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April 2011
Chats on Change: New Ways to Communicate With Patients
Thank you for participating in the Chat on Change held April 5th.  During the Chat, the Innovations Exchange provided numerous examples of innovations and tools that enhanced communication with a range of patient populations through means such as phone-based care management, patient navigators, e-mail and texting, and personal health records.

  About our facilitator: Victor M. Montori, MD, MSc is a diabetologist and clinical epidemiologist. He is the lead investigator of the Knowledge and Evaluation Research Unit and a Professor of Medicine at Mayo Clinic in Rochester, Minnesota. He serves as co-director of the Knowledge Translation Research Unit of the NIH-sponsored Mayo Center for Translational Research, and Director of the Healthcare Delivery Research Program, the Shared Decision Making National Resource Center, and the Mayo Clinic Center for Social Media. He has published a book titled Evidence-based Endocrinology and has more than 250 peer-reviewed publications. He was born in Peru, where he obtained his medical degree.
Summary

Culturally Competent Communication
Health Literacy
Internet-Based Communication
Patient Centered Communication
Patient Visits and Communication
Provider-Patient Communication
Self-Management
Text Messaging

Culturally Competent Communication

Stephen W.: Patients all have unique expectations, wants, beliefs and previous health experiences. Physicians need to tailor their communication to patients.

Connie D.: I learned the term “cultural humility” from my colleagues in the Indian Health Service, which really fits! A foundational idea for better partnerships.

Quinn M.: I like that term “cultural humility.”

Victor Montori: I love the term cultural humility; it’s pertinent to clinicians who haven’t made the transition from "god to guide."

AHRQ Innovations Exchange: Here are profiles of culturally competent communication innovations on our Website:
A telephone service that connects Spanish-speaking patients with bilingual nurses
A health plan’s culturally competent care management program improved care for Latinos
Lay health advisors increase breast cancer screening among American Indian women

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Health Literacy

Kathy K.: Is there any action to eliminate or translate 'jargon' (beyond health literacy)?

Ted Herman: Having a patient-provider health literacy roadmap is essential for primary care, let alone dealing with multilingual challenges. Does one exist?

Kansas PCMH: Not so much multi-lingual as multi-cultural challenges will have an impact on communication.

AHRQ Innovations Exchange: Here’s a profile of a health literacy innovation on our Website: Home visits can improve health literacy among low-income pregnant women and new parents

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Internet-Based Communication

Quinn M.: How many providers on this chat use Twitter with patients?

Victor Montori: I do not use Twitter with my patients.

Corinne F.: Do you communicate via patient portals?

Victor Montori: I do not use those yet as an endocrinologist, but I have primary care colleagues that do.

~ ~

Kansas PCMH: Thinking outside the exam room, any good pointers for email follow up?

Connie D.: I use email to follow-up on action plans, which works well. I can often negotiate a new plan if the relationship is sound.

~ ~

Kansas PCMH: Thinking outside the exam room, how do you better prepare the patient for a higher quality dialogue using technology?

Jodi S.: Good Question.

Kathy K.: The University of Toronto is developing an application for patient-physician communication.

AP2010: Can you share the link to the UToronto study?

Kathy K.: Technologies for aging gracefully at http://taglab.utoronto.ca/

~ ~

AHRQ Innovations Exchange: Here are profiles of Internet-based communication innovations on our Website:
A solo family practitioner provides 24/7access to care through the use of "virtual" or e- mail visits
Online communities help patients with life-changing disease interact with clinicians and similar patients
Cognitive behavioral therapy via instant messaging can enhance access to therapy

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Patient-Centered Communication

Kasner K.: Check out this innovation profile on a hospital that used current and former patients as advisors to improve patient satisfaction.

Kansas PCMH: As part of our patient-centered medical home initiative, we will be teaching patients to communicate with doctors and medical teams.

Victor Montori: Yes, we do that in our work related to shared decisionmaking, which I find easier to define than communication.

Gallant P.:  Also, giving patients a greater voice in helping them shape the health care systems.
Check out http://www.patientvoices.ca/

Mark R.: Continuing to empower patients is an essential step in making communication safe, effective, and beneficial.

AHRQ Innovations Exchange:  Here's a profile on a shared decisionmaking innovation on our Website:
Proactive communication helps breast cancer patients better understand their treatment options.

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Patient Visits and Communication

Lee A.: We're trying this new video approach at the Mayo Clinic to prepare patients for their first dental appointment. See http://www.youtube.com/watch?v=1eMQPZw9lmA

Quinn M.: Also, in line with Lee Aase, we complete a pre-office visit phone call so the patient is prepared for the visit.

AHRQ Innovations Exchange: Here are profiles of telephone-based innovations on our Website.
Phone calls to at-risk individuals can increase vaccination and cancer screening rates
Telephone calls and home visits can improve high-risk pregnancy outcomes

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Provider-Patient Communication

Stephen W.: Poor physician-patient communication has been a problem for 30 years. What’s different now? That's what I'm curious about.

