For the past decade, Geisinger Health System has been ahead of the curve in embracing information technology to connect with patients, medical professionals and the community; improve both health and efficiency; and save money. Patients can use their personal computers to check their test results, send messages to their doctors and fill out health questionnaires. Family members and friends of new mothers can even tap into Geisinger’s online site for viewing pictures of the newborn.
The Danville, Pa.-based healthcare system now hopes to expand its reach beyond consumers’ and medical professionals’ personal computers to their mobile devices. Geisinger’s far-flung operations give it a powerful reason to do so. The $2.7 billion (revenue) non-profit organization serves a wide swath of rural Pennsylvania — 44 counties in the central and eastern parts of the state that are far from its two biggest cities (Philadelphia and Pittsburgh). For many Geisinger patients and medical professionals, traveling to and from the organization’s five hospitals and 39 primary care clinics can be time-consuming. Mobile technology’s communication and coordination tools can help Geisinger patients avoid unnecessary trips to the clinic, remember appointments and know which medications to take and when.
But the second reason Geisinger is so intent on exploring mobile technology is that technology-driven operational change is in its DNA. Widely praised in recent years by everyone from President Obama to Time Magazine, the organization is considered a pioneer in providing cost efficient and quality health care. It has already embraced technology to streamline recordkeeping and communicate with patients. As Geisinger CEO Dr. Glenn Steele Jr. stated in the company’s 2011 annual report, “In order to reengineer healthcare to better serve the patient and keep costs under control, you have to do everything – everything–differently.”
So what has Geisinger already done with mobile technology? So far it’s been lots of experimentation, intermingled with strands of enthusiastic adoption, according to ChaninWendling, Geisinger’s manager of eHealth.
Two years ago Wendling joined Geisinger’s Clinical Innovation Division, dedicated to finding more effective and efficient ways to deliver healthcare. Its charter is clear. “Our division helps support better quality for patients, safety or improving the cost model – anything that benefits healthcare in the organization,” Wendling says. “We help the entire Geisinger organization – including our primary care, specialty care and hospitals — figure out how to improve the way they work.”
The Clinical Innovation Division has a rare luxury among healthcare companies: It doesn’t get involved in the day-to-day interactions of nurses, doctors, administrative staff and patients. That frees up the division’s employees to focus on the big picture of Geisinger’s busy overall operations.
Even before the organization launched its Clinical Innovation Division, Geisinger has been a pioneer in the creative use of IT in health care. For example, since the 1990s the organization has been an early adopter of electronic medical records (EMR), which has boosted the quality, cost and safety of health care.
The Focus of Mobile: Improving Patient Care
Geisinger has connected itself to patients and medical professionals online for a decade. In 2001 Geisinger launched a patient portal called MyGeisinger, enabling patients to replace phone calls and even some visits with email communication and a secure web site. Ten years later, about a third of the system’s 600,000 active patients have registered to use the system – about 204,000 in all. Patients use MyGeisinger to send notes to physicians, enter data on their conditions, and schedule appointments with primary care and women’s health physicians. In turn, Geisinger uses the portal to remind patients of upcoming exams or medical conditions they need to watch. A 2010 article in a health care journal said the portal had reduced by 25% the number of patients who came in for a visit after surgery, and eliminated about 12,000 phone calls a month from patients.15 Efficiencies such as these are critical for all healthcare providers, and especially so for Geisinger, since it also owns a health insurance plan, with about 300,000 subscribers today.
In the last 1½ years, Geisinger has ramped up efforts to get more patients to enter data on their health. Through MyGeisinger, the organization surveys patients as well as provides questionnaires for those with acute conditions. For example, those with persistent asthma are asked to fill out an online questionnaire (the Asthma Control Test, a national standard of care for persistent asthmatics) about their condition every 90 days. Previously, patients were only able to complete the asthma control test during a clinic visit using a paper form. “A lot of patients don’t come in every 90 days,” says Wendling. “So by using a third-party questionnaire in MyGeisinger, you don’t have to have a clinic appointment to fill in the tool.” The information is included in patients’ electronic medical records. Those who score poorly get follow-up calls. “Essentially, we’re trying to check up on people and make sure their asthma doesn’t get out of control and they end up in the emergency room. It allows us to check in on patients more frequently,” Wendling explains.
