Digital Transformation and Patient Engagement

Many health systems are in various stages of developing digital interactions with patients that include implementing a digital front door strategy and enhanced patient portals to welcome and promote a good experience for patients when they engage care. Quickly setting up telemedicine visits during the COVID-19 pandemic accelerated one digital touch point with patients, but a comprehensive strategy around digital health incorporates much more. 

Today, patients are frustrated with existing touch points when engaging a provider. Most of this frustration results from the fragmented nature of providers and with the lack of interoperability compared to other industries of which patients engage. A complete discussion of digital patient engagement strategies is available from several sources including a book by Ed Marx and Paddy Padmanabhan, The Healthcare Digital Transformation (2021). Some health systems are implementing these strategies very effectively. However, what may be lacking to date that could further accelerate benefits for enhanced patient satisfaction and enhanced care quality would be to include diagnostic medical images as part of digital front door and other digital patient engagement strategies. 

Medical images from all sources may constitute 90% of healthcare data. Thus, it is important to include medical imaging data in digital health strategies designed to empower patients. Simplifying the ability to integrate medical images into a patient-focused digital strategy are enterprise browser-based medical imaging visualization platforms that do more than simply display images. These platforms have evolved to enable comprehensive visualization, communication and sharing of any type of medical image in coordination with the electronic health record (EHR) or other digital health applications.

This article discusses three reasons why corporate leadership, IT leadership and operational leadership should include the patient’s medical images such as X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), medical photographs, endoscopy snapshots, surgery videos and other medical images into these digital patient centered initiatives.

The Spirit of the 21st Century Cures Act

This new rule took effect April 5, 2021, to prevent information blocking in healthcare. The act further empowers patients and their agents to have access and portability of their healthcare information. Technology such as fast healthcare interoperability resources (FHIR) now helps with application programming interfaces (API) to free textual data now locked within the EHR. But what about medical images? Even though not currently mandated in the initial phase of the Cures Act, it may be wise to move now to enable your organization to provide patients electronic access to all their medical images which constitute a very critical piece of information for consults, transitions of care and referrals. These images increasingly are originating at the point of the patient’s care and not just from ancillary specialty departments such as radiology and cardiology. 

It has been customary for healthcare organizations to use physical media such as DVDs to share medical images and often only upon a formal request from another provider. However, COVID-19 has exposed the weaknesses of this as a primary method of transporting data as patients did not want to expose themselves to a trip to a doctor’s office, nor did they want the inconvenience and susceptibility to pathogens by dealing with physical media that has been handled many times.

The spirit of the 21st Century Cures Act is to share all data with the patient within their medical record including the medical images, which include clinical information that clinical documents do not. Part of every provider’s enterprise imaging strategy should include the implementation of a platform for gathering these images that are outside of the EHR and presenting them to the patient electronically via integration with a patient portal, personal health record or mobile application. As medical images can facilitate a primary diagnosis, it is important to implement rules to allow personal communications from the provider to the patient to be employed prior to and discharge of their medical images, similar to release of their other healthcare information. The user interface should be customized for easy patient viewing, downloading and sharing with other providers of their choice.

Once enforcement mechanisms are in place, large penalties may apply for hampering access to healthcare information. Several providers have paid fines up to $70,000 for violations around the patient’s rights to access their medical information. Why wait for fines to remove the transparency of medical images as part of your innovation and digital transformation strategy?

Patients Want Control

A survey by Pew Charitable Trusts suggested strong demand by patients for easy access to their health information including their medical images via applications on mobile devices. In addition, patients appear to be very comfortable allowing their healthcare providers to share their medical information and medical images electronically for optimal care collaboration.

Patients have grown accustomed to convenience and accessibility from the many services of which they digitally engage whether it be banking, retail or transportation. It is time this convenience comes to healthcare, and patients are demanding it by choosing providers and health systems based on these expectations.

Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma said in early 2019, “Healthcare consumers own their data.” Political and social momentum for empowering the control and access of patients around all their healthcare data including costs are motivating providers to enable better experiences for patients. 5G and other enhanced broadband and communication technologies will further enhance this experience.