Paul G.: I'd add provider-patient and patient-provider communication too.

Victor Montori: Poor communication is an old problem, but the new crisis is that while chronic care requires a partnership, healthcare is running away from the patient.

Mark R.: My understanding is that Medicare will start assessing provider communication skills. That will drive attention to this topic.

Stephen W.: Yes, about 1/65th of Medicare reimbursement will be based upon patient satisfaction scores with physician communication.

Kansas PCMH: How will they assess? How do we measure good communication? Lower blood pressure?

Amit S.: Ditto. "Communication" is highly dependent upon expectations. They have to be set early in the conversation in order to be satisfied.

Carl R.: The proposed rule on Accountable Care Organizations has quite a few measures on patient experience.

AHRQ Innovations Exchange: Here’s a patient communication tool on our Website.
An online training course can help providers improve their patient communication skills.

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Self-Management

Connie D.: In a chronic disease self-management program, peers teach better communication with health care providers. See http://patienteducation.stanford.edu/programs/cdsmp.html

Connie D.: When piloting the Patient Assessment of Care for Chronic Conditions (PACIC), patients became empowered to ask more questions about their health care and expect answers.

AHRQ Innovations Exchange: Here are profiles of self-management innovations on our Website:
Asthma management program featuring home visits can reduce hospitalizations and ED visits
Automated calls to diabetes patients in their native language improves self-management

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Text Messaging

Jen D.: Text messages between doctors and patients work best for outcomes when they are based on a firm relationship and there are multiple avenues for communication.

Victor Montori: Do you want to tell us more about your use of text messaging for young people with diabetes?

Jen D.: Check out Texts add extra 'real time' support and reminders for teens with diabetes.  Also, need motivation and information per BJ Fogg theory. 

Jen D.: Mobile texts are a way teens like to communicate so doctors 'meeting them where they are' just makes the health and caring message clear.

Victor Montori: So, a demonstration of technology supporting the "dance", rather than replacing it! You cannot outsource communication.

Quinn M.: This is going to be more and more the trend, especially as land lines go away.

AHRQ Innovations Exchange: Here’s a profile of a text messaging innovation on our Website.
Can text messaging improve percentage of diabetes patients receiving recommended tests?

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Transcript - Tweets from the Chat

AHRQIX (Innovations Exchange): Welcome to today's #AHRQIXChat on New Ways to Communicate with Patients with Victor Montori MD at Mayo Clinic.

vmontori (Victor Montori, MD): Welcome everyone to the AHRQ Chat for Change - #AHRQIXCHAT - and use this hashtag to make sure others can follow Q&A

Healthmessaging (Stephen Wilkins): Hi all. I am curious about the choice of this topic? Why now?

better_care (Campaign Better Care): @better_care here, excited to join the on Provider-Patient Communication!

mnx (Mary Nix): Great to have you lead the chat @vmontori. Can there by SRO on a twitter chat? You know how to draw a crowd!!

vmontori (Victor Montori, MD): Thanks!!! The answer is yes @mnx: Great to have you lead the chat @vmontori. Can there b SRO on a twitter chat?

amcunningham (AnneMarie Cunningham): @vmontori what is AHRQ?

vmontori (Victor Montori, MD): Engaging pts essential to respond to chronic dz epidemic @Healthmessaging: I am curious about the choice of this topic?

ElaineSwift3 (Elaine Swift): Will use of new media to deliver health care/info pass by vulnerable populations? I am concerned it will

AHRQIX (Innovations Exchange): AHRQ is the Agency for Healthcare Research and Quality at US Health and Human Services.

WellnessCheck (VirtualHealthCheck): diabetes communication trial enrolling in May in South Texas. High touch patient outreach of a FQHC in Harlingen Texas.

amcunningham (AnneMarie Cunningham): @vmontori ok I found info http://is.gd/eMLVsP

KathyKastner (kathy kastner): I've found a place at the back (SRO:) Terrific that AHRQ's doing this!

Healthmessaging (Stephen Wilkins): poor physician-pt communications has been a problem for 30 years...what's different now? That's what I'm curious about.

jsperber (Jodi Sperber): Glad to see AHRQ using SM to connect (I'm an AHRQ fellow). Are you calling the topics or is it open ended?

therman (Ted Herman): @WellnessCheck tell us more, please

HealthWorksBC (Paul Gallant): I'd add provider>pt & pt>provider too RT @Healthmessaging: poor MD-pt communications been a prob 4 30 years...what's diff now?

AHRQIX (Innovations Exchange): Innovation shows automated calls to diabetes patients in their native language improves self-management. http://go.usa.gov/2GC

vmontori (Victor Montori, MD): Poor communication is old problem, but new crisis as chronic care requires partnership yet healthcare running away from patient

NAPH1981 (NatlAssnPubHospitals): @jsperber wondering the same thing! great idea for a chat - awaiting topics/guidance on how you want it to run @vmontori!

