1. Shaping the Frontier Of Patient Engagement:
A CNO/CNIO Perspective
Mary Beth Mitchell, MSN, RN, BC, CPHIMS
Chief Nursing Informatics Officer, Texas Health Resources
Laura J. Wood, DNP, MS, RN
SVP, Patient Care Services & Chief Nursing Officer, Boston Children’s Hospital
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2. Conflict of Interest Disclosure
Mary Beth Mitchell, MSN, RN, BC, CPHIMS
Laura J. Wood, DNP, MS, RN
Have no real or apparent conflicts of interest to report.
© 2014 HIMSS

3. Learning Objectives
.
Shaping the Frontier Of Patient Engagement: A CNO/CNIO Perspective
This session will explore CNO and CNIO perspectives related to the evolution of
patient engagement, how engagement and experience are distinct yet increasingly
integrated to promote patient/family activation in their own care / health
management, and the value of informatics principles to transform and improve
health.
1. Describe the evolution of contemporary patient engagement frameworks;
2. Identify key organizational strategic priorities for creating meaningful patient and
family experiences;
3. Explore current and emerging technologies to impact patient experience across
health care delivery models; and,
4. Outline core measures of success to lead rapidly changing patient expectations.

4. Boston Children’s Hospital (BCH)
Care
Research
Teaching
Community
4

5. Boston Children’s Hospital:
Organizational profile
 Founded 1869. Primary pediatric teaching
hospital of Harvard Medical School.
 World's largest pediatric research enterprise &
leader in translational scientific innovation.
 3 satellite locations, community health center,
and 18 hospital and health center affiliations.
 Broad and historic commitment to patient and
family-centered partnerships and shared
decision-making via advisory councils and
participation from point of care to board room.
 Active executive prioritization of quality & safety,
innovative use of information technology, and
patient / family experience and engagement.
 CNIO, CMIO, and clinical informatics teams
actively engage re: patient / family directed
priorities.
2015 BCH Statistics
Inpatient Beds = 396
Admissions = 17,173
Emergency Room Visits = 58,782
Inpatient Surgical Cases = 7,037
Outpatient Surgical Cases = 19,497
Hospital Photo: 1919

6. Complex care management demands:
Quality, innovation & informatics
6
Ranked #1 in 8 out of 10
pediatric specialties by
US News & World
Report: 2014 Honor Roll.
Leapfrog Group Quality
and Safety Designation
2014 & prior.
Only Massachusetts
HIMSS Analytics Level 7
designated hospital 2014
& prior.
Healthcare’s Most Wired
designation 2014 & prior.

7. Nursing practice impacts patient &
family engagement + outcomes
7
American Association of Critical
Care Nurses (AACN)
 Only hospital with 6 Beacon
Awards.
 Only pediatric or adult
hospital with 100% Beacon
Awards in all ICU’s,
including only NICU with
Beacon designation.
Magnet designation /
redesignation in recognition
of exemplary professional
nursing practice.
One of (8) 2012-15 recipients:
Recognized for quality & innovation
in Emergency Dept (ED) nursing.

8. Welcome to the value revolution:
The Triple Aim meets patient engagement
IHI Triple Aim. Accessed March 4, 2015. https://images.search.yahoo.com/

9. The Patient Engagement (PE) Enigma:
 The operational definition of patient or person-centered engagement
continues to be widely debated in healthcare.
 PE is increasingly conceptualized to include a composite of practices
that impact key behaviors and health.
 Commitment behaviors by the patient, provider / system, technology
partner are all involved in an individual’s well being and increasingly
include:
 Understanding
 Communication
 Delivery
 Consumption
 Retention
 Compliance
Antekeirer, K. (2013). The Patient Engagement Enigma. Accessed March 4,
2015. http://engagingthepatient.com/2013/04/18/the-patient-engagement-
enigma/

10. The Evolution of Contemporary PE Models:
HIMSS Five Phases of Patient Engagement
http://www.himss.org/ResourceLibrary/genResourceDetailPDF.aspx?ItemNumber=283

