The persistent nudge of government policy has undoubtedly pushed the health-care world into modern times. Whether welcome or not, mandates such as meaningful use have made concepts such as patient engagement a priority among RIS/PACS design teams across the country. Even without rules and regulations from government entities, the organic evolution toward greater patient involvement has mirrored the free flow of information inherent in the smartphone revolution.
“Patient engagement is being driven by meaningful-use adoption, but I think we are also at a crossroads. In fact, we’ve probably actually passed that crossroads,” says David Wild, director of medical informatics, FUJIFILM Medical Systems.
Easy access to data in so many other aspects of life, Wild explains, has enhanced convenience and productivity. The result is that people expect the same level of easy access in their health-care lives, and for many, that means mobile access to data.
“Look at the integration of biometric data-capture devices for health care, such as the Fitbit® (and how it can piggyback with your mobile device),” Wild says. “The Nike FuelBand, with its yellow, green, and red lights, can have an impact on behavior. The wearable technology can influence people to make sure they show up on time to appointments. Eventually, you will see wearable devices and mobile devices encapsulating health-care information that is disseminated to radiologists at the point of interpretation.”
Push to the Future
Push notification, on smartphones and/or wearable devices, has the theoretical (and actual) ability to bring unprecedented speed and awareness levels to health-care information. “People can be proactive with their own care, if you give them notification and access to information,” Wild says. “As a result, they can follow up on their own care conveniently.”
The problem for patients and physicians alike, Wild says, is usually the sheer number of moving parts. A man who injures his neck, for example, might go to a primary-care physician, a radiologist, a specialist, and a surgeon.
After seeing so many physicians, he might be admitted to the hospital, which might (or—more likely—might not) have access to data from the preceding points of care. As part of the continuity of care, the patient, Wild believes, must be part of the process, with unfettered access to his or her personal health information. “From there, you give that transparency of data, and you let responsible people behave responsibly,” Wild says. “I think that is what is going to happen, the majority of the time. That’s why it’s so important, in patient engagement, to provide access to accurate information quickly.”
The patient portal—a tool likely to be used widely in getting patients to access their health data electronically (a meaningful use stage 2 requirement)—will make it easier for patients to engage with the radiology practice. It’s no small cultural change, but the shift is on, and Wild believes that the industry is starting to get on board. Part of the challenge, he says, is that referring physicians typically read a radiology report from the bottom up, but patients will read it from the top down, first reviewing the findings.
“The bottom of the report always says, ‘Here is what I think,’ with the impression,” Wild says. “The patient reads the findings before reading what the physician thinks. Physicians read what the radiologist thinks before they get into the details. There are certain pieces of information patients are not well equipped to understand, but it doesn’t mean you should not give them the information and give them an opportunity to be proactive about helping disseminate it among the providers, who may be overloaded with information.”
Push notification capability in the Synapse RIS is enabling radiologists and radiology department personnel to “subscribe” to specific patients and follow them through the department via alerts that arrive when, for instance, a patient needs to be protocoled or a patient-hold pending a preliminary report is in order. “Somebody needs to keep a pulse on a patient if there is a possibility of a negative result, and the referring physician is waiting for the results,” Wild says. Fujifilm calls the feature Synapse Pulse.
Engaging at the Gate
When it all works well, this entire IT experience can assist radiology practices in engaging patients—from the point of entry to preparing for the exam, accessing results, and obtaining follow-up care. For Wild and his staff, the totality of the experience contained in the patient portal can (and should) encompass all of these elements—up to and including where the data should ultimately be disseminated, the financial status of the exam, and safety parameters.
“Patient engagement is not just accessing an exam,” Wild says. “Our portal helps patients prepare for the exam. Patients have the ability to request studies online and access their records upon finalization. The patient portal structures the final report for referring physicians, but it also allows radiologists to communicate with patients within the portal.”
He adds, “We also structure it so that we can give comments and information related to that particular study as part of the report-access process, with integration with PowerScribe voice-recognition macros. To preface the report for patients, radiologists essentially add a note so that patients can understand the report.”
Designers at Fujifilm have enhanced the clarity of this information through an intuitive interface with the company’s redesigned Synapse Patient Portal. The new version of the patient portal debuted at last year’s RSNA annual meeting in Chicago, Illinois, and will be available to Fujifilm RIS users as a native tool. “We build tools to ensure radiology practices can go about the IT experience without worrying about training patients. It’s similar to that mobile-user interface that people feel so comfortable with; nobody needs training in how to use an app from the iTunes store. They figure it out,” Wild explains.
In the wake of breaches at Target and elsewhere, Wild believes that patients expect a certain level of online security. Patients who use the Synapse portal will have the comfort of two-factor authentication, which Wild believes fosters a high level of trust (since patients are being validated through both mobile phones and email addresses). From a practical standpoint, filling out forms online means that there’s no need grab a clipboard in the waiting room, writing names and addresses multiple times.
With this in mind, Wild emphasizes that patient engagement is a high priority for Fujifilm, with dedicated teams specifically working on patient engagement and the patient experience. “We must give patients the experience that allows a practice to differentiate itself,” he says. “The patient-engagement experience, via true patient portal, is a very high priority for Fujifilm, and one we are investing in heavily.”
Wireless and Wearable
In the grand scheme of patient wellness, patient portals within radiology might ultimately reach a level of integration that is currently unthinkable. Then again, Wild has thought about the topic a great deal, and he points out that so much technology is already here that it’s important for radiologists to have as much information as possible. All of it could affect the interpretation process.
On a here-and-now level, Wild believes that push notification is extremely valuable to alert patients concerning their status, to tell them where they have to be (and when), and to issue reminders. “Wearable technology can influence people to make sure they show up on time and do certain things,” Wild says. “It’s almost like a virtual string around your finger.” Noting that Google is developing wearable glucose monitors (as a contact lens), and Apple is developing a health-care suite, he adds, “Eventually, these wearable devices are going to power information that can be given to various health-care providers.”
All these reminders can ultimately serve to bring more people in the door, while effective patient portals keep them engaged in (and satisfied with) the process. “I have a smart watch that sends me SMS text-messaging data and relays my phone messages to my watch,” Wild says. “The next evolution will be incorporating affinity-based health care, where people subscribe not only to a patient, a finding or a report, but to specific markers and trends that you will find within data that say, ‘If these things occur, then I want to send a push notification to somebody.’”
Wild continues, “They will look for a patient with a particular event, particular history, or particular population—and then, they can act on it. When the events occur, you are notified immediately. There is no reason those things can’t happen in health care. That’s why I’m excited about the concept of affinity—how we subscribe to news events and are alerted in our day-to-day lives— and the implications for early detection, screening, and patient engagement.”