AHRQIX (Innovations Exchange): It's open-ended around the topic of patient communication.

vmontori (Victor Montori, MD): Agree clin<>pt is what is needed @HealthWorksBC @Healthmessaging:

KansasPCMH (Kansas PCMH): Thinking outside the exam room how do you better prep the patient for higher quality dialogue using tech ?

HealthWorksBC (Paul Gallant): whew...RT @vmontori: Agree clin<>pt is what is needed @HealthWorksBC @Healthmessaging:

KathyKastner (kathy kastner): Is there any action re elminination or translation of 'jargon' (beyond health literacy)

KansasPCMH (Kansas PCMH): Are docs ready to re-think communication or with their support teams lead the charge?

jsperber (Jodi Sperber): Good Q RT @KansasPCMH: Thinking outside exam room how do you better prep patient 4 higher qual dialogue using tech?

AHRQIX (Innovations Exchange): Online #communities help patients with life-changing disease interact with clinicians and similar patients:http://go.usa.gov/2Du

Healthmessaging (Stephen Wilkins): According to patient satisfaction surveys pts think their docs are great communicators...hard to get traction on this topic

KathyKastner (kathy kastner): Uof toronto developing app 4 pat/md communications RT @KansasPCMH: Thinking outside the exam room how prep patient 4 dialogue

KathyKastner (kathy kastner): IMHO, surveys ask wrong qRT @Healthmessaging: According to patient satisfaction surveys pts think docs gr8 communicators..

LeeAase (Lee Aase): .@KansasPCMH We're trying this at @Mayoclinic to prep patients for first dental appt http://www.youtube.com/watch?v=1eMQPZw9lmA

ACOhealthgal (Quinn Martinson): Key to best use of provider time is clear post office visit education WITH the patient...not just TO the patient. visit.

HealthWorksBC (Paul Gallant): currently in parts of Cdn there is > focus/action on pt-provider communication in primary health incl mds/grps/orgs wrking btr

micscha (Mickey S Schafer): @Healthmessaging I thnk 1 way is better user experience, e.g. Goetz in TEDMED talk http://bit.ly/ezh027,

vmontori (Victor Montori, MD): Disagree - our surveys show half of pts unhappy about communication "@Healthmessaging:

Healthmessaging (Stephen Wilkins): this is a non-issue for most primary care docs even those involved in PCMH - buy an EMR system and problem fixed..lol

KathyKastner (kathy kastner): RT @ACOhealthgal: Key to best use of provider time is clear post office visit education WITH the patient...not just TOpatient.

HealthWorksBC (Paul Gallant): Grt RT @ACOhealthgal: Key to best use of provider time is clear post office visit ed WITH the patient...not just TO the patient

KansasPCMH (Kansas PCMH): Comm outside the visit has to be re-thought of as support, educ, not one on one med practice to work

RichmondDoc (Mark Ryan): My understanding is that Medicare will start assessing provider communication skills. Will force attention on this topic.

ACOhealthgal (Quinn Martinson): Also, in line with Lee Aase...complete pre-office visit call so patient prepared for office visit.

KansasPCMH (Kansas PCMH): "Communication" is highly dependent upon expectations. Have to be set early in conversation to be satisfied

mnx (Mary Nix): But then what is health plan role in chronic dz mngmnt and comm? @vmontori Agree clin<>pt is what is needed

KathyKastner (kathy kastner): Getting link. eg.is MyVoice (4 aphasia pts) lets u program relevant words

vmontori (Victor Montori, MD): @Healthmessaging AHRQIX innovations contain evidence ratings: (innovations.ahrq.gov)

Healthmessaging (Stephen Wilkins): yes about 1/65th of Medicare reimbursement will be based upon pt sat scores with physician communication @RichmondDoc

MikeBoehmer57: Like idea of translating medical terms into plain English. Also, docs spend more time w/ patients. Listening. Explaining

ConnieLDavis (Connie Davis): Talk to Your Doc program in BC-volunteers teach peers about getting the most out of visits ://www.chd.ubc.ca/dhcc/ttyd

KansasPCMH (Kansas PCMH): @RichmondDoc How will they assess? How do we measure good comm? Lower blood pressure?

amitns (Amit Singh): Ditto RT @KansasPCMH: "Communication" is highly dependent upon expectations. Have to be set early in conversation 2 be satisfied

cprath (Carl Rathjen): @RichmondDoc yep, the proposed aco regs have quite a few measures on patient experience

HealthWorksBC (Paul Gallant): We need diverse multiple methods 2 better engage WITH pts/providers & narrow the power/knowledge gap 4 btr person centered health

apattabi (AP2010): Ditto @CuriousIris Can you share the link to the UToronto study? @KathyKastner

amcunningham (AnneMarie Cunningham): @vmontori I'm not saying pts shouldn't be unhappy with commn but @healthmessaging may be right. your pts may be different

Informatics4CH: RT @AHRQIX: on Provider-Patient Communication 2-3pm ET with@vmontori. Share your thoughts.

amcunningham (AnneMarie Cunningham): @Healthmessaging Ron Epstein said recently that pts tend not to be very good assessors of physician communication

Healthmessaging (Stephen Wilkins): Evidence-based AHRQ guidelines also calls for a whole bunch of preventive measures that are not followed either.

