Eisenhower Health in Rancho Mirage, California, serves residents of the Coachella Valley, where as many as 70% of its patients are seniors. The health system is a healthcare complex comprised of a 463-bed hospital, the Annenberg Health Sciences Building at Eisenhower, and the Barbara Sinatra Children’s Center at Eisenhower, in addition to its outpatient facilities in Palm Springs, Cathedral City, Rancho Mirage, Palm Desert and La Quinta.
The clinic division reports approximately 500,000 outpatient visits annually, including areas of oncology, cardiology, orthopedics, primary and urgent care, as well as several specialty clinics.
“One of the primary challenges faced in the clinic division was addressing a no-show rate of 8% across all outpatient services — 5% within the clinic division alone,” explained Mark Steffen, chief administrative officer, primary and specialty care clinics, at Eisenhower Health.
“Manual patient reminder calls were made by clinic employees as a service to our patients. Clinic administration determined that approximately only 50% of these calls were actually being performed by employees due to the other priorities within the clinics or lack of adhering to standard work.”
IT vendor Well Health proposed a communication platform that would consist of both automated phone and text reminders using a bi-directional interface with the electronic health record.
With a one-time integration fee, Well Health would assist the Eisenhower Health information systems team to implement the platform with a conservative goal of reducing the no-show rate by 17%, based on the outcomes of previous installations.
There is a variety of patient text messaging solutions on the health IT market today. Some of the vendors of these technologies include Casetabs, Demandforce, Medici, OhMD, Patient Trak, PerfectServe, Revenue Well Systems and Solutionreach.
MEETING THE CHALLENGE
Once the three-year agreement was finalized, the project lead formed a steering committee to work with the Well Health team to develop an implementation plan. With support from the vice president of ambulatory services, the steering committee agreed to implement the solution across 55 primary, specialty (including cardiology and orthopedics), rehabilitation, and imaging clinics, and 522 providers, all on the same date.
“The application needed to be interfaced with the Epic EHR so that data from the EHR could feed patient demographics into Well Health,” Steffen said. “And based on recommendations from the legal team, a patient must sign consent for treatment and opt in before they can receive text messages.”
“The Eisenhower Schnitzer/Novack Breast Center estimated three hours per day in staff time could be allocated to other functions.”
Mark Steffen, Eisenhower Health
Messages were standardized throughout the organization by creating “quick responses” that staff could use, thus eliminating the need for free text. Content of messages was customizable by department and then reviewed for consistency by the project co-chair and the marketing department.
“We designed text messages and phone calls to be sent 72 hours prior to patient appointment time based on best practices from a consulting organization that Eisenhower Health used during the EHR installation,” Steffen said. “For instance, patients who responded ‘N’ to cancel/reschedule to their reminder notification were called by the clinic to determine if the appointment needed to be rescheduled.”
If the patient did not confirm or cancel, another text or call was sent 24 hours prior to the patient’s appointment time.
“For patient satisfaction, appointment reminders for Monday and Tuesday were sent on Friday of the prior week to eliminate the need to contact the patient over the weekend,” Steffen explained. “Patients would receive links summarizing provider experience and location to assist patients that were not familiar with the campus.”
Eisenhower Health found an early win with the implementation of the technology, using an automated message to provide additional instructions, such as notices to allow for extra time and the existence of valet services in areas under construction.
“Another feature that Well Health offered was the ability to send a broadcast message out to all scheduled patients at the same time in the event that a provider was unexpectedly unavailable to see patients,” Steffen added.
After go-live, the steering committee changed its focus from implementation to oversight of the system, with goals to standardize messages when possible, identify training needs, identify best practices within the organization, prioritize new clinic onboarding requests, and evaluate other features of the application (for example, campaign messages).
During the first eight months after implementation, the no-show rate for patients using the new technology continues to hold steady at 2.3% (down from 8%), with the orthopedics and cardiology centers achieving a no-show rate of 0.3% and 1.5%, respectively. 73.8% of all billed appointments used the Well Health reminder system.
“Clinics that used the system reported substantial savings in the time spent calling patients,” Steffen said. “For example, the Eisenhower Schnitzer/Novack Breast Center estimated three hours per day in staff time could be allocated to other functions. The Eisenhower Imaging Center estimated a greater savings of eight hours per day.”
For the month of August 2019, 42,269 outbound automated text reminders were sent to Eisenhower Health patients, and 29,287 automated calls were made. The organization achieved a 65.37% confirmation rate by patients that received at least one automated message, and a response rate of 69.14%.
“The finance department also showed an estimated net revenue increase of $158,596 through the same time period,” Steffen reported. “Subtracting the monthly cost of system utilization, Eisenhower Health is projecting an annualized net income of more than $75,000. This revenue enhancement is projected to increase to more than $260,000 if the organization can increase utilization of billed appointments to more than 75%.”
ADVICE FOR OTHERS
Based on feedback from the steering committee, the following are suggestions for other organizations considering this kind of technology:
- Involve the organization’s legal and marketing teams early in the process – identify potential problem areas, harness current marketing initiatives and strategies to develop and oversee standardized message for quick responses.
- Implementation should include an HL7 interface over a file data transfer.
- Gauge the organization’s preference for standard work.
- Understand how the interface with the patient portal used by the organization might be impacted.
- Don’t underestimate the need for formal training on this type of application.
Email the writer: [email protected]
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