The engaged patient
Part of the emphasis on patient engagement can certainly be traced to meaningful use regulations. In Stage 2 and the proposed rule for Stage 3, the Centers for Medicare & Medicaid Services places an emphasis on ensuring that patients can access their health records and become more connected with their providers. Stage 2 requires hospitals to show that 5 percent of all discharged patients have viewed, downloaded or transmitted their health information to a third party.
Of course, making records available is one thing, getting patients to participate online is something else entirely. At Citizens Memorial Hospital, Bolivar, Mo., staff called patients during the 90-day attestation period to get them to sign up for the patient portal and use secure messaging, says Chief Information Officer Denni McColm.
“We had to do some crazy things,” she explains. “If you signed up for the portal and sent a secure message, you were entered into a contest to win an iPad or a TV. We had one staff person in particular who would call up patients and say, ‘I saw you were at the doctor’s. I wanted to see how you were doing. Why don’t you get on the portal and let me walk you through it.’ And she would get them signed up.”
Most of those patients remain active users of the portal, McColm says.
To a certain degree, engaging patients online is a question of value, says Michael McCoy, M.D., chief health information officer, Office of the National Coordinator for Health IT. Is there enough information and meaningful interaction with providers to entice a patient to regularly visit a portal and become engaged?
“From my perspective, hospitals are missing the mark,” he says. “They complain about the number of [meaningful use] measures, rather than finding ways for doctors to be more proactive and responsive.”
While she contends that the regulations are too burdensome, Chantal Worzala, director of policy at the American Hospital Association, agrees that portal usage ultimately will increase as the sites become more user-friendly and useful. She says it’s encouraging to see in the Most Wired data that hospitals are going beyond meaningful use requirements to find ways of promoting patient engagement. For instance, 63 percent of Most Wired hospitals offer self-management for chronic conditions through the patient portal. And, 67 percent can incorporate patient-generated data through the portal, an important point since proposed Stage 3 regulations would require that hospital EHRs ingest patient-generated data from nonclinical settings for more than 15 percent of unique patients.
Worzala says there are still significant hurdles to marrying patient-generated data with an EHR, not the least of which is standards. McCoy adds that physicians are rightfully concerned about “being overloaded with noise.” It will be important going forward to figure out what information is truly useful to clinicians.
To that end, Worzala says the federal government needs to slow down on the regulator front.
“This is an opportune time to build on the tremendous investment in EHRs over the past few years,” she says. “We have so much interesting technology, let’s allow providers to figure out what the best uses are for providing care.”
As with nearly everything in society, mobile technology is another part of the puzzle. The key is finding ways to connect with patients on their terms.
“I was surprised to see the high level of usage on mobile devices,” says Russ Branzell, president and CEO of the College of Healthcare Information Management Executives, H&HN’s partner in the Most Wired project. “We are seeing that mobility is an expectation in all parts of a consumer’s life. They’ll demand that from a patient engagement standpoint.”
Among Most Wired hospitals, 89 percent allow patients to access the portal via a mobile app, up from just 58 percent last year. Even among all respondents, there was a huge jump — 47 to 79 percent. Additionally, 63 percent of Most Wired organizations enable secure messaging, up from 40 percent in 2014. And 50 percent provide a mobile app for a personal health record, compared with 32 percent a year ago.
Looking more broadly, the field is challenged by the interoperability dilemma and the ability to exchange data across the continuum. As long as that challenge remains, it will be difficult for hospitals to fully move toward accountable care and value-based delivery.