AHRQIX (Innovations Exchange): Proactive communication helps breast #cancer patients better understand treatment options. Learn more at http://go.usa.gov/2fF

KathyKastner (kathy kastner): FYI..Communication checklist cited/used by pt advocacy groups and Jour of Participatory Meds http://tinyurl.com/3d7tjbg

KansasPCMH (Kansas PCMH): Need to define communication to make it measurable.

amitns (Amit Singh): There needs to be some clarity on whose risk is being addressed: doctor's or patients?

ConnieLDavis (Connie Davis): in CD slf-mgmt program peers teaching better communication with hcps http://patienteducation.stanford.edu/programs/cdsmp.html

amcunningham (AnneMarie Cunningham): @DOBloss partly because of the way the question is asked- pts tend to be very positive about docs even if not good!

KansasPCMH (Kansas PCMH): To understand effective comm must also understand learning types. Verbal is only one piece.

Healthmessaging (Stephen Wilkins): And I believe Street et al. says that most physicians over estimate their own communications skills as well. @amcunningham

amcunningham (AnneMarie Cunningham): @DOBloss also expectations- patients might think they were involved in decisions but someone else listening wouldn't agree

HealthWorksBC (Paul Gallant): RT @KathyKastner: FYI..Communication checklist used by pt advocacy groups & Journal Participatory Med http://tinyurl.com/3d7tjbg

amcunningham (AnneMarie Cunningham): @Healthmessaging patients are happy! doctors are happy! we're winning:)

EndoGoddess (Jen Dyer MD, MPH): Good communication just is not valued in current system: talking about obesity $0 payment vs barietric surgery $20000

KathyKastner (kathy kastner): Technologies for aging gracefully tag http://taglab.utoronto.ca/

cprath (Carl Rathjen): @KansasPCMH agree. . . it key to give PCPs more time with their patients to build relationships.

carolyndv (Carolyn DerVartanian): Getting a behind the scenes look at @vmontori on. It's frenetic but very informative!

AHRQIX (Innovations Exchange): Check out an profile on telephone service that connects #Spanish-speaking patients with #bilingual nurses http://go.usa.gov/2D6

KathyKastner (kathy kastner): RT @mnx: RT @KansasPCMH: "Communication" is highly dependent upon expectations. Have to be set early in convo to be satisfied

therman (Ted Herman): Pt<>Prov health literacy roadmap essential for primary care, does one exist? Let alone multi-ling challenges

KansasPCMH (Kansas PCMH): Stories stick. http://bit.ly/ibhKm3

EndoGoddess (Jen Dyer MD, MPH): Payment = value in healthcare system like it does in all other systems.

RamboMSRDLD (Julie Rambo,MS RD LD): As part if the team, I use Motivational Interviewing techiques to help the pt find the goals

RichmondDoc (Mark Ryan): @LeeAase just sort of passing through. :).

ConnieLDavis (Connie Davis): When doing piloting of PACIC, noticed pts became empowered to expect more by answ ?s about their care http://tiny.cc/fohxd

KansasPCMH (Kansas PCMH): @therman not so much multi-ling as multi-culture will impact comm

RobinPregnancy (Robin Elise Weiss): It's crazy! RT @EndoGoddess: Good communication just is not valued: talking about obesity $0 payment vs barietric surgery $20000

ehealthirc (Stephanie Shimada): To measure gaps in pt- provider communication need to look at results stratified by health status and utilization.

RichmondDoc (Mark Ryan): I think, as a rule, that docs *think* we communicate better than we do. Hopefully these new rules will encourage reassessment

Healthmessaging (Stephen Wilkins): The medical exam limits how much patients say in visit. Doctors talk 60% of time in primary care visits..still phys-directed.

AHRQIX (Innovations Exchange): Read how a health plan’s #culturally #competent #care #management program improved care for #Latinos at http://go.usa.gov/2DR

KathyKastner (kathy kastner): RT @RichmondDoc: I think, as a rule, docs *think* we communicate better than we do. Hopefully new rules will encourage reassess

KansasPCMH (Kansas PCMH): Thinking outside the exam room...Any good pointers for email follow up?

