Located in Holdrege, Nebraska, Phelps Memorial Health Center is a 25-bed critical access hospital that delivers a broad spectrum of healthcare services. Because of our rural location, which means many of our patients travel from far away for appointments, we are focused on reducing care gaps.
One important aspect of reducing care gaps is patient follow-up, which meant that a team of nurses would spend hours individually calling patients to remind them of upcoming appointments or test results. To reduce this burden on our clinical staff time and reach more patients, we decided to partner with Luma Health to help us automate this process.
The biggest problem we saw identified was not having a way to confidently send reminder messages to our patients for upcoming appointments and then see our electronic health record and practice management system update based on the patient replies. Our system did not provide a comprehensive view of sent messages, and the messaging updates within our MEDITECH EHR were only partially useful. For example, we could see only basic information about the patient’s response, not the full context that staff needed for a complete view of each patient’s care journey.
We also needed more customization in the way we communicated with each patient scheduled in Meditech to make it a more personalized interaction. Because our previous system was not integrated with the EHR, our nurses were continually switching back to manually call patients to remind them about upcoming appointments. These challenges prevented us from really scaling up our patient engagement and it’s why we started to look for a new partner who was more deeply integrated with MEDITECH.
Once the project got underway, Phelps Memorial and Luma were selected to be the first MEDITECH Expanse customer to utilize the MEDITECH API for patient reminders and to enable patients to self-schedule their appointments. We were very impressed by the resulting user interfaces — both for our hospital end users and as well as the messaging user interface for our patient population. One concern we had was the ability for the Luma and MEDITECH teams to get on the same page, as MEDITECH was working with another vendor at the same time. However, the Luma team worked diligently to ensure the project continued to move down the tracks. It was a bleeding-edge project that presented numerous hurdles to navigate, but everyone involved was pulling in the same direction and we were able to bring this project to a completion. Since deployment, the integration between Luma and MEDITECH has been very solid.
Phelps chose to start with Patient Reminders for our Phelps Medical Group (PMG) clinic to make sure we were confident with the results generated by the Luma product. Once we were able to realize successes, we then moved to our specialty clinic as well as for imaging and ortho/spine appointments. We use MEDITECH APIs to send reminders to patients on the schedule on a specific cadence, and once the patient confirms the appointment, that response is sent back to change the appointment status in MEDITECH. This provides the entire team with visibility into patient status, even if they don’t have access to the Luma system.
At first, the organization was hesitant about the integration and whether everything would work the way we expected, but after the success of patient reminders, everyone was on board to expand the Luma and MEDITECH integration. From there we went with follow-up texts and responses for all appointment types, and then moved on to intake forms and insurance cards. In particular, intake forms have been very successful, with 84% of the patients that receive the forms completing them before their arrival. Our patients like using text messaging — even our older patient population. We see patients in their eighties responding to text outreach.
For all these mini projects, our project manager was a product specialist or was able to contact programming to get all items addressed. We continue to evaluate additional workflows that Luma can manage. For example, we recently went live with patient self-scheduling via the Luma integration with MEDITECH — and we were the first organization nationally to do so.
The Luma integration and development team was able to get access to the fully integrated MEDITECH test and integration environment, named MEDITECH Greenfield. Using that, they were able to build integrations using a standards-based approach to integrate with MEDITECH’s Community-Wide Scheduling and Scheduling Grid applications and were able to test how their product would work ‘in the wild’ with a real health system before even having to involve us.
The APIs that Meditech provided to Luma were based on open standards, which helped Luma quickly build, iterate, and test the various functions, such as reading and updating the schedule, scheduling appointments, booking new patients, and more. Phelps provided the access needed for both Meditech as well as Luma to be able to access our data through the API. The Phelps team was a testing user, but we were not actually sending commands to the API to get open appointment times or previously booked appointments — all that was all handled by the Luma team.
Our response rate of people responding to appointment reminders has been way more than we ever imagined. In the past year, we have sent out appointment reminders to 14,000 appointments. 70% of those patients confirmed that they were planning on attending the appointment. Our no-show rate went from around 8% to less than 4%. The ability for the Phelps Memorial team to be able to message back and forth with scheduled patients has been a huge satisfier for the ortho/spine team. They have cut down on calls and messages left for patients and reduced the frequency of playing phone tag with them.
Intake forms are also seeing a great response rate of 84%. This is a significant time savings for our staff. Having patients be able to upload their insurance card and provide their consent before they arrive —those are small pieces by themselves— but these small processes can really make a big difference in that ‘whole patient’ visit with us.
We are just a few weeks into patient self-scheduling, but even without any social media promotions, we are already getting patients to self-schedule with our PMG providers. I am looking forward to seeing the results of a little marketing and word-of-mouth referrals to this project. I think it is going to be a big hit with our patients.
Kurt Schmidt
Kurt Schmidt is the Director of EHR for Phelps Memorial Group.
