Practice Management Alert

Ensuring that the right people make medical decisions is the goal of capacity determination. Especially for patients with dementia, better patient engagement means better health outcomes and a simpler decision-making process, says Lesley Kadlec, a patient engagement expert and director of Health Information Management Practice Excellence for AHIMA.

Engaging patients makes it simpler to determine capacity. “It’s easier to notice changes [in mental acuity] if you know the patient’s baseline,” says Kadlec. Properly engaging a patient and their informal caregivers ensures that the right people can make decisions when the patients cannot. Kadlec offered the following tips for providers and practices looking to engage this population:

1. Build Relationships Early. “Building strong relationships with patients early in the process is key,” says Kadlec. Building rapport with patients helps you learn who should be involved in their care and decision-making. No one knows this information better than the patient. By building this relationship, says Kadlec, you can ask such important questions as “Who lives with you? Who do you want to participate in your care? Who should have access to your information?”

This process is often complicated by dementia, especially when new patients arrive with preexisting dementia. That’s why Kadlec recommends making these questions standard protocol and putting the information in the patient’s file, just like other medical information.

2. Create a Portal Account During the Visit. The patient portal can be a good way to communicate and store health information. Especially for geriatric and dementia patients, the portal provides reliable medical history and care instructions. “Written or verbal instructions for something like wound care often get lost or don’t make it to the right caregivers,” says Kadlec. “Getting those instructions into the portal is crucial for continuity.”

Because of the portal’s importance, Kadlec recommends signing patients up for a portal account during their initial visit. This ensures that they have an account and allows your staff to teach the patient (and their caregiver) how to navigate the system. Equally important, says Kadlec, is having the right tech support. “Help videos, people who can field questions, and accessible feedback loops throughout the portal” are necessary for a patient-friendly system. A more patient-friendly portal is a better resource for patients and providers alike.

3. Get the Right People on the Portal. Once the portal account has been created, family members and other caregivers can be added very easily. These important surrogates and advocates help provide care and monitor that care at home.

“Most of the day-to-day care happens at the home, not at the office,” says Kadlec. Family members and other caregivers provide most of the care and have daily contact with the patient. “Patients might not notice a change in their condition, but their caregivers might.” Connecting other caregivers to a patient’s portal allows them to enhance the information and contact the providers directly.

Connecting caregivers means more community engagement too, says Kadlec. By making the family part of the care team, they can coordinate and document community resources, like neighborhood support and meal assistance.

Future Trends

Kadlec projects that as more people live longer and vie for health resources, the availability and affordability of healthcare will likely decrease. Kadlec sees a “trend towards homecare and an increased reliance on family members, who will want more control over the patient’s health information.”

As more intelligent and intuitive technologies like Amazon’s Alexa and Apple’s Siri pervade the market, Kadlec thinks patients will expect other technologies and software to keep pace. “People will start to expect their interactions with technology to feel like interactions with humans,” says Kadlec. “Providers who capitalize on that will be ahead of the game.”

For more patient-engagement resources and information, check out AHIMA’s free Consumer Engagement Toolkit at http://bok.ahima.org/PdfView?oid=301404 - a great resource for practices of all sizes.