KathyKastner (kathy kastner): Gr8 RT @RamboMSRDLD: As part of the team, I use Motivational Interviewing techiques to help the pt find the goals

ConnieLDavis (Connie Davis): I learned term cultural humility from my colleagues in IHS--really fits! a foundational idea for better partnerships

EndoGoddess (Jen Dyer MD, MPH): Promotion from assistant prof to associate prof isn't based on good pt communication but rather pubs, grants, $ productivity

GHideas (Aman Bhandari): RT @AHRQIX Read how a health plan’s #culturally #competent #care program improved care for #Latinos at http://go.usa.gov/2DR

KansasPCMH (Kansas PCMH): Simple teach back method to increase understanding http://bit.ly/haHzoJ

Healthmessaging (Stephen Wilkins): Pts all have unique expectations, wants, beliefs and previous hlt. experiences.. physician needs to tailor to patient

ACOhealthgal (Quinn Martinson): @ConnieLDavis I like that term...cultural humility

ConnieLDavis (Connie Davis): @KansasPCMH I use email to follow-up on action plans, works well. Can often negotiate new plan if relationship sound

amcunningham (AnneMarie Cunningham): @DOBloss no not at all- read more about Epstein's thoughts here http://www.annfammed.org/cgi/content/full/9/2/100

Healthmessaging (Stephen Wilkins): How is patient to be compliant with new Rx if average doc spend <1 minute of total visit talking to pt about how to take Rx??

RichmondDoc (Mark Ryan): My current soapbox: if we valued face-to-face care and gave docs necessary time to truly *talk* with pts, comm would improve

amcunningham (AnneMarie Cunningham): @QIsupporter lots of research about knowledge post-consultation - yes!

KathyKastner (kathy kastner): What about in-between md visits.. when patients live their lives. IMO that's when support's reallly needed

KansasPCMH (Kansas PCMH): @ConnieLDavis Excellent! Follow up is key. Words, pics, audio, video, links...

RichmondDoc (Mark Ryan): @vmontori @KathyKastner Good comm requires bilateral engagement; not supported by current payment/delivery structure

rphteach (Mary Gurney): I'm trying to show students the value of letting the patient talk in pharmacy school. It's a challenge.

ConnieLDavis (Connie Davis): It's about the team. Great video on CHCF webpage of MA doing adherence counseling http://tiny.cc/6lvge.

ACOhealthgal (Quinn Martinson): @RichmondDoc In the meantime, what can be done to take some of the burden off the doc? Utilize other staff to help.

AHRQIX (Innovations Exchange): A solo family practitioner provides 24/7access to care thru use of "virtual" or e-mail visits, http://go.usa.gov/2h8

ElaineSwift3 (Elaine Swift): Can text messaging improve % diabetes patients receiving recommended tests? Yes, shows one profile http://go.usa.gov/2Gc

vmontori (Victor Montori, MD): @RichmondDoc on board - how do we make that happen??

EndoGoddess (Jen Dyer MD, MPH): Text message between docs and pts work best for outcomes when based on firm relationship and multiple avenues for communication.

KansasPCMH (Kansas PCMH): @RichmondDoc Comm should be a team effort. Not just on doc.

vmontori (Victor Montori, MD): @EndoGoddess wanna tell us more about your use of text messaging for young people with diabetes?

ACOhealthgal (Quinn Martinson): How many providers on this tweet use twitter with patients??

ConnieLDavis (Connie Davis): I learned new golden rule from colleague: Treat others as they would like to be treated. I have different expectations

Healthmessaging (Stephen Wilkins): Not necessarily @RichmondDoc. Is "Lack of Time" Really the Problem w/ Poor Phys/Pt Communication? http://wp.me/pGXmn-5h

KathyKastner (kathy kastner): Isn't that what GPs)supposed 2 do?RT Pts all hve unique expectations, wants, beliefs,previous hlt. xperiences.md needs 2 tailor

rphteach (Mary Gurney): How are hc providers dealing with technology advances and HIPAA rules?

vmontori (Victor Montori, MD): @Healthmessaging Our shared decision making tools make that 3-5 min w/ some emerging evidns of effectivnss kercards.e-bm.info

vmontori (Victor Montori, MD): @Healthmessaging It is this dance that relates to the art of medicine - thus the need for innovations in policy and practice

vmontori (Victor Montori, MD): Love cultural humility as term - pertinent 2 clinicians who havent made transition from "god to guide" @ConnieLDavis

Annie_LeBlanc (Annie LeBlanc, PhD): Agree ! RT @RichmondDoc Good comm requires bilateral engagement; not supported by current payment/delivery structure

RichmondDoc (Mark Ryan): @vmontori Models of care such as #PCMH could help, so could re-assessing the RUC's valuation of health care services.

