Christiana Care Health System in Delaware views patient engagement as a core strategy to improve patient outcomes and hospital performance. Christiana Care began using an interactive software system in 2006 as a principal means for engaging patients in their care process. From the outset, the goal in utilizing this technology has been to foster a more patient-centered care experience. The result for Christiana Care has been improvements in quality, safety and the service experience for its patients as well as improvements in nurse workflow efficiency.
The vendor the hospital is using is a hospital bedside software solution that includes a wide range of applications, content and workflow capabilities to proactively engage patients as active participants in their hospital care process. Using a computer at the bedside, the in-room television as a monitor, easy to use navigation devices (i.e. integrated pillow speaker, keyboard or touch screen monitor), patients and families are guided through their stay with appropriate interventions that result in a more empowered patient and better quality/safety outcomes. The average cost to install and operate this beside technology is approximately $3.50/hospital bed per day.
Christiana Care identified three key outcomes priorities for its patient-engagement strategy: patient-education completion, patient satisfaction with medication education and improvement in nursing workflow.
This case study reflects the work and impact of this vendor on patient education completion and patient satisfaction with education.
A specifications interface was built between the vendor and the electronic health record system at Christiana Care. With this interface, an education order placed in the EHR is automatically conveyed to the system. Once conveyed, a patient education pathway is triggered and the education process is initiated. A core element of Christiana’s use of the vendor is a workflow engine that fosters and facilitates patient engagement through prompts and through a workflow mechanism. These patient pathways have proven to increase patient utilization because of the proactive approach to communicating with the patient.
Once the patient education pathway is triggered from the EHR order, the patient receives an alert on their television indicating that their care provider prescribed education for them and asks the patient if they are ready to receive that information at that time. If the patient is not ready or not viewing their television at the time, the pathway goes to a queue and the patient will be asked again at certain intervals up to a maximum number of times all configured by the hospital. If the patient does not choose to receive the education, the system has the capability to alert nursing so that further follow-up may occur.
Once the patient is ready, the patient is taken to video-based education content for viewing. Once completed, the patient may be asked comprehension questions. Again, the system will trigger nursing indicating if and what the patient did not understand regarding the education provided to them.
Once the education is complete, the evidence of education is then automatically sent back to the EHR as a result within the patient’s record.
Christiana Care takes a very deliberate approach to process change and the implementation of new technologies in patient care. The organization’s priority needs are first clearly established. A strategy is developed.
Applications, content and interfaces needed to fulfill the strategy are built and tested. Christiana Care begins with a beta test where there is significant change in processes. In this particular case, the interface between the EHR and the vendor offered significant improvements in nursing workflow because of automated triggers, the patient pathway and the automated documentation capability. Once demonstrated in beta testing, the functionality, interfaces, content and training are then progressively rolled out across nursing units.
This advanced use of the technology coupled with enhanced content, and staff training has resulted in impressive outcomes for Christiana Care. The phased roll-out utilized by Christiana Care allows them to measure the direct impact of this education initiative, which realized full functional capacity in the fourth quarter of 2008. The baseline performance was significantly improved upon in the following areas (also shown in the chart below):
- 127% increase in education utilization on the GetWellNetwork System
- 24% increase in education completion
- HCAHPS performance: unit 4C at CHC also concurrently realized significant advances in HCAHPS "Top Box" scores (rating of “Always”) post process redesign.
- 23.2% increase in satisfaction with “Explain things in a way you could understand.”
Parameters for the American Recovery and Reinvestment Act of 2009 funding through the Agency for Healthcare and Research Quality are being established by the Institute of Medicine and will be available June 30, 2009. Following that, the AHRQ will most likely seek funding opportunities that are consistent with its mission of improving quality, safety, efficiency and effectiveness of healthcare. While specific stimulus law grant opportunities are unknown through AHRQ, we anticipate the opportunity to seek funding either through a small grants program or through a call for proposals to support further research demonstrating the impact of patient engagement through the vendor on medication safety.
Steve Hess
CIO
Christiana Care Health System
Wilmington, Del.
