Patient Engagement&

Telemedicine

Lisa Tayman MS, RN, CEN, CCRNSalisbury University

NURS 525

Federal Policy Brief

TITLEPatient Engagement. People actively

involved in their health and health care tend to have better outcomes—and, some evidence suggests, lower

costs

Patient Engagementcalls for reforms to achieve a patient-

centered health care system, wherein individual patient preferences, needs, and values are respected and patients guide all clinical decisions

combines patient activation (a patient’s knowledge, skills, ability, and willingness to manage his or her own health care) with interventions designed to promote positive patient behavior, such as obtaining preventive care.

Patient EngagementShared Decision Making= When there are multiple, reasonable

treatment options, each with their own risks and benefits, the correct path to follow should be guided by a patient’s unique needs and circumstances

Shared Decision MakingDecision aids such as: booklets,

videos, websites, and interactive media are used

All of these helpful aids will give patients information on the risks and benefits of various treatment options and help them make the choice that most reflects their personal values.

Research on Patient EngagementPatients who received enhanced decision-

making support had overall lower medical costs and fewer hospital admissions than for those who received only the usual support

People with the least skills and confidence to actively engage in their own health care (patient activation) incur costs between 8-21% higher than patients with higher activation levels

Patient EngagementMay be affected by such factors as: cultural

differences, gender, age, and educationFor patients to engage effectively, they must

have a certain degree of health literacyOne strategy to incorporate into practice is

the “teach-back” method

Teach-Back MethodThe provider will ask the patient to

explain back to them what they have learned, such as: their own understanding of their condition, the options available to them, and their intentions to act on the information

Future ResearchMore studies need to be conducted

to determine the best practices for engaging patients, as well as determining the extent of the relationship of patient engagement to health care cost savings

Patient EngagementEfforts are under way to hold health care

organizations accountable for engaging patients.

The National Committee for Quality Assurance surveys patients and ask about whether clinicians engage them in shared decision making or provide support for them to manage their conditions to determine if this quality measure is being met.

State Policy BriefShared decision making and being

engaged in their care, increased compliance for such issues as:

blood sugar testing for gestational diabetes

CPAP use

TelemedicineDefinition: The use of interactive audio, video,

or other telecommunications or electronic technology by a licensed health care provider to deliver health care services at a site other than the site the patient is located.

“Telemedicine Recommendations”This report addressed that effective use of telemedicine can increase access to health care, reduce health disparities, and create efficiencies in health care delivery

Telemedicine BenefitsHas the potential to increase access and reduce the cost of care.

Both consumers and providers can benefit from telemedicine

TelemedicineConsumers can experience increased access

to providers, quicker and more convenient treatment, better continuity of care, and a reduction in lost work time and travel costs

Providers can experience instant access to other providers, a reduction of medical errors, and increased efficiency with reduced travel and research times

Research shows:Telemedicine improves time-to-diagnosis facilitates access to care for patients

in remote regions increases patient satisfaction

TelemedicineTelemedicine offers an alternative to the

traditional method of care delivery (face to face)

Health care organizations faced with provider shortages, access disparities and budget challenges, are adopting telemedicine in order to connect geographically-remote patients with specialists, to allow scarce specialists to be available across networks, and to provide remote monitoring of patients

TelemedicineIt is recommended that payments

accurately reflect the cost of delivery for providers and the effectiveness of the treatments must be proven to payers and patients.

Payment must be sufficient to cover actual costs, but should not favor telemedicine over face-to-face services

Telemedicine legislationAccording to the Department of

Health and Mental Hygiene, telemedicine should be used to address access to care issues related to specialists being located a long distance from patients and not as a replacement for in-person care

TELEMEDICINECurrent fiscal and policy notes: SB 494 regarding developing strategies and

recommendations for advancing telemedicine technologies

SB 496 regarding the reimbursement of telemedicine services by Medicaid

SB 776 regarding establishing a Task Force on the use of telehealth to improve Maryland health care

Policy recommendationsTo establish a Task Force on the use of

telehealth to improve Maryland health care

This task force must assess factors related to telehealth and identify opportunities to use teleheath, as well as collaborate with organizations such as the Rural Maryland Council, and make recommendations regarding the use of telehealth in the State

Patient Engagement & TelemedicinePatient engagement combines

patient activation with interventions designed to promote positive patient behavior

Interventions such as telemedicine improves time-to-diagnosis, facilitates access to care for patients in remote regions, and increases patient satisfaction

References Capistrant, G. (2013). Letter to Maryland House of Delegates. Retrieved

from: http://www.americantelemed.org/docs/default-source/policy/ata-comments-on-maryland's-hb-931-and-934.pdf

Commission on Maryland Cybersecurity Innovation and Excellence-Duties. Maryland General Assembly 2013 Session, SB 494. Retrieved from: http://mgaleg.maryland.gov/webmga/frmMain.aspx?id=sb0494&stab=01&pid=billpage&tab=subject3&ys=2013RS and http://mgaleg.maryland.gov/2013RS/fnotes/bil_0004/sb0494.pdf

Health Policy Brief: Patient Engagement. (Feb. 14, 2013). Health Affairs, 1-5. Retrieved from: http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_86.pdf

Homko, C.J., Santamore, W.P., Whiteman, V., Bower, M., Berger, P., Geifman-Holtzman, O., and Bove, A.A. (2007). Use of an Internet-Based Telemedicine System to Manage Underserved Women with Gestational Diabetes Mellitus. Diabetes Technology & Therapeutics, 9(3), 297-306. doi: 10.1089/dia.2006.0034

References Maryland Medical Assistance Program – Telemedicine. Maryland General

Assembly 2013 Session, SB496. Retrieved from: http://mgaleg.maryland.gov/2013RS/fnotes/bil_0004/sb0494.pdf and http://mgaleg.maryland.gov/2013RS/fnotes/bil_0006/sb0496.pdf

Stepnowsky, Jr., C.J., Palau, J.J., Marler, M.R., and Gifford, A.L. (2007). Pilot Randomized Trial of the Effect of Wireless Telemonitoring on Compliance and Treatment Efficacy in Obstructive Sleep Apnea. Journal of Medical Internet Research, 9(2), e14. doi: 10.2196/jmir.9.2.e14

Task Force on the use of telehealth to imfprove Maryland health care.

Maryland General Assembly 2013 Session, SB 776. Retrieved from: http://mgaleg.maryland.gov/webmga/frmMain.aspx?id=sb0776&stab=01&pid=billpage&tab=subject3&ys=2013RS and http://mgaleg.maryland.gov/2013RS/fnotes/bil_0006/sb0776.pdf

Telemedicine Recommendations. Maryland Quality and Cost Council, December 2011. Retrieved from: http://mhcc.dhmh.maryland.gov/hit/Telemedicine/Documents/sp.mhcc.maryland.gov/telemed/md_telemedicine_report.pdf