11. HIMSS Patient Engagement Framework
http://himss.files.cms-plus.com/HIMSSorg/NEHCLibrary/HIMSS_Foundation_Patient_Engagement_Framework.pdf

12. Regional Primary Care Coalition:
Six Dimensions of Patient Engagement
 Patient satisfaction: providers learn about
patient and family experiences via surveys and
feedback
 Informed choice: clinicians share treatment
plans and “allow” patients to guide planning
 Shared decision-making: providers work with
patients and families closely to better align
options with preferences
 Partnering with patients: patients & families
and health systems jointly design the delivery of
care
 Ownership of health: patients & families have
high health literacy and engage the health
system as needed
 Engagement in population health: patients
and family members engage to improve health
and healthcare
RPCC (2012). Accessed March 4, 2015. http://www.regionalprimarycare.org/assets/RPCC-Graphic-6-20-12.pdf

13. Vision for patient and family engagement:
Eight strategies for change
 Patient and family preparation
 Clinician and leadership
preparation
 Care and system redesign
 Organizational partnership
 Measurement and research
 Transparency and accountability
 Legislation & regulation
 Partnership in policy
Gordon and Betty Moore Foundation. A roadmap for patient + family engagement in healthcare practice and research. Practical strategies for advancing
engagement in healthcare – starting today. Accessed March 4, 2015 http://patientfamilyengagement.org/

14. Meaningful Use Phase 3:
Identification of key engagement priorities
① Increase from 5 to 25% of patients reviewing,
downloading and transmitting their personal
data
② >35% of all patients seen by a provider or
discharged from the hospital will receive a
secure electronic message via the electronic
health record (EHR) or in response to a
secure message sent by the patient
③ >15% of patients to contribute to patient-
generated health data or data from a non-
clinical setting to integrate in the EHR.
Connecting health and care for the nation. The office of the national coordinator for healthcare information technology (2015). 1-163. Accessed
March 30, 2015. http://healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf

16. A medical note is a health care provider’s report of an office
visit or hospital stay. These notes are part of the medical record.
A note may have:
– a summary of what you (or others) told the clinician
– findings from a physical exam or lab, radiology, pathology or other test
results
– an assessment or diagnosis of medical conditions or symptoms
– what kind of care was delivered
– the treatment plans and next steps
How do health care providers use medical notes?
A health care provider writes a note so other members of your
health care team can stay up to date on your child’s condition
and care plan.
16

17. Reading health care provider’s notes strengthens communication with
the care team and can help you keep families healthy. These notes can
also help a family:
– fully understand their child’s condition
– make sure they are following the most current treatment plan
– remember to follow up on procedures, tests or appointments
– stay up to date with visits
– prepare for the next visit
– feel connected with doctors and nurses
17

18. MyChildren’s
18

20. Texas Health Resources
• 25 hospitals in North Texas
– 14 wholly owned hospitals
• 133,903 Inpatient Visits
• 1,238,392 Outpatient Encounters
• 469,309 ED Visits
• 89,452 Surgeries
• 27,200 Deliveries
• 5,500 Active Physicians
• 7,500 RN’s
• 22,000 Employees

21. Doug Hawthorne – 2008
1st & 2nd place
Edward Marx
Nanda Lahoud – 2011
Debbie Jowers – 2009
Semi Finalist
THAM, THD, THFW
THP, & THSW
HIMSS EMRAM Stage 6
designation at all hospitals
THA, THAL, THAZ, THC
THD, THDN, THFW, THSH,
THS, THSW, THK
Top Technological Innovators across
America for the 13th consecutive year
2008 Healthcare SIG
Project of the Year
2013 Enterprise Award
Innovator
State Advocacy Award
John E. Gall Jr. CIO of the Year Award
Edward Marx
Edward Marx
Ranked 8
Large Company
Ranked 18
14 of the past 15 years
Finalist