EndoGoddess (Jen Dyer MD, MPH): Texts add extra 'real-time' support and reminders for teens with diabetes. Also need motivation/info per BJFogg theory. #mHealth

rphteach (Mary Gurney): @KansasPCMH @RichmondDoc Suggests that we need to train patients to communicate as well as hc providers.

clinchemchick (Corinne Fantz): @ElaineSwift3 what a cool idea. Thanks for the link!

vmontori (Victor Montori, MD): @KathyKastner @RichmondDoc We have videos 2 proof our docs wrong...some times. I think issue is communication depends on both

KathyKastner (kathy kastner): RT @rphteach: @KansasPCMH @RichmondDoc Suggests that we need to train patients to communicate as well as hc providers.

vmontori (Victor Montori, MD): Agree with @EndoGoddess time for a patient revolution! healthcare is about profits and not about patients - let's change that!

AHRQIX (Innovations Exchange): Check out how #hospital used current & former patients as advisers to improve #patient satisfaction. Visit http://go.usa.gov/2fe

vmontori (Victor Montori, MD): @KansasPCMH Yes, we do that in our work related to shared decision making which I find easier to define than communication

HealthWorksBC (Paul Gallant): worth a read/watch: Put People 1st, Expect the Best...Transforming Care 4 Cdns w Chronic Hlth Conditions http://bit.ly/esQE8f

Healthmessaging (Stephen Wilkins): Totally agree...the key to the dance lies not with the physician..they key lies with the patient! @vmontori

KansasPCMH (Kansas PCMH): Teens diabetes text link http://bit.ly/9UOGC7

KathyKastner (kathy kastner): AMENRT @vmontori: @KathyKastner @RichmondDoc We have videos 2 proof our docs wrong...some times. communication depends on both

vmontori (Victor Montori, MD): @mnx Create conditions by which pt-clin communication is as important for performance than HbA1c

vmontori (Victor Montori, MD): + about pt involvement in the latest ACO rules from Medicare www.ofr.gov/ofrupload/ofrdata/2011-07880_pi.pdf @RichmondDoc

KansasPCMH (Kansas PCMH): @Healthmessaging @vmontori It's both if it's truly a dialogue.

RichmondDoc (Mark Ryan): @Healthmessaging Time will not be a magic bullet, but I feel would be a great boon to better communication overall.

KathyKastner (kathy kastner): Love it! Check out how #hospital used current/former patients as advisers 2 improve #patient satisfac. http://go.usa.gov/2fe

HealthWorksBC (Paul Gallant): Also giving patients a greater voice in helping shape health care system/advisers & more (BC Cdn). www.patientvoices.ca/T

ElaineSwift3 (Elaine Swift): : gr8 videos on pt comm: http://www.innovations.ahrq.gov/videos.aspx

KansasPCMH (Kansas PCMH): As part of our pcmh initiative we'll be teaching patients to comm with docs and med teams

RichmondDoc (Mark Ryan): @Healthmessaging I think that even good communicators feel time pressure, and could do better w/ more time.

RamboMSRDLD (Julie Rambo,MS RD LD): Here is some info on Motivational Interviewing http://www.nova.edu/gsc/forms/mi_rationale_techniques.pdf

AHRQIX (Innovations Exchange): Learn how #EHR & #PHR System Enhance Patient Engagement & Improves Efficiency of Physician Practice Visit: http://go.usa.gov/2zM

RichmondDoc (Mark Ryan): @Healthmessaging but I also agree that if docs are not good communicators, they will need to learn the necessary skills.

vmontori (Victor Montori, MD): @ACOhealthgal I do not use twitter with patients

EndoGoddess (Jen Dyer MD, MPH): Mobile/texts are way teens like to communicate so docs 'meeting them where they are' just makes health/caring message clear.

HealthWorksBC (Paul Gallant): Here's another try at that Patient Voices Link http://bit.ly/dkG2q3

RichmondDoc (Mark Ryan): @Healthmessaging And continuing to empower patients is an essential step in making communication safe/effective/beneficial.

vmontori (Victor Montori, MD): @EndoGoddess so demonstration of technology supporting the "dance", rather than replacing it! You cannot outsource communicax

giustini (Dean Giustini): Dr. Victor Montori "Chats on Change: New Ways to Communicate with Patients" on Twitter using (Nicely done, Victor.)

amitns (Amit Singh): GR8 RT @RamboMSRDLD: Here is some info on Motivational Interviewing http://bit.ly/f1I3aK

Healthmessaging (Stephen Wilkins): Great idea @KansasPCHM - how will you do that? Simply providing information or telling pts to ask questions..is not enough

KansasPCMH (Kansas PCMH): @AHRQIX Tech will make it all faster - good and bad communication

AHRQIX (Innovations Exchange): #text messaging improves percentage diabetes patients receiving recommended tests shows one profile http://go.usa.gov/2Gc

ACOhealthgal (Quinn Martinson): @EndoGoddess This is going to be more and more the trend especially as land lines go away.

