digital stuff right if me does its job properly.
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Shahid Shah: What is that trust worth and then, once you've gained that trust through this means what else could you do with these patients with now.
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Shahid Shah: That increased trust, because I think it was increased trust.
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Shahid Shah: which reduce the cancellation right because they trusted you guys to say okay this probably is important, so let me go ahead and come in rather than just saying hey I don't understand what all this is about, so what else do you get if you can build that trust.
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Emily Dumas: Right, I think, in engaging with our patients, we really want to encourage them on that self growth journey but in providing them education in a more preventative way.
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Emily Dumas: We think we're able to better connect with those patients don't want to have bad news.
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Emily Dumas: They want to have hey, this is what we can do to prevent future bad news so anything we can do to really make sure that we're connecting with the patient at that right time in that right place in the way that they want to be connected with is going to benefit us.
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Emily Dumas: So in connecting for colonoscopies we're reaching out multiple times throughout the year, we have the colorectal awareness month that we can reach out to patients, but we want to be engaging with them.
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Emily Dumas: In order to make sure that they know hey we might be physicians but we care about you, you know your nurses care about you, your staff cares about you.
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Emily Dumas: And for things like the transition program that's falling those patients, you have a real life nurse that's going to call you back and make sure that whatever issue you said.
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Emily Dumas: we're following up on that we are here for you across your care journey and we want to make sure that we're engaging with you in a way, you want to be engaged with.
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Shahid Shah: yeah I love that, in fact, as you started to talk about the second and third case studies.
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Shahid Shah: You honed in on one key important factor in that is that the staff were able to spend more time on the things that are most useful to patients, rather than a bunch of administrative kinds of things you didn't mention.
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Shahid Shah: The word that we're hearing about quite often, which is a burden reduction or burnout So could you talk, are you are you able to make any guesses or think about whether this really helps with staff burden reduction or data just shift the burden.
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Shahid Shah: And if it does help with burden production.
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Shahid Shah: Does it also help with burnout reduction or was that not something you guys noticed much at all.
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Emily Dumas: It is something we tracked so it's something that I find really interesting, so I have a team of five nurses currently that work under me and they are the me transition nurses.
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Emily Dumas: Their whole role is to respond to those patients who received a call series report a red flag and and my team goes in response to them.
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Emily Dumas: So they're each specially trained for whichever area they might be responding to be that heart failure diabetes COPD.
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Emily Dumas: pneumonia has big a bit been a big win over the last couple of years with Kobe we also see that coven induced pneumonia and so through those programs were able to respond to patients.
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Emily Dumas: For, however, they want to so with the call series, the way that works is, we can automate through the system using power chart it's also workable for epic if anyone uses epic.
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Emily Dumas: So everything is fully integrated if you put in a diagnosis code or do something with a location, you can track those patients.
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Emily Dumas: And then from there, you can fire off the call series, you can fire off the me engage education, whatever you need to do to connect with that patient back, but you are following them through that journey.
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Emily Dumas: So then, it gets back to our nursing staff and so instead of your nurses spending, you know.
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Emily Dumas: Eight hours a day, calling however many patients numbers, they can get through, you have a computer system that is doing this all for you.
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Emily Dumas: We have really taken the heavy burden off of the nurses and given them just the work that they need to be doing, which is talking and connecting with patients to make sure that they know we care about them.
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Emily Dumas: And we're getting to them as fast as we can we don't want you to receive a phone call and then get a phone call from a nurse five days later, when your issue might have gotten worse, we want to be there and be able to escalate you to wherever you need to go.
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Shahid Shah: Right and and at this point, this program that you are studying did not incorporate.
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Shahid Shah: email and text and so almost all the value you're getting at the moment is just you know regular old plano phone calls at the moment, what do you feel will happen as you get more digital and text and other things going.
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Emily Dumas: Right, so I do, I guess, need to have a correction um, so we are using me engage, which is an email based platform so.
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Emily Dumas: that's what.
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Emily Dumas: is used to that smart computer soft so where you need a smartphone device or an iPad or anything like that.
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Emily Dumas: But we are currently working on text messaging so i'm very hopeful that that will be coming out the next month or two but i'm very excited I think as technology has grown and, as people have become more adjusted to what kinds of technology are out there.