Despite its impressive online innovations, Geisinger is still in the early stages of using mobile apps for both patients and physicians. Rather than a sales tool for gaining new patients, Geisinger’s mobile initiatives focus on using the technology to help patients engage in their healthcare, such as patient reminders for their medical appointments and their medications. For example, in December 2011 Geisinger implemented a standard app from the health care software firm Epic. The smartphone app gives patients remote access to their MyGeisinger data – test results, health summaries, and more. The impetus to make MyGeisinger easily accessible from mobile devices came two years ago, in September 2010, when physician leader Dr. Thomas Graf suggested to Wendling that Geisinger should be doing more with mobile devices. “We were just talking about general things and then he said one of the things he’d like to see us do is get into the smartphone space,” Wendling says. “He said, ‘We have all our patients walking around with these devices and we don’t do anything with them.’ That stuck in my head. So we started to look into what other healthcare organizations were doing with these tools and how we might use them for patient care.”
Today, mobile access is making it easier for Geisinger patients to stay up-to-date with their health. Adoption for the mobile app that provides smartphone access to MyGeisinger has been slower than expected, even though patients who use the app have reacted enthusiastically. Seven months after launch, about 1% of MyGeisinger users have used the mobile app, a lower rate than the 8 to 10% that Wendling had expected. (She noted that 13% of MyGeisinger log-ins are from mobile devices.) Wendling believes additional marketing campaigns should raise that percentage. To date, the company has promoted the mobile app on its website, the MyGeisinger home page, press articles and Twitter. Still, the organization’s goal is for 25% of MyGeisinger portal users to use the mobile app by 2015.
But that’s not the only mobile access that Geisinger has in play. The health care system has also optimized its popular iNursery site for mobile devices, enabling friends and family to “visit” new babies in the hospital through their smart phones. (See link.) Another site that Geisinger has built, called Find-a-Doc, helps mobile users locate physicians and clinics in the Geisinger network.
Geisinger Mobile Initiatives for the Next Three Years
For its patients, the healthcare company’s mobile initiatives will focus on the concept of “patient activation” – essentially, encouraging consumers to take more responsibility for their health. “The idea is that to really improve results, you need patients to be concerned about their health and believe in their role in improving it,” Wendling explains. To further that goal, Geisinger is exploring ways to engage patients through mobile apps, text messages, Twitter, Facebook, widgets and games. For example, Wendling’s team is developing a wellness game to be played on both a mobile app and the web portal. Her team has also implemented a pilot wellness site that includes a mobile app that tracks people’s walking and running activities and automatically uploads them onto a cardio log so that they can monitor their own health (and see the impact of daily exercise).
Geisinger is also launching text message options for patients. They currently pilot text messages to mobile users to remind them of upcoming medical appointments. “We’re pursuing a lot in that space now,” Wendling says. In the fall, Geisinger will launch a text message program for patients on cholesterol medications who are not refilling their prescriptions on a timely basis. This program will send a text message to remind patients daily to take their meds. Down the road, Wendling sees this as a broader opportunity to involve other family members in sharing information about when the patient needs medications and or when appointments are so that they are less likely to forget.
Based on previous healthcare innovations, it won’t be a surprise if Geisinger gets “mobile right” before many other healthcare systems. As Wendling points out, the organization has “a culture of innovation which sets the tone for trying new things.” In addition, having a division dedicated to clinical innovation makes a “huge difference,” she says. “Other divisions often don’t have the time that’s needed to simply try new things.”
15 E. Gardner, “Will Patient Portals Open the Door to Better Care” Health Data Management, March 1, 2010.