Have You Watched Our Videos?

Please feel free to share the link as they reinforce our mission and vision for a  healthy community.
 

Clinical Leadership 

Mental Health

HIT / Meaningful Use

Rick and Diana's Story

Performance Improvement  

Patti's Story

Bangor Beacon Leadership 

Eric's Story

Is it me or did November charge in like a lion? We had our first snow fall on Election Day and now Thanksgiving is right around the corner! I refuse to start a countdown for Christmas though! I'm taking a lesson from many of our patients to live one day at a time and to its fullest.

Throughout the length of our grant, we have witnessed the importance of building strong relationships with our patients and their primary care team. It's pretty amazing to see what can happen as a result. A case in point is our oldest patient, Margaret Taintor, who turns 99 in December. Margaret recently fell at home and the first thing she did was call Kathleen Bates, RN, her care manager at EMMC's Husson Family Medicine. "The closest family Margaret has is an 85 year old niece five hours away," shares Kathleen. Knowing this, Kathleen met her in the emergency department. The inpatient care manager worked alongside Kathleen to provide Margaret with the care she needed. She required stitches and was back at home before dinner. Because of this guidance, Margaret's transition of care was smooth and Kathleen continues to monitor her and check on her recovery.

I hope you all can take a moment during the next few weeks and consider all the ways that you are thankful - I know I sure will.

 Happy Thanksgiving,

Lanie Abbott 

Primary care providers are a key group that has the ability to greatly transform healthcare. As an integral part of the Bangor Beacon Community project, and healthcare in general, we wanted to learn more about their experiences during the project. What is working well and what could be improved upon with the implementation of the care management interventions. After meeting with all nine primary care practices, several themes emerged, including information technology and its use in healthcare, the sustainability of care management in primary care, strengths and limitations of the different care management models, and how care management has influenced the provider's workflow process.

Through these conversations, the overall sentiment is that health information technology and being able to access patient information without multiple log-in steps was a beneficial improvement. The addition of nurse care managers in primary care practices are a positive addition. One provider shared, "My diabetic patients have done significantly better with the support and help of care managers."

Not only did providers share the improvements made by patients who had care management, but they also noted that care managers "provide a lot of follow-up for patients that I [the primary care provider] don't have time to do and they also provide additional emotional support for patients."

The relationships built with care managers are getting stronger. Another provider shared, "I think patients feel they are getting more and better care when they have more than one person calling them to check on them. I think they feel more cared for with this team approach."

This sense that patients believe their healthcare is provided through multiple people led to this statement by a provider: "Patients feel like they are getting more thorough and well-rounded care."

Now that the benefits of care management are visible in the practice, the next steps are to evaluate how to best move forward with care managers influencing provider workflow. To improve efficiencies in the practices, it is necessary to identify specific ways that care managers are able to care for patients and work to the top of their license. "If we develop a protocol that states they don't have to check with the provider for everything, it would help take some things off our plates." Defining what that protocol will look like and the specifics of what it will include are still not defined, but the involvement of the care managers are proving to be an invaluable asset to primary care providers in their current role.

Members of the Bangor Beacon Patient Advisory Group continue to offer great insight in our work of enhancing the way we deliver primary care and engage patients in their health. During the latest meeting we focused discussion on what it would take to build a meaningful patient portal. Lorri Wright, information system architect and Debbie Macaulay, project manager, both from EMHS, wanted patient perspectives as they develop a tool that meets the needs of providers, nurses, and patients throughout our region. 

"A patient portal is more than a secure email to your provider, it's meant to be a personal way to allow you to interact with your provider and care team and to show you how to engage in your own care to stay healthy," explains Lorri. This was welcome news to Carrie Dwelley, our 25 year old patient from St. Joseph Internal Medicine. "I like the idea of communicating with my provider or nurse online. I don't have to wait for a phone call back; it needs to be a tool for two way communication."

To date, none of the patients in the advisory group had used secure email or prescription refill options that some primary care practices currently offer, in fact a few were unsure if their practices even had any online option. Lorri and Debbie shared information about the current state of online patient portals and then asked what options the group would need and want to have in order to make this a useful tool:

• It needs to feel personal
• Easy to navigate
• Don't use medical words, jargon, or acronyms - straight forward and meaningful
• What does the information I'm seeing mean to me
• A snapshot of your health - last time seen, next mammogram, colonoscopy, immunizations due
• Sign in and logon needs to be easy
• Make it a two way conversation between patients and primary care practice
• Provider approved information about your diagnosis so you can learn what you need to know without going out and "Googling" it
• Wellness component where you can log your efforts, find support and information to help you improve your health, and also allow your provider or nurse to check up on you in between visits
• Make sure there is a mobile app

The consensus is, if you want patients to engage using a patient portal, you need to sit down and show them how to use it and then make sure it's delivering on the promise of why it's an important tool.

Dyan Walsh, executive director of Eastern Area Agency on Aging, said if we do it right we shouldn't be surprised how useful a tool it can become. "When we started offering live chat as a way to quickly answer questions our consumers were having, I didn't think anyone would ever use it. It's surprising there are still those that won't use it, but there are many more out there that will and are."

Julian Haynes, patient, shared these words of advice, "Make sure to separate the goal of simple information exchange from using the portal to actually delivering care. That will take an added comfort level that will come with time; I think it would cause mass confusion if you open it all up to patients at once."

Kathy Bragdon, RN, care transitions, PCHC, says, "I can see this tool being very useful especially if we can email patients reminding them of an appointment and asking if there is anything they want to talk about with their doctor or nurse at their next appointment. It could increase satisfaction for patients and providers and allow them to have a two way conversation about their healthcare."
 

In the coming months, the patient portal conversation will be a reoccurring topic as we look to these patients to help us along the way in developing and implementing a tool to build a healthy, more engaged community.

The Patient Advisory Group will reconvene in November.