HealthWorksBC (Paul Gallant): Agree+ RT @RichmondDoc: @Healthmessaging continuing 2 empower pts is an essential step in making comm. safe/effective/beneficial

clinchemchick (Corinne Fantz): @vmontori Do you communicate via patient portals?

KansasPCMH (Kansas PCMH): @Healthmessaging @KansasPCHM Deeper. Teaching comm skills to pts, docs, others in the same room...Crazy, but effective

jsperber (Jodi Sperber): Scalable? Panel is 400 pts. RT @AHRQIX: Solo family doc prov 24/7access thru "virtual" or e-mail visits, http://go.usa.gov/2h8

Healthmessaging (Stephen Wilkins): Poor physician phys-pt comm costs billions in terms of non-compliance, re-admits, poor self care and preventable deaths

heathergrzych (Heather Grzych): Apparently @vmontori most believe they are more responsible for their personal health than their doc: http://bit.ly/g6KttR

KathyKastner (kathy kastner): RT @HealthWorksBC: Agree @RichmondDoc: @Healthmessaging continuing 2 empower pts =essential in mkng comm.safe/effec/beneficial

vmontori (Victor Montori, MD): @clinchemchick do not use those yet as a specialist (endo), but primary care colleagues do

QIsupporter (Todd Jackson): http://e-patients.net/ is a project of the Soc. for Part. Med.

Healthmessaging (Stephen Wilkins): @KansasPCMH - not crazy..fair body of research supporting that approach.

RichmondDoc (Mark Ryan): There are many ways to improve how docs communicate w/ pts. A big one: docs need to sit, listen, respect pt's experiences.

apattabi (AP2010): @Healthmessaging Costs billions to whom? Who's accountable? therein lies the problem...

AHRQIX (Innovations Exchange): #Online #training course can help providers improve #patient communication skills. See tool http://go.usa.gov/2Gg

KathyKastner (kathy kastner): RT @RichmondDoc: Many ways to improve how docs communicate w/ pts. A big one: docs need 2 sit, listen, respect pts experiences.

EndoGoddess (Jen Dyer MD, MPH): To change health outcomes, mobile/text communication must correspond to a theory/strategy, my favorite is @bjfogg

therman (Ted Herman): via @csmonitor: When talking poverty & inequality, language matters. http://bit.ly/gZwgsl be mindful of our "gap" constructs

KansasPCMH (Kansas PCMH): @jsperber @AHRQIX Scalable with the right team and supported by payment changes perhaps

rlhunte (Rebecca Hunter): @RichmondDoc It is important to ask/understand patients fears about diagnosis as communication is colored by these fears

jsperber (Jodi Sperber): I haven't looked through this resource from @AHRQIX until now - good stuff to be found! http://ow.ly/4tLLA

KathyKastner (kathy kastner): Where does literacy (health and otherwise) fit into text based communication

ACOhealthgal (Quinn Martinson): @heathergrzych @vmontori Isnt' that the way it should be? Personal accountability for health?

KathyKastner (kathy kastner): RT @rlhunte: @RichmondDoc important to ask/understand patients fears about diagnosis as communication is colored by these fears

Healthmessaging (Stephen Wilkins): @EndoGoddess If docs can't find time for learning how to talk face to face where they find time to txt??

AHRQIX (Innovations Exchange): Can Cognitive Behavioral #Therapy be effective when conducted via instant #messaging? Find out here: http://go.usa.gov/2mk

KathyKastner (kathy kastner): RT @Healthmessaging: @EndoGoddess If docs cant find time for learning how to talk face to face where they find time to txt??

jsperber (Jodi Sperber): @KansasPCMH Agreed. Major payment changes. Ans system changes... @AHRQIX

apattabi (AP2010): What about behavior change? @KansasPCMH @ConnieLDavis Excellent! Follow up is key. Words, pics, audio, video, links...

KansasPCMH (Kansas PCMH): @Healthmessaging @EndoGoddess Use tools to assist with text push, timing, permissions...

EndoGoddess (Jen Dyer MD, MPH): @Healthmessaging Finding time: it's a matter of priority. Time taken to communicate well initially SAVES time in the long run.

Healthmessaging (Stephen Wilkins): Do people here think most believe there is a problem with Phys-pt communication..or do hlt leaders need to be sold on problem?

HealthWorksBC (Paul Gallant): (3rd try of #, apologies) Not new but yes "listen to each other" = innov in approach clin<>pt interaction

vmontori (Victor Montori, MD): Lack of time is an excuse for outsourcing communication - we must outsource documentation instead @Healthmessaging @EndoGoddess

RichmondDoc (Mark Ryan): @rlhunte Absolutely. To truly engage in patient-centered care, then we need to *listen* to patients' experiences/fears/worries.