22. What is Patient Engagement?
Why does it matter?
• Patient engagement is the process by which patients become
invested in their own health.
• Health systems with effective patient engagement programs provide
patients with the information and tools needed to take control of their
care.
• From Meaningful Use to Value-Based Purchasing, patient
engagement is a key feature of payment reform and is instrumental
in readmissions reduction, HCAHPS, and patient loyalty.
• Engaged patients not only have better outcomes, but engaged
patients are better business.
• Not only offer electronic access to patient health records, but also
provide the resources patients need for the day-to-day management
of disease.
• If patients are to take charge of their health, then health systems and
plans must meet them where they are--and that would be their
mobile devices.
Rohde, Joanne, 2014. The process by which patients become engaged in their own health. Executive Insight: Advance Healthcare Network.
http://www.advanceweb.com/EBlasts/2014/10/NOINSERTION/6755Newsletter.htm

23. Patient-Centered Care
• Move to patient-centric healthcare
• Patient is at the center of his experience and controls the environment.
• Use of many tools to connect the patient to the healthcare arena
– Mobile apps
– Wearable devices
– Social media
– Portals- personal health record, HER
– Interoperability
– Internet Sites-
• Patient’s Like Me
• More Data exchange and availability of data in one location
• Tools to help patient’s manage their healthcare information
Dr. Charlotte Hovet, MD, Medical Director of Global Healthcare Solutions, Dell Services/Healthcare and Life Sciences. Dec. 2, 2014 from New Mandates,
New Solutions: The Evolving Roles of the CMIO and Clinical Informatics Team- Slide 8-10

24. Patient Directed Care
• Patient-centered care,” “is all about the patient, but it often
doesn’t include the patient [and what he or she wants].”
Patient-directed care, Chase continued, “has them leading
and taking charge.”1
• The “Patient” will see you now.
• Patient information digitalized
• Connecting patients to their care-
allowing them to take ownership.
Mapping-transitions-from-patient-centric-to-patient-directed-care,664. http://newsletter.convergenceri.com/stories/
Mapping-transitions-from-patient-centric-to-patient-directed-care,664. http://newsletter.convergenceri.com/stories/

25. Benefits
• A Commonwealth Fund-supported study
demonstrated that patients with the lowest
engagement generated 21% more health
costs.
• In another study, patients suffering from
depression were given interactive engagement
tools. These patients showed a 33% increase
in antidepressant medication adherence,
decreased overall depression scores, and a
61% increase in satisfaction.
Rohde, Joanne, 2014. The process by which patients
become engaged in their own health. Executive Insight:
Advance Healthcare Network.
http://www.advanceweb.com/EBlasts/2014/10/NOINSERTI
ON/6755Newsletter.htm

26. Gartner Hype Cycle
Gartner, 2014: http://www.gartner.com/newsroom/id/2819918

27. What do patients want?
• Patient Engagement is “the latest big thing”
• Google returned About 6,870,000 results for Patient Engagement.
• Keys areas of Pt. Engagement:
– EHR Access-Integration of data and systems
– Mobility
– Interactive- integration
– Efficiencies
So,How Do
We Do This?

28. THR’s cHealth Architecture
A consumer and provider engagement framework enabling
health and well-being anytime, anywhere.

29. Phases of
Engagement Capabilities (Examples)
Seek Information - Static information retrieval
-Physician, Facility, Condition, Medication,
Procedure lookups
Access Care - Online Forms
- Pre-registration, questionnaires
- Social Media (e.g. "Yelp reviews")
- Insurance quotes
- Share PHI in advance
- Scan documents (e.g. prescriptions)
- Well-being assessments, wellness surveys
Receive Care - eCheck-in
- eCare
- eReferrals
- eReminders (e.g. prescriptions)
Follow up Care - Patient Satisfaction Survey
- Care Management, Care Transitions
- Reminders, Compliance
Manage Personal
Health & Wellness
- Wellness plan management
- Virtual coaching
- Ongoing monitoring, trend analytics/alerts
- Aggregate 3rd party apps
- Behavior-based push recommendations
- Integrate family health records
- Appointment reminders
- Chronic care management
- Social incentives
The cHealth
Consumer
• cHealth services will be
consumed across five
phases of engagement.
• Each phase will need to be
enabled via capabilities built
into the cHealth framework.
• Each of the phases target
one of two consumer
audiences:
“Captive”, i.e. THR patients
People of North Texas
29

