[MUSIC] Hello, this is Bruce Darrow, and we're going to be talking about what patients tell us that they want from health information technology. Now, to be fair, most patients don't specifically go into their healthcare encounters, or to their doctor's office, or to their hospital, thinking about what they want from information technology. They think more along the lines of what they want from their doctors, their nurses, their therapists and the people who are taking care of them. However, if we look at the answers to those questions, there are a lot of things that we can learn in terms of how we can use technology to help further those ends for patients. So a company called Press Ganey does a lot of surveys of patient satisfaction on behalf of hospitals, doctors and emergency departments. And what I'll show in these next three slides here is information for Press Ganey about the responses we get from hundreds of thousands, if not millions, of patients who have responded to these surveys. What they ask in these surveys is, are you likely to recommend this doctor, this hospital, this emergency department to family or friends? And for those people who answered either yes or no, they looked at the major drivers behind that decision. So for these these three slides, on the right side what you're going to see, in yellow, is those questions that when the person taking the survey answered yes, it drove the furthest acceptance of satisfaction of the patient and the likelihood to recommend things. So the first slide here is showing responses for office based care. If you go to see your doctor in your doctor's office, what will make a patient likely to recommend that doctor? So the first question is, do you have confidence in your provider? If you answer yes to that question, and 81% of patients answer yes to that question, the vast majority of them will recommend that provider to a friend or a colleague. If you further subdivide those, and look at the next leading question in terms of determining likelihood to recommend, the second order question is the answer to the question, my doctor worked together with other clinicians and people on my care team. So that was the second level driver of satisfaction, and then at the bottom, the third level driver was my provider showed concern for my worries. If a patient answered yes to all of those questions, then the likelihood that that patient would recommend that provider or that providers office, was 99.4%. So very highly correlated with likelihood to recommend, and as you look at rest of the slide you can see that when you go down some of the other choices there, you get slightly different questions. But those are three biggest drivers of ambulatory patient satisfaction, confidence in the provider, providers and clinicians work together and the provider's concern for my worries. When you look at patients answering from a stay in the hospital as to what would lead them to recommend that hospital, the questions are slightly different. The top level question for driving patient satisfaction is staff worked together. And this likely represents the fact that in a hospital setting, you have potentially multiple doctors, you may have different specialists, you have nurses, you have social workers, therapists. You may have at a teaching hospital not just your attending physician, but physicians in training or medical students on your team. So the the top level question and the top driver satisfaction for what patients want, in a hospital setting, is a sense that the staff worked together. And if you were among the 70% of patients who said, yes, my staff worked together, then you're 87% likely to be recommending that hospital. The second order question is about cleanliness of the room which is not necessary a health IT issue, but is definitely important to patient satisfaction. And then the third is that nurses are listening to me. If the answer to all three of these questions is yes, then 93% of the patients who answer yes to all three will recommend that hospital to others. Finally, the experience in the emergency department is slightly different. So, at the top, the question that's the biggest driver of satisfaction is the question, did the staff care about you? If the answer is yes, that drives patient satisfaction the most. The second one is, did the doctor keep you informed? And this is an interesting one because when you do the substudy on this, it doesn't matter what the length of time is if they're informing you that something is going to take a certain amount of time. It doesn't matter if they're waiting one hour or five hours. If the doctor comes over and says, we expect the answer in one hour or we expect the answer in five hours, just the act of informing is a strong driver of patient satisfaction. And then the third driver is information about delays which is related to keeping you informed. So three drivers, and you can see that there are different drivers of patient satisfaction in the three settings of the emergency department, the hospital and in office based care. However, there are certain common lessons that we can take from these questions and these answers. It's clear that patients want to have confidence in their providers and their care team, whatever the setting. It's clear that patients want their clinicians to listen to them, care about them and talk to them. Patients want their clinicians to work with one another, it's not enough to be satisfied that you had a good doctor, you want that doctor to be working with other doctors, taking and giving information, working with nurses and other staff. And finally, patients want information from their clinicians when it comes to the fact that some care doesn't happen immediately and there may be delays., and expectations at how long things will take. So lets look at that set of lessons one at time. The implication for health information technology. If you want to have confidence in your providers, then health information technology should make health data accessible, available and easy for your clinician to find and use. And let your patient know, yes I know what your other doctor said about you, I know the results of your tests, I know what we talked about the last time you were here. Health IT should make your doctor know what happened to you. If you had something happen at another hospital, if a doctor prescribed a medication for you and you're not quite sure which one it was, so you wanted to know whether or not it's going to be a problem. The patient will want the doctor to have that information available, and that will be one of the main drivers of satisfaction. And health IT should help your patient know that the doctor is going to make right decisions. If you are taking a medication, and it's not clear to you whether you should take that medication as a patient, you would want the technology to make your provider a better caregiver. To be able to say, yes this medication doesn't react with any of your other medications, this medication is appropriate for your condition or your therapy. And to take whatever technology information is there to drive quality care. So to the second point, patients want their clinicians to listen to them and care about them. This is a place where health information technology potentially is not a help but is a barrier. They want health information technology that's not going to interfere with the relationship between the doctor and the patient. They don't want the doctor or the nurse to be treating the computer. They want the doctor or the nurse to be treating them as a patient. And the computer should supplement but not interrupt that relationship. The third lesson is that, patients want the clinicians to work together so health IT should connect the care team members to the patient and to one another. Two doctors working in coordination with one another are better than two well skilled physicians who are not working in combination or are knowledgeable of what each other is doing. And if they are both communicating with each other and the patient simultaneously, then it's giving a stronger benefit. And as we discussed before health information technology means that my clinician knows what happened to me. And then the last point about patients hoping for information about how long things are going to take and how long they have to wait for things. Heath information technology has the potential to make that available to our clinicians, so they can share it with the patients, or in some case, it may make it directly available to the patients. If a patient can tell online what the waiting time is to be seen at an emergency department, they are more likely to make an informed decision about whether to go to that emergency department. And the other thing that they want is for the fact that health information technology is available. That should reduce delays, you don't have to wait for somebody in medical records to pick up the phone to get a signed document and fax something over, if you can sign a release for electronic access to that information. So where possible health IT should be the enabler to, not only inform about delays, but to reduce them. [MUSIC]
