– June 04, 2020 – If you asked her in January, Ellie Zuehlke, director of Community Benefit and Engagement at Allina Health, would have said the health system would fully implement its virtual strategy, including digitizing its social determinants of health screening and referral, in about five years. She couldn’t have imagined that just a few months later the health system would have pivoted to digital in less than a week.
“In March, our world flipped upside down and we in Minnesota basically shut our clinic,” Zuehlke said to PatientEngagementHIT. “People joke about it but it’s really true. We implemented our five-year virtual strategy in five days.”
At break-neck speed, Zuehlke and partners in the health technology and accountable communities departments revamped technology from NowPow. This tool allows providers to assess a digital social determinants of health screener and provide virtual links to community-based services that can meet the needs detected in the screener. The technology also enables virtual connections between the highest-risk patients and healthcare navigators.
But before that, this was largely a paper-based system, Zuehlke described.
“From our primary care to outpatient mental health to mom and baby and then in the emergency room of three of our hospitals, our workflow was very much a paper-based process,” she said. “A patient would come in, and when they were checking in at the front desk there would be a pop-up in our Epic EMR that would trigger the front desk worker to give the patient a paper-based screening.”
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Once the patient completed the screening, a care team member — usually a medical assistant — would transcribe the form into the health record. Integration between the EHR and the SDOH software would produce a tailored list of resources. Earlier this year, Allina began work to digitize a referral tracking process, too.
But as Zuehlke noted, COVID-19 took over the healthcare industry in March, pushing many organizations like Allina, to close its primary care and other non-emergent healthcare facilities. And like many others in the industry, Allina filled care access gaps using telehealth to help maintain care management for patients.
But that didn’t really jibe with their paper-based system for SDOH screening.
“We saw 85 percent reduction in our visit volumes, and those office visits really were the driver for patients to screen for social needs,” said Dan Behrens, MHA, manager of Accountable Health Communities at Allina Health.
Of course, there was a way the Allina team could still lean on paper-based SDOH screening. The patient could still complete a form and send it to her telehealth provider, and then the provider could transcribe that into the EHR. But this is time- and labor-intensive and doesn’t deliver on the quick, convenient, and cost-effective care that telehealth promises.
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“We started looking at how we could try to build the same screening for people,” Behrens said. “We built the screen into our patient portal. That allows us to basically send this screener out through the patient portal five days prior to the visit so the patient had ample time to document and review the screening tool. Then all of those answers and responses would go directly back into our EMR.”
The health system has also digitized how it tracks these referrals. Referral tracking is an important aspect of SDOH interventions because it allows medical providers to know if patients have connected to the services that they need. Additionally, it helps providers know whether those interventions worked to improve health.
Allina is able to track referrals with any social services that have also jumped on board to digital SDOH tracking and referral. In other words, if a social service has also integrated with NowPow, Allina can conduct digital coordination and tracking with it.
“Let’s say we had a food need in the north metro, our navigator would hand that patient over to the organization directly,” Behrens offered as an example. “That organization would do outreach to that patient for that need. All the community partner is doing around the resolution of those needs is documented in the tool, which links back through to our EMR where our navigators can see the outcome of that intervention.”
If the patient hasn’t accessed the social service or is facing access barriers, the patient navigator can link back with the patient to overcome any challenges.
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Of course, this system isn’t flawless — at the time of publication, Allina has only been on the technology for a few days. That newness compounds with the newness of virtual visits and telehealth, which Zuehlke said can be stressful for providers and patients.
“What is a defining factor — which relates to the implementing a five-year virtual plan in five days thing — is the amount of change,” she said. “It makes it a little bit harder to really understand which of the numerous issues we are facing.”
This is putting a strain on how Allina can assess the success of this program, Zuehlke said. Virtual visits are new for many patients. This SDOH screening technology is new for a lot of patients. And, as COVID-19 has pushed social needs and the importance of community health to the forefront, these evolving relationships with community figures are new for patients.
According to Behrens, this is exactly the area he and his team plan to focus on as they roll out the technology and work to refine the system. The digital program must supplement, not detract from, the face-to-face interactions that have long defined the basis of community-based health and SDOH screening and intervention.
When front desk staffers issue an SDOH screening to a patient, they have the opportunity to explain why the clinic is collecting this information and how providers can use it to improve patient’s health and wellbeing. This practice is essential for building patient trust, which in turn is key for patients disclosing their greatest social and personal needs.
“We’re going to keep a close eye on kind of the response rate that we’re seeing from patients,” he concluded. “Our concern is if they’re feeling that this is an appropriate and comfortable means for them to fill out our screening tool and express needs. We’re keeping an eye on what the completion rate looks like in comparison to what had been our baseline in the offices.”