Reach, Engage, and Care for Remote Patients: 4 Tips

Family physician Linda Girgis is exploring how mobile devices and other technologies can help her better reach and engage with patients when they are outside her practice. So far, so good. The South River, N.J.-based physician says she and her husband, also a family doctor, are finding that encouraging patients to use wearable devices and other tools at home helps them capture more patient health information than they would typically capture in the exam room. "We do sleep studies, we do cardiac monitors, [and] 24-hour blood pressure monitors," says Girgis. "The patient will wear the device and they'll bring it back [to the practice] at the appropriate time, and then we'll upload the information and analyze the results."

Girgis is also encouraging more of her patients to use smartphone applications at home, such as those related to weight loss or fitness. For some of the patients who stick with the apps, she says, the technology is leading to higher engagement and better health outcomes.

Girgis, who is on the advisory board for physician social networking site SERMO, is part of a growing group of physicians exploring how different technologies and devices can help them better care for patients outside of traditional face-to-face visits. At Physicians Practice, we refer to this as mobile health, or mHealth. While definitions of mHealth vary, we define it as the use of technology to track, engage, monitor, and care for remote patients. Here's more on how incorporating mHealth into your practice may benefit you and your patients.

COLLECTING HEALTH INFORMATION

If your practice has a secure patient portal, you may already be exploring one area of mHealth: using technology to collect health information from remote patients. For instance, remote patients may be inputting their medical history and current medications into your patient portal.

But you may want to consider additional mHealth tools, such as wearable devices and apps, to collect more specific health information from remote patients over longer periods of time.

A patient, for example, might use a device to capture health information related to his blood pressure, caloric intake, or fitness level. Then, he might bring the device to his next appointment so that you can review the information stored on the device, and possibly, add it to his medical record.

Ultimately, the information gathered remotely might help guide future medical decision making and/or treatment recommendations. For instance, Girgis has asked patients to use a blood pressure monitor remotely so that she, and the patient, can better understand the patient's condition and treatment needs. "A lot of times with the blood pressure monitors, we can show them that their blood pressure is indeed a problem; they need medication," she says. "Sometimes they'll say, 'My blood pressure is always high when I come to the doctor,' and there's no way to really judge that … so we use a 24-hour blood pressure monitor and we show them, no actually, it's high at home as well."

ENGAGING PATIENTS

Another aspect of mHealth your practice may want to consider adopting is technology to help remote patients take more control over their health. In this type of situation, smartphone apps might be a great tool to consider using, says Robert Tennant, an executive consultant at Beacon Partners, a healthcare management consulting firm. If a patient uses an app to track caloric intake, for instance, and he closely monitors his intake on a daily basis, he may begin making healthier food choices independently. Plus, the information stored on the app might serve as a great tool during future consultations with the patient, says Tennant, adding that physicians might even be able to work out an arrangement with payers so they are reimbursed for the work associated with the app analysis and review.

Physicians who are interested in recommending apps to patients should look for apps that are easy to use and easy to understand, says Jonathan Linkous, CEO of the American Telemedicine Association (ATA). Otherwise, he says, patients are likely to stop using the app after a day or two. "There are a lot of these things that have lots of bells and whistles on them, but it's only [useful] as a good marketing element; it's not necessarily used for good healthcare," he says.

In addition to apps, physicians may want to consider using automated text messaging to engage remote patients, says Diana DeRuyver, also an executive consultant at Beacon Partners. For example, automated text message appointment reminders might increase patient adherence with follow-up care; and motivational texts to a defined group of patients, such as diabetic patients hoping to lose weight, might lead to health improvements, she says. "I really like the idea of mobile text messaging ... because you're still involved in inspiring them after they leave [your practice]."

MONITORING HEALTH STATUS

A third aspect of mHealth you may want to consider is the use of technology to track and monitor remote patients' health information and health status, also known as remote health monitoring. In this scenario, a patient might use a device that automatically sends health information back to your EHR. You may even be able to set up an alert so that you are notified immediately if the information relayed by the device indicates a serious health problem.

 "Remote patient monitoring is an area that is really a 'win-win' for the patient and provider in the sense it gives the provider a snapshot of what's happening with that patient on an ongoing basis," says David Collins, senior director of health information systems at the Healthcare Information and Management Systems Society (HIMSS). "It provides additional data trends and information to enable a more informed decision to treat a patient, rather than the very brief data collected during the typical face-to-face visit."

As more remote monitoring devices hit the market and their capabilities expand to better meet the practice's needs, more vendors may begin approaching your practice about using them. But proceed cautiously before making a significant investment in such devices, says Brian Rothman, a member of the HIMSS mHealth Physician Task Force and medical director for perioperative informatics at Vanderbilt University Medical Center. "There are folks out there that will tell you that their application is the best thing since sliced bread," he says. "Be very certain that the literature and their solution both have delivered on that in a meaningful way ... you could be spending quite a bit of money for very little benefit."

Also, consider if the time you will need to spend reviewing remotely transmitted patient information is practical for your practice, says Linkous. "The last thing a doctor wants to have is a flood of data from every patient that they don't know what to do with, and they can't get paid for."

TREATING PATIENTS

A final aspect of mHealth you may want to consider is using technology to treat remote patients, such as care provided through a telephone consultation, a patient portal, or a video visit.

Of the three, Derek Kosiorek, a principal consultant with the Medical Group Management Association Health Care Consulting Group, says messaging via a patient portal may be the most practical route for physicians who want to begin answering simple patient questions and making basic diagnoses for remote patients. Messaging, he says, is often more efficient than telephone consultations, as physicians can answer messages when it is convenient for them and without engaging in a two-way conversation. Plus, he says, some payers are beginning to reimburse for messaging if certain requirements are met.

To get started with messaging to remote patients, Kosiorek recommends opening the portal messaging feature to a select group of portal users, reviewing payer requirements to see how you might get reimbursed for such care, and making sure staff members only relay messages to physicians if they require a physician's response.

Video visits are another area of remote patient monitoring you may want to consider. Not only are physicians and patients using them - the ATA estimates that approximately 800,000 virtual patient consultations will be performed this year - more payers are also reimbursing for them. "Some physicians would consider [the increasing use of e-visits as] a bit of a competition that's coming into their area, [but some are using] it as a way to reach out to their own patients and establish better care and a stronger and bigger practice as well," says Linkous. "It all depends on how you consider it, but it is definitely a wave that's here, it's not just coming, it's here."

In Summary

New technology makes it easier for physicians to reach, engage with, and care for remote patients. Here are some tools to consider using at your practice:

• Apps and wearable devices that collect remote patients' health information

• Apps and automated text messages that engage remote patients

• Monitoring devices that automatically send patients' health information back to the practice

• Secure messaging that enables physicians to answer remote patients' questions and provide basic diagnoses

Aubrey Westgate is senior editor for Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the May 2015 issue of Physicians Practice.