by Kellie Goodson, MS, CPXP

Director, Performance Improvement Programs

Leveraging technology to communicate with patients is not only efficient, it’s required starting April 5, 2021. The 21st Century Cures Act of 2016 mandates providers give patients full access to their electronic medical records, including clinical notes and test results, free of charge and without delay. Traditionally, providers have not made their clinical notes available to patients and have waited to share test results with patients until they have previewed them.

The BMJ indicates that open access to electronic medical records can “strengthen patient-clinician communication, raise health literacy, promote self-management, enhance teamwork, and increase trust.” The authors cite evidence that “patients who read what is written about them by clinicians feel more involved in and knowledgeable about their care, feel better prepared for visits, and report being more likely to follow their clinicians’ advice.” Additionally, a study published in the JAMA Network Open found that  one in five patients who read ambulatory visit notes find mistakes and concludes that transparent sharing “improved record accuracy and patient engagement in safety.”

Providers need to adjust how they communicate with patients not only to meet the requirements of the 21^st Century Cares Act, but to ensure patients receive necessary care and create lasting relationships with their patients. Technology, such as an electronic medical record, assists in communicating with patients, but its not a cure-all. A “one size fits all” approach will not help people recognize when they should access care.

A recent Vizient survey of patient preferences, Connecting with patients during COVID-19: perspectives on safety, found that patients need to fully understand their own personal risks and benefits of a given procedure; they do not want to be communicated with in the same manner as other patients who happen to be the same age or have the same diagnosis. They want open, honest, and frequent communication that is tailored to their condition and delivered by their doctor. This applies to elective procedures, preventative screenings and even vaccinations.

The patients we connected with during the pandemic regularly weigh their risks of exposure to COVID-19 versus the benefits of accessing the care they need. They tended to have one of four potential responses:

1. Those desperate to move forward no matter what the risk (oncology patients, patients whose activities of daily living are impaired or who are in pain)
2. Those who feel safe because they perceive that their own risk of getting COVID-19 is low or the care they need carries low risk and requires little follow-up
3. Those who have many questions and will need to have discussions with their doctors about their personal risks and benefits before they proceed
4. Those who will not move forward until vaccines are in widespread use

Communicating with patients in the first and second groups can be business as usual. However, those in the third group need a different approach. This group needs details and data. They want to talk with their doctor about their personal risks and benefits and they will take their time to decide if they will move forward with a given procedure, preventative screening or getting vaccinated. For the last group of patients, discussions and data won’t convince them to move forward. They will wait for the vaccination rate to reach critical mass and there will be no convincing them otherwise.

The report also indicates that patients surveyed prefer using technology (e.g., patient portals and virtual/telehealth) to communicate with their doctors and access routine care. They would like the current technology to be improved (e.g. stronger internet connections, better instructions on how to connect) and they would like to explore new technologies that virtually connect families, caregivers and patients to providers in more meaningful ways (e.g. allows families to connect with hospitalized patients and discuss treatment plans with providers when visitation is restricted). Yet they realize that using technology does not meet the needs of every patient or situation. For example, they noted that telehealth options need to be made more equitable by using basic technologies such as email and text and it should be better incorporated into health care delivery to meet patient needs. They are concerned about the payment system as well and realize that insurers need to reimburse virtual health at an appropriate rate to encourage future use.

The report confirmed that provider communication and relationships matter to patients. Patients and families want a health care system that supports education and empowerment, builds trusting partnerships and delivers patient-centered care. Not only should we seek patient feedback about how to integrate technology into existing care pathways where it can be most beneficial, we must invite them to the table to co-design these changes. Providers can leverage technology, but the key to building and maintaining trusting partnerships with patients starts with listening to them and creating space for open, honest and frequent communication with them.

About the author

A thought leader in the areas of patient and family engagement (PFE) and health equity, Kellie Goodson has implemented Vizient performance improvement networks on those topics as well as co-led national Affinity Groups for the Centers for Medicare and Medicaid Services. She led the Patients First project, a multiyear analysis of hospitals leveraging and deploying PFE in quality and safety improvement. Also deployed under her direction was a multisystem program using quality improvement science to improve patient outcomes through the identification and resolution of health disparities. A certified patient experience professional, Goodson recently served on a National Quality Partners Action Team to Co-Design Patient-Centered Health Systems