30. Patient Engagement Use Cases
• Electronic Health
Record
• Remote patient
monitoring
• NICU videoconference
• Patient education
• Mobile Apps
• Interoperability-
wearable devices
• Gamification
• Internet Health Sites
30
OtherTHR

31. Access to Medical Record and Portals
• Patients want and need tools that help
them communicate and collaborate with
their providers
• Shared medical records helps provide
availability of information.
• Portals help because “They’re
important because they allow patients
to take charge and do the things they
should be doing on their own like
scheduling appointments and receiving
notifications and reminders for those
appointments and medications.”
Walsh, Beth (2014) Help Patients be More Engaged. Nancy Finn Quote. Clinical Innovation Plus Technology: http://www.clinical-
innovation.com/topics/clinical-practice/help-patients-be-more-engaged-collaborative

32. Patient Portal
• Patient’s access to their record- inpatient and outpatient
• Messaging
• Online ability to make appointments, pay bills and ask questions to
providers
• Integrated patient information-patient entered data- Assessments,
History
• Open Notes
• Genomics- Future

33. Remote Patient Access & Monitoring
• Video Visits
• Telemedicine
• Peek-A-Boo https://www.youtube.com/watch?v=6XQcgx75BRw

34. Patient Education
• Interactive
• Pre-Admit- Auto assigned based on procedures scheduled
• Inpatient- Ordered by the RN through the EHR
• Ambulatory- Ordered by staff to be viewed at home.
© 2013 Emmi Solutions, LLC. Atrial Fibrillation program

35. Mobile Apps
• Mobile Apps- Mayo Mobile App
• https://www.youtube.com/watch?v=AqfNsFNud-Q Pt. Engagement
Data
Used by Permission: Jason Fratzke, CNIO, Mayo Clinic. 2015.
Used with permission: Jason Fratzke, CNIO, Mayo Clinic. 2015.

36. Wearable Devices
• Internet of Things- 20-30 Billion Things Connected to the Internet by 2030
• Apps- Healthcare Apps
• Integration with EHR
Dr. Charlotte Hovet, MD, Medical Director of Global Healthcare Solutions, Dell Services/Healthcare and Life Sciences. Dec. 2, 2014 from New Mandates, New
Solutions: The Evolving Roles of the CMIO and Clinical Informatics Team- Slide 8-10

37. Gamification: The Avatar
Will See You Now
Medical centers are testing new, friendly ways to reduce the need for office visits
by extending their reach into patients’ homes.
Receiving remote medical care is
becoming more common as technologies
improve and health records get digitized.
Sense.ly, the California startup running the
trial, is one of more than 500 companies
using health-care tools from Nuance, a
company that develops speech-recognition
and virtual-assistant software. “Our goal is
basically to capture the patient’s state of
mind and body,” says Ivana Schnur,
cofounder of Sense.ly and a clinical
psychologist who has spent years
developing virtual-reality tools in medicine
and mental health.
Lieber, Jessica. (2013). The Avatar Will See You Now. Business News, June 10, 2013.
http://www.technologyreview.com/news/514881/the-avatar-will-see-you-now/

38. Websites
• Patient’s Like Me
• Caring Bridge
• My Lifeline.org
• Healing well.com
Patients engage through access to
websites for health information from other
consumers.

39. Challenges with patient engagement-
related technology
• Adoption- by patients
• Disparate systems- not a single
unified experience
• Language concerns
• Nursing Challenges
– Increased workload
– Patient identification- correct
patient access
– Confusion/Lack of knowledge
about the portal content and
functionality.

40. Value on Investment (VOI):
Successful Patient Engagement
Used with permission Kaycee Roberson, Director of cHealth, Texas Health Resources. 2015.

41. :
- Thank you -
Mary Beth Mitchell, MSN, RN-BC, CPHIMS
Chief Nursing Informatics Officer
Texas Health Resources
MaryBethMitchell@texashealth.org
Laura J. Wood, DNP, MS, RN
Senior Vice President, Patient Care Services & CNO
Sporing Carpenter Chair for Nursing
RWJ Foundation Executive Nurse Fellow
Boston Children’s Hospital
laura.wood@childrens.harvard.edu