Strategically Implementing Technology for Follow-Up Care Engagement

June 08, 2023 - Close to 45,000 emergency department visits means a lot of phone calls for follow-up care and engagement. But that’s been the reality at SUNY Downstate Health Sciences University, where just two nurses are in charge of calling patients and ensuring continuity of care and care coordination.

Add to that another 9,000 inpatient stays that get discharged and it can be pandemonium.

But it won’t be like that for much longer, according to Mafuzur Rahman, MD, FACP, the Brooklyn-based organization’s chief medical information officer. In a new partnership with Memora Health, currently in pilot stages, SUNY Downstate will be able to automate patient communication and follow-up phone calls for ED discharges and discharges for patients admitted from the ED.

That’ll be a boon for the staff members who have previously been beleaguered with the arduous, albeit essential, task.

“We all know that care doesn't end when a patient leaves our door,” Rahman told PatientEngagementHIT in a phone interview. “If a patient came to the emergency room and got discharged home or had stayed in the hospital for a few days and is going home, we have a job to do and we need to make sure patients get home safe.”

Following up with a patient after an ED visit—or an ED visit that turned into a hospital stay—entails ensuring patients have everything they need to recover and take care of themselves at home. Follow-ups might include asking if patients have scheduled in-patient follow-up appointments, are taking their medications as prescribed, or even if they have social determinants of health, like transportation barriers to picking up pills or housing insecurity problems.

Helping patients coordinate all of this is important for preventing adverse outcomes down the road, but Rahman said it’s come at a major cost to workflow, efficiency, staff satisfaction, and burnout.

“We were relying on few nursing staff to take care of that,” he explained, pointing out that clinical staff members are crucial to follow-up patient engagement because they are able to immediately address any clinical questions.

Hiring non-clinical workers to make follow-up phone calls may have resulted in even more inefficiencies, Rahman alluded, because it would have required those non-clinical workers to pass the buck; they’d have to refer clinical questions to providers, which could have created bottlenecks.

Still, given the level of automation possible in healthcare, Rahman and the team at SUNY Downstate knew there were more efficient options for follow-up patient outreach.

The new system uses SMS messages to ask patients whether they need anything after their ED or inpatient stay. Through collaboration with its vendor, SUNY Downstate has worked out some natural language processing systems that would allow the system to assess and even act on some patient requests. For example, patients who need to schedule their in-person follow-up appointments will be prompted to an appointment scheduling system.

Selecting a patient engagement technology vendor

In the age of patient engagement technology, embarking on a new implementation can be difficult. While systems may be more sophisticated, the options are abundant, so healthcare organizations need to be judicious in their purchasing decisions.

Rahman said going with text message patient outreach for follow-up was a no-brainer. People don’t always answer phone calls from unknown numbers, and they are also unlikely to call back even after they find out who was on the line.

But with a text message, folks can seamlessly see the message’s sender and answer the prompt when it suits them. Rahman said this model will likely support patient engagement and open rates.

Moreover, an automated, text message system makes it easier for SUNY Downstate to practice high-touch patient engagement. Usually, the organization would do a first call with a patient and coordinate their care.

“But what happens if a patient had another need five days down the road?” Rahman posited. “We give them a number to call back and leave us a message, but we haven’t been proactively following up on those patients because the sheer volume of that follow-up was just too much for this staffing that we had.”

Going with a text message option made the best sense for automating the follow-up process and ensuring patients got multiple touches.

SUNY Downstate was also working to ensure it could meet patient language needs. The organization serves not just patients who speak English, but also a significant population that speaks French Creole, not to mention a number of other languages. Rahman said he and his team assessed their options in part based on which tool simplified language access.

From there, the organization spoke with vendors to determine what level of collaboration they’d offer. Rahman indicated that SUNY Downstate wanted to be able to customize offerings based on the organization’s workflow needs and that the vendor he and his team chose needed to be able to form a working partnership.

“At the end of the day, finances are also a big part of the conversations,” Rahman added as a final criterion. “If every hospital has a lot of money and unlimited resources, then they can probably do whatever they want. But we all have to be mindful of where our dollars go and the choices given by various vendors.”

To that end, SUNY Downstate is looking at a few different areas to measure return on investment (ROI).

First, it’s looking at how the tool can pull in social determinants of health data. Anecdotal evidence indicates that addressing social determinants of health, including food, housing, and transportation needs, can yield better outcomes and therefore better ROI. By using the follow-up outreach tool to collect that data and then coordinate access to social services, Rahman said the organization hopes to see some return.

Additionally, the organization hopes to pull in more patient satisfaction data, particularly by boosting its HCAHPS return rates.

“Currently, our HCAHPS survey return rates are pretty low, not that it's high for a lot of people, but it's quite low for us,” Rahman explained. “We think that with the reminder to our patients that they're communicating with us, letting them know that they'll be receiving a survey. If they can kindly complete that and send it back to us, that would be helpful.”

Increasing patient satisfaction survey return rates could help SUNY Downstate with other quality improvement projects. Plus, given the weight HCAHPS scores carry in some value-based reimbursement models, more data could create some tangible return.

And in a final patient-facing measure, the organization is eyeing its hospital readmission rates. This is a key metric in value-based care.

“Maybe we can prevent patients missing their medication doses and give them reminders to follow up with the doctors and that might actually keep them healthier and therefore away from the hospital, not be readmitted,” Rahman predicted.

Notably, Rahman said SUNY Downstate will also keep an eye on staff satisfaction. The current telephone-based follow-up model is seriously unworkable for the staff, Rahman said, and automation will be critical for eliminating some of that burden.

“Staff satisfaction is key in retaining staff. If we give everybody too much work to do, they get tired and people leave, people get burnt out, they move from one job to another or altogether they leave the healthcare industry,” Rahman concluded. “And right now, we can't afford that.”