Closing the Loop Use technology to make patient engagement a priority BY ARNOLD G. LEVY, MD

The overarching goals of population health are to improve the overall well- being of a designated popu- lation while lowering costs.

“Burden and Costs of Gastrointestinal Disease in the U.S.,” an October 2018 column in NEJM Journal Watch, esti- mates direct and indirect spending on GI diseases in the US to be $136 billion per year, with many procedures and surgeries costing patients hundreds or even thou- sands of dollars. A crucial part of low- ering costs, therefore, is dependent on expanding the delivery of preventive care. Let’s take colonoscopy screenings

as our focus. Not all polyps are can- cerous but almost all cancers begin as polyps. Finding and removing a polyp with a colonoscopy saves the patient the tremendous burden of current or future cancer—physically, economically and emotionally—and makes sense from a population economics perspective. According to the Institute of Health- care Improvement (IHI), by some esti- mates, up to 50 percent of referrals are never completed. Additionally, estimates suggest that 12 million diagnosis errors occur each year in the US. A study refer- enced by IHI, indicates that 20–30 per- cent of those are caused by breakdowns in the referral process. The National Center for Biotechnology Information’s (NCBI) publication “Improving Diag- nosis in Healthcare,” defined a diagnos- tic error as the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) com- municate that explanation to the patient. A diagnostic error can occur at any of the seven stages of the diagnostic pro- cess, one of which includes the refer- ral stage. If there is no streamlined and timely transfer of information among an ASC, its gastroenterologist and the pri-


mary care provider, a breakdown can occur and result in a diagnostic error. These statistics and other information indicate the critical roles that communi- cation, tracking and closing the referral loop plays in patient care. Robust population health tools can help monitor at-risk patient populations, allowing providers to identify and fol- low up with patients who miss screen- ings rather than letting them fall through the cracks. A part of the equation to more effectively close the loop and actively include the patient in the pro- cess requires having the right technol- ogy in place. That technology includes a gastroenterology electronic health record (EHR) system, patient engage- ment tools and analytics software.

Colonoscopy Screenings: Getting Patients in for Care According to a study published in PubMed in October 2005, “Projected National Impact of Colorectal Cancer Screening on Clinical and Economic Outcomes and Health Services Demand,” screening has decreased colorectal can- cer incidence by 17–54 percent to as few as 66,000 cases per year and mortality by 28–60 percent to as few as 23,000 deaths per year. How can we improve the percentage of patients who receive colonoscopy screenings when they turn 50? These statistics indicate room for

improvement when it comes to getting patients in the door and returning for necessary follow-ups. Part

of this answer includes the

patient’s experience at the ASC. If it is positive and they heed the follow-ups recommended by their provider, they likely will return to the original facility. Just like any business or service, ASCs value repeat customers. They obtain those customers by providing good care and excellent customer service that cre- ates satisfied patients. From the moment the patient first contacts the ASC— remember, you have only one chance to make a first impression—to the end of the episode of care, inclusive of pay- ing the bill, every effort should be made to leave a good impression. If and when a patient needs additional services, you want them to come back to your facility.

Relationship Between Population Health and Patient Engagement Improving outcomes for individual patients usually requires effort by both the patients and their providers. Fear, embarrassment, cost and transporta- tion are key patient challenges. Being busy adds to the list of the reasons that I have heard patients cite for not fol- lowing up on their physician’s recom- mendation or referral when it comes to scheduling a recommended colonos- copy. Another major reason is that they

The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.

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