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Emily Dumas: Especially with different generation gaps, I think.
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Emily Dumas: Some of our younger people don't want to necessarily answer a phone call, especially if you're at work, you know you miss your phone call.
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Emily Dumas: it's not a big deal we're going to attempt to call you again through the automated software, but with a text message you can respond to any point throughout the day.
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Emily Dumas: And then same thing a nurse can call you back same day or next day, because you engaged.
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Emily Dumas: So I think it's going to be a wonderful thing I think technology really opens the door to be able to connect with our patients it's just making sure that they know that this is there for them, and that we're here for them at uab.
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Shahid Shah: No perfect and and the education material that I think it was in your second first or second case study that you mentioned.
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Shahid Shah: The graphics you showed about the colonoscopy and explaining things in advance, are those standard already produced materials that.
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Shahid Shah: me is giving you with the package, where does uab have its own custom materials that you're using with your own doctors and nurses and stuff on it then just talk about that and then i'll ask you for the question based on that.
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Emily Dumas: I think that's actually really good question um so you have the option of doing both are we utilize both that you may be.
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Emily Dumas: So me has a wonderful platform, they have this program called try me we're all of their education lives, I think there's over 400,000 documents on it it's crazy number, you can find something about anything you're looking for.
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Emily Dumas: But me is really good to work with is anything a team brings me and says hey I need a video on this thing is that something you have or said something you're working on.
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Emily Dumas: And I can say hey I can see that's in the list or yes, I have that for you i'll put it into the system, you can start using it today.
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Emily Dumas: And then at uab certain physicians want to do things their way as i'm sure you can imagine, so if they have anything particular.
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Emily Dumas: they're able to go through our marketing department create their own video and then me can host that for them, so it works, the same way, just a little bit more leg room for it uab where they can create what they want to we're able to share that.
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Shahid Shah: perfect and what I was going to add to that was is there anything that you guys have noticed in terms of the data that you might have or that you might explore in the future is.
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Shahid Shah: Does it matter to the patients, whether or not their personal physician or physicians from their university in your in your case, your institution or there.
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Shahid Shah: or hey if, as long as the information is good, they don't find any big difference between the personalized education versus the non personalized when any any guests guesses on about that.
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Emily Dumas: I think it varies I think some patients might prefer to see their loving Dr space.
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Emily Dumas: But most of the time, it seems like everyone is just happy to have the education at their fingertips, I think, having easy access in a simplified format.
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Emily Dumas: All the education is at about the fifth grade literacy levels so me really makes it easy to understand and I think just through the ease of use the ease of understanding the ease of access that really does just kind of nail it for our patients I think it's a good thing for them.
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Shahid Shah: perfect and and just as a last question, I know we're running out of time, almost talk to us a little bit about what are some ways that you think that many organizations like if you are about to do this again.
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Shahid Shah: You know you've gotten some success, out of it, what would you do differently, based on what you've learned.
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Shahid Shah: And, did you have any myths or misconceptions about what you're about to get into any advice for people who are about to get into this about what you might do differently if you were to do it again.
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Emily Dumas: I think fully integrating earlier that takes we've had several systems i'm sure, as everyone at a hospital knows is some people know about something some people know about something else, and then it no one understands what everything does.
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Emily Dumas: So I think getting out there to every single position team every service and saying hey me is hear me has all these things available for you, this is what we can do for you.
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Emily Dumas: I think that's been one of the biggest challenges that I wish we had done a little faster a little earlier.
Emily Dumas: Just to compete, but really it's such an overarching system with so many amazing points, especially with all the different technology format, so it uses and brings everything together it's a great Program.
Shahid Shah: yeah perfect and my just you know concluding remarks would be, this is not one of those things where you say hey should we do it or not, of course, you have to do it, you have to go digital, you have to go engaged.
Shahid Shah: You have to put all these tools in, and I really love that advice Emily that you gave this.
Shahid Shah: don't have acid go all the way in get your integrated model going and the other advice everybody should.
Shahid Shah: Take from Emily is get your contact numbers and everything in order beforehand, because if you just have if you have bad data in your contact databases, this process is not going to be as Nice as it as that me has turned out.
Shahid Shah: For the university where she's at, but this was fantastic Thank you so much Emily for sharing all your partnering with patients advice and we look forward to you in our next session everybody.