Addressing Health Equity through Innovations in Access to Care

It's now a familiar refrain: over the last two years, so much has changed in healthcare. When we last met in person for the annual conference in 2019, our theme was on "embracing disruption." And we certainly did! Healthcare continues to evolve, as patient preferences, continued provider burnout, and crisis levels of mental health needs force us to adapt how we deliver care.

This year’s HIMSS Oregon Chapter Annual Conference brought together senior leaders across healthcare to explore the next era in healthcare. We discussed everything from the state of Health IT to lessons learned from the cloud and interoperability for both rural and large systems.

As a panelist for the Addressing Health Equity through Innovations in Access to Care session, here were a few favorite questions I had the pleasure of discussing.

Eva, you have an eye on design thinking, user experience and access to digital.  Assuming we could level the playing fields for broad digital access for all, what industries give you inspiration or models to look to for comparables to the challenges that we have in healthcare.  What experiences delight us as consumers, elsewhere?

Actually, any industry can serve as inspiration! It’s of course great to see what our peers are doing, but I recently facilitated a workshop within our Office of Digital health where our asynchronous, ambulatory, and inpatient digital care teams split into groups to observe customer experiences downtown. Some of us when to coffee shops, AAA, and DMV. We shared what we learned and found ways to tie back to our day-to-day patient experiences. One pain point we have is when patients join a virtual visit early, or even on time, and the provider is late – the patient just sits in a blank digital “waiting room,” and it can really feel like you’re not in the right place. So when we were at a busy coffee shop, instantly when you walk in, you’re greeted so you know they’re aware you’re there, and you can see exactly where you should be standing, you can see the line getting shorter and have expectations of when you might be helped. There was merchandise right next to the line, so you could have something to look at and consider. So, we thought about ways that messaging could be provided to patients to let them know, you’re in the right place, maybe if the provider is running late, being able to call them or let them know how many minutes they are behind. A lot of the social scripts that we take for granted with traditional customer service experiences haven’t been written yet for digital.

First can you clarify further for us, what is meant by patient-led solution design? How do you go about accomplishing that?

Rather than starting solutioning with what’s technically feasible, or how our internal structures or processes are, we start with the current state of the patient experience, and create prototypes to test with them iteratively, along the way. We intentionally show rough looking sketches, black and white wireframes, just really enough fidelity to gather useful feedback. We’re not too precious with it. This saves us time and money, because once we get to the launch phase of a project, we’ve already vetted it with patients and know with more confidence that it will solve the right problem and have better utilization. And of course, we ideally love to continue to watch the data after launch and continue improving.

What are some examples of community engagement/patient-led solution design that we should consider for improving access, digital literacy, and ultimately outcomes for patients (How have you engaged patients)?

Same-day/low acuity care medical decision making: We looked in the marketplace and other organizations had their same-day care options split between virtual and in-person options, and patients could choose from there what they wanted. That was kind of the prevailing thought of how we would do it, because that’s largely how our internal departments are set up. We recruited some patients and asked them about the last time they had to seek out urgent care – how did they feel, what was their mindset, how did they make that decision? And it wasn’t about modality at all – it was how quickly they could be seen, and how much it would cost. So, we set up our website to display cost estimates (actually, based on the Yelp model of showing dollar sign icons) and level of urgency for primary, immediate, and emergency care. Once they picked one of those three, they were then presented with virtual vs. in-person options. When we presented the information like this, the way patients already think about healthcare intuitively, they were able to make decisions faster and more confidently.

Live support for digital care: A lot of the focus at the beginning was on putting together instructions for patients, but it was all on the website. That’s not helpful for people that are struggling with technology. Going to community events, we heard from patients that they really wanted a live, immediate IT help phone line. We actually already have one, too! But it isn’t well advertised, and when we told patients we had a line, they were skeptical, saying, “Yeah, but I don’t want to wait on hold.” And there was another false assumption – our live IT help line actually has little to no hold time. So, rather than building an entirely new solution, the better idea was actually a cheaper one- how to better advertise and set more accurate expectations of hold times? And when the service popularity grows, knowing that we need to keep to that promise of short to no wait times in order for it to be successful. 

MyChart support booth: We tested the idea of a MyChart genius bar by placing a community health worker with a booth, putting up different signage options at different locations and seeing who approaches, with what kind of questions.

Takeaway- the goal is to save time and money, so this can and usually is done on a budget and on a short timeline.

Some ideas:

• Vaccine equity events at elementary schools– card sorting activity to help prioritize different MyChart intervention ideas, included with native Spanish speaker as a facilitator, offered Fred Meyer gift cards as an incentive.

• Community based organization leaders who have the lived experience of the population you’re hoping to engage

• Clinic observations

• Phone and email After visit surveys

• Snail mail recruitment for phone interviews

• We’ve posted job posting on Craigslist gigs

If you look across the industry and you think about digital disruptors for patients and providers where do you see the most innovation happening - if a provider or health system were to “skate where to the puck is going” what solutions do you see as the most valuable - AI to distribute workload, virtual care, hospital at home?  Eva or David: what are your thoughts on this?  What is an easy or fast win, vs. longer term?

I’m thinking of Cityblock which is a Google spinoff project. They are combining primary care, behavioral health and chronic disease management to address social determinants like transportation, housing and access to healthy food. They make money by absorbing all the risk for its members from Medicaid and other federal assistance programs. They’re built on the idea that supporting patients when and where it’s convenient for them in the community, outside of hospitals and doctors’ offices whenever reasonable and in their homes is more cost-effective and results in better outcomes than episodic care.

A PM walks into a design conference. Why?

Honestly, I love web design. Attending An Event Apart has been a dream of mine for the longest time, and it was a great opportunity for me to nerd out with other like-minded individuals who fall more on the design side of the spectrum. Coming from a UX background, I relish every opportunity to keep my creative skills sharp. 

However, the value I also brought back to my agency as a project manager was significant.

Be a better client communicator.

The talks at most conferences range from the 10,000 foot view down to weed-whacking with the best of them. At An Event Apart, the higher level web design trend talks were excellent for my role in being the my internal team's proxy for many conversations.

Being able to answer client questions from a position of understanding earns you trust. Being there first hand and being able to ask the speaker questions is invaluable in the learning (and retaining) process. There are only so many blog articles and Dribbble shots you can absorb passively.

Even if you aren't a designer yourself, web design is the world you live and operate in. Be interested in the "how its made," and share that wealth of knowledge with your clients, who are undoubtedly mired in their own industry and counting on you to be the expert. 

Be a better cross-functional team communicator.

Similarly, your team lives and breathes this stuff. They're moving so quickly, keeping up with trends, and learning so much that sometimes, it's hard to take a moment to explain concepts to a layperson. 

Plus, as a project manager, it's your job to be the translator. Attending a conference for development or design helps you understand not just individual ideas and where the industry is headed in the near future, but also the discipline's guiding philosophies. Immersing yourself in the culture helps you communicate better with your team, and they will sense you understand where they are coming from.

Be an active participant on the team.

The more you understand the details of what makes other disciplines work, the better you can work with others. And - it opens up the opportunity to be even more of a contributing member to your team.

Be a producer! Come up with ideas. Run with the wolves a little. Understand that your team often has a lot going on - and you can help by filling in the gaps when you see them, or helping in brainstorming sessions. Understand that everyone has their area of expertise; but that doesn't mean the ideas of outsiders isn't valued.