Annie_LeBlanc (Annie LeBlanc, PhD): Whether we focus on MD com skills or PT com skills, we need to aligned them to ensure closing of this gap (not creating bigger one)

RichmondDoc (Mark Ryan): @Healthmessaging I think many clinicians feel that it *isn't* a problem, but I think patients would argue otherwise.

EndoGoddess (Jen Dyer MD, MPH): @Healthmessaging Also, texting is soooooo much easier, faster, succinct than phone calls...and teens like it so much more.

KathyKastner (kathy kastner): RT @Annie_LeBlanc: Whther we focus on MD com skills or PT , we need to be aligned to ensure closing gap (not creating bgr )

Healthmessaging (Stephen Wilkins): Actually pt-centered communication in studies takes about 6 seconds longer than physician-directed communications.

AHRQIX (Innovations Exchange): Thanks everyone for participating. A transcript of this on Change will be posted on #AHRQIX next week.

vmontori (Victor Montori, MD): Wow - what an hour - went thru quickly - thanks a million will keep going - nothing more important to comm than meeting pt needs

KathyKastner (kathy kastner): Points 2 importance of tailoring medium to audienceRT @EndoGoddess: @Healthmessaging and teens like texting so much more.

smsLilak (Steph Synoracki): Great statistic! RT @healthmessaging: Actually pt-centered communication in studies takes about 6 seconds longer than...

Healthmessaging (Stephen Wilkins): Great exchange! Thanks

HealthWorksBC (Paul Gallant): TY all too Grt chat RT @AHRQIX: Thanks everyone for participating. A transcript of on Change will be posted on #AHRQIX nxt wk

KansasPCMH (Kansas PCMH): Communication (& whether or not it's a prob) is in the ears of the beholder

rlhunte (Rebecca Hunter): @RichmondDoc patients are more "compliant" to care plan when clearlly understand within personal context rather than "disease"

KathyKastner (kathy kastner): Thnks @vmontori:for gr8 moderating and for AHRQ taking initiative. Fab energy and thots. Thnx all.

Informatics4CH: Check out the @AHRQIX #ICH related #innovations profiles, browse #HIT at http://ow.ly/4tLRj - great resource!

Healthmessaging (Stephen Wilkins): If you like that stat check out the rest of my stats stash at www.healthecommunications.wordpress.com

apattabi (AP2010): @EndoGoddess If texting succintly, possibility of miscommunication? Better to answer patient q's face-to-face?

RamboMSRDLD (Julie Rambo,MS RD LD): Don't forget, MDs, you have a team to help you

apattabi (AP2010): @Healthmessaging Wow! link to study with pt-centered comm 6 secs longer?

RichmondDoc (Mark Ryan): @rlhunte I like to think pts "adhere" to agreed-upon plans of care when plans reflect shared decision-making and pt priorities.

Healthmessaging (Stephen Wilkins): @KansasPCMH I would love to learn more about what you are doing in the sunflower state with PCMH

RichmondDoc (Mark Ryan): Glad I stumbled into the chat; total dumb luck. Glad I could tag along a bit.

smsLilak (Steph Synoracki): Communicating well from the start is worth the time to allow better health outcomes to occur

apattabi (AP2010): Thanks! So many useful resources, will have to browse through now...

smsLilak (Steph Synoracki): What a great discussion today! RT @ahrqix: Thanks everyone for participating. A transcript of this on Change will be posted...

amitns (Amit Singh): So true. Busy hour ahead! :) RT @apattabi: Thanks! So many useful resources, will have to browse through now...

QIsupporter (Todd Jackson): Talking with instead of to the patient is of utmost importance.

amcunningham (AnneMarie Cunningham): "EBM and patient choice: the case of heart failure care" http://is.gd/Zvq6SL interesting paper to those following

TopLineMD: Darn, we missed Chat on Change with @vmontori. Is another chat coming up soon? We hope!

TopLineMD: For those of you who missed Chats on Change too, here's a synopsis: http://bit.ly/hkM6cP

mmm5063 (Melissa Malski): What a productive conversation. Can't wait for the next one!

akroundtree (Aimee Roundtree): Which surveys? Of ethnic pop. too? "@Healthmessaging: Pt satisfaction surveys say they think their docs are great communicators"

akroundtree (Aimee Roundtree): What about prep for procedures like joint replacement? "@LeeAase: @KansasPCMH @Mayoclinic to prep pts 4 first dental appt "

akroundtree (Aimee Roundtree): Sorry to have missed it. Hope another scheduled soon! "@vmontori: will keep going"

mnx (Mary Nix): Incl pts in developmnt of EBGdlns to remove buttress? @amcunningham EBM & pt choice: the case of HF care http://is.gd/Zvq6SL

amcunningham (AnneMarie Cunningham): @mnx the issue is the application of guidelines not their development

bridgeshealthca (Michelle Lemme): MT@ HealthWorksBC:Check out Patient Voices at http://bit.ly/dkG2q3 #patient #health

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