When a large northeastern U.S. health system recently added digital access to medical images from their EHR patient portal, 1,200 medical imaging studies were accessed by patients within the first 24 hours without any advertising that the new functionality was available through their patient portal. That demonstrates demand. Complementary to allowing patients to access their images, the same enterprise viewing platform was used to build an uploader for patients to send their medical images to the health system electronically, which further facilitates convenience for patients while increasing efficiency within the health system by minimizing the labor required to process physical media.

Once a patient enters the health system, transition of care across service lines often includes medical images. These images are most likely scattered across several locations within the health system, requiring the patient to first notify the originating department or clinic of the need for the images, then go directly to the originator to pick up a DVD, then transport the images to the next provider office. Each step in this process inserts increased frustration to the patient, extra work for the healthcare staff, security risks, increased costs and decreased quality of care. The same technologies employed to facilitate empowering patients to control their medical images can also be employed to manage the transfer of medical images within the health system, or facilitate the patient obtaining a consult from a provider of their choice outside the health system.

Health systems that do not execute a fully leveraged digital experience which includes medical images for their patients may experience revenue leakage as patients transfer to other provider organizations and methods of care that are more technologically evolved around enterprise image management and provide better satisfaction.

Engage the Patient or Your Competitors Will

Forrester Research has defined the digital front door as the following: “An approach where intuitive, right-sized and just-in-time recommendations are shared with customers across digital touch points throughout the journey. These touch points are moments that will lead to increased revenue, brand advocacy, loyalty and improved health outcomes for the customer. To effectively execute this strategy, healthcare organizations must focus on those technology investments that improve personalization and convenience and continuously gather input to improve the customer experience.”

It’s no longer a luxury in healthcare to take it slow and methodical when the need for change is obvious. Digital transformation is accelerating rapidly, and a better way to engage and provide patients with a better experience is required or your market share will erode. The status quo must be disrupted or patients will simply go elsewhere for care. Health systems may risk losing primary care services especially to new entrants such as Amazon, Walmart, Rite Aid and others wishing to encroach into serving the primary care experience for consumers.

The competitors of the future may not be the ones you suspect. Although there have been fits and starts, Walmart and other large consumer organizations have their eyes on the healthcare market, especially the young healthy market comfortable with technology and a big part of any healthcare organizations entry point for further life care. These consumer organizations have established digital strategies that delight and engage the customer while leveraging the platform across all areas of their businesses.

Empowering patients with these digital strategies is not primarily technical, but is mostly cultural within healthcare organizations. However, if not enacted it may be hard to recapture the patient and their families once lost. These strategies are no longer a “nice to have” and organizations must accelerate enabling patient access and control of their health information including medical images or competitors will. 

To support these strategies, and which is often overlooked, is an enterprise imaging governance strategy within the organization that represents all service lines that produce and consume medical images as nuances occur in how various departments capture, manage and consume medical images which should be considered. 

Best to get medical imaging data into a unified vendor neutral archive (VNA) platform with software that can actively harmonize the various medical imaging data formats and workflows needed to support these patient initiatives. There are many ways to scale and implement this approach customized to the organization’s operations. Complementary, an independent enterprise medical imaging visualization platform operating off only a web browser and able to visualize any image format can act as a platform to federate and consolidate clinical medical images from various service line image repositories to enable patients to access and control all their medical clinical images.

Digital Transformation Goals

Growing empirical evidence suggests that healthcare leadership should not hesitate to nurture, fund and support the inclusion of digital medical images in all patient engagement initiatives supported by a sound enterprise medical imaging strategy and governance.

Integrating medical clinical images into your patient experience fits directly into your digital transformation goals for increased patient engagement, population health, increased ease of access for care, enhanced care delivery and reduced repeat diagnostic imaging tests. Don’t wait as it might cost many times the initial investment to recover if your health system or practice falls behind. Enterprise platforms are available to achieve quick wins without the limitations or proprietary nature of departmental solutions by connecting all medical imaging repositories throughout your organization in order to leverage your digital front door and patient engagement strategies.

EHRs do not manage the clinical medical images, but can facilitate driving the digital transformation strategies such as digital patient empowerment. Implementing an enterprise medical image visualization platform tightly integrated with the information contained within the EHR may yield significant competitive advantages. The EHR is not fully optimized until all medical clinical images are directly linked for patient, provider and researcher access.

Todd Allman is an enterprise medical imaging sales consultant with Hyland Healthcare with over 15 years assisting healthcare customers leverage medical imaging IT technology to achieve best outcomes for both patients and the organization.