While some of us are running around with Fitbit devices, staying active and tracking every step (yes, I'm one of them), there are plenty of us opting not to follow doctor's orders to reduce this or cut that out of our diets. Admittedly, I'm one of them, too.
And so it goes with patient engagement. Like that familiar saying, it seems you can engage all of the patients some of the time and some of the patients all the time, but you cannot engage all of the patients all of the time.
Still, the industry continues to retool itself for value-based payment models that emphasize prevention of readmissions and population health — models that will require us to place patients squarely at the center of our collective efforts to bend the health care cost curve and improve patient outcomes.
As we contemplate the benefits that patient engagement and population health will have on the industry, it's unclear if the throngs of patients we're seeking to engage — let alone our nation's health care providers — are ready to play such a starring role in their own care. As we know, the willingness and ability of patients and providers to engage varies depending on a host of socioeconomic, infrastructure and demographic factors — many of which we've only begun to penetrate.
Indeed, we are at a critical juncture where patient engagement is concerned. This fall, as the first round of eligible hospitals attest for Stage 2 meaningful use, they will be required to let patients view, download and transmit their health information within 36 hours of discharge. Eligible professionals are required to do so within four days of the information being available to the provider. Additionally, the minimum threshold for this measure is set at 5 percent of patients — a number some are skeptical is even reasonable.
This step is only a modest contribution in a long journey toward ensuring that patients are informed and playing an active role in their health care. It is, nonetheless, an important demonstration that our nation's providers are working to involve patients more in their own care.
Getting There from Here
In large part, the HITECH legislation is shifting our focus from adoption to meaningful use of health care information technology. But, we won't get much from our investment without patient engagement.
For example, research tells us that less than half of nonsurgical patients follow up with their primary care provider after discharge, one in four chronically ill older adults do not comply with their doctor's recommendations about prescription drug regimens, and less than 50 percent of elderly patients are up-to-date on clinical preventive services. The costs associated with these dismal statistics cannot be eliminated even if every provider in the nation is fully using the most elegant electronic health record.
To counter these noncompliance tendencies and transition-of-care issues, a variety of interventions must be employed to stay in constant contact with patients and gently nudge them toward better self-care and prevention. In general, we must recognize that patient non-engagement often is not due to patients' lack of willingness: They may not be able to afford their medications. They may not be able to get a ride to their physician's office. They may not be able to read English. Still, many of our interventions will employ electronic tools and patients' personal devices to bridge the gap between hospital and home.
However, despite the benefits of patient-centered technologies, a provider's move toward patient portals, EHRs integrated with personal health records and provider-patient messaging, for example, is often low on the IT priority list.
For instance, when respondents to the 2013 HIMSS Leadership Survey were asked to identify the top IT priorities to be addressed at their organization in the next two years, 28 percent cited implementing the systems needed to achieve meaningful use. Another 20 percent indicated their top IT priority was to optimize the effective use of their currently installed systems. A focus on using information housed in data warehouses and business intelligence systems (17 percent) rounded out the top three priorities.
Only 2 percent of the HIMSS respondents indicated that health care consumer issues were a top IT priority or a primary clinical IT focus. In fact, with all that must be accomplished in fairly short order for meaningful use Stage 1 and 2 preparations, many organizations are left wondering how to develop a comprehensive patient engagement strategy — not to mention how to balance the various competing IT initiatives.
Those organizations seeking guidance in launching or strengthening their patient engagement strategies can turn to some excellent work released late last year by the National eHealth Collaborative.
Taking into consideration the patient engagement criteria for Meaningful Use Stages 1 and 2, NeHC's Patient Engagement Framework outlines several attributes of organizations that successfully engage and support patients, and ultimately their communities, in their care. The phases of the framework include Inform Me, Engage Me, Empower Me, Partner With Me, and Support My e-Community. The framework helps organizations build out their capabilities in providing useful facility information, e-tools, forms and patient education, and patients' access to their information, as well as letting patients help generate their information and be a part of the care team.
Little Things Can Make a Big Impact
In working with dozens of providers over the past few years, I'm frequently introduced to innovative projects that span the breadth of NeHC's Framework. Often, I'm awed by how a seemingly simple initiative can make such a big impact.
For example, understanding that a hospital stay is a confusing and overwhelming time for patients and their families, Main Line Health, in the Philadelphia area, developed a patient-directed daily care plan (Inform Me) to help educate patients and their families on the various tests and treatments they will receive.
Employing its clinical information system's reporting tools, the plan summarizes information for the patient and care team. To ensure that the plan was suitable for patient consumption, Main Line Health created a table to translate terms like "antihypertensive" into "used to treat high blood pressure."
Prior to the patient's daily care plan inception, physicians and nurses made up the majority of users for the provider's clinical information system. Now, patients have become users — or consumers — of clinical information system data and participants in the information flow.
In post-visit surveys of patients who received the daily care plan, the majority reported finding the care plan very helpful and wanting themselves or a loved one to receive such a report during a future hospital stay. Additionally, scores increased significantly for things we may take for granted, such as knowing all the names of the doctors who are treating the patient, knowing the names of medications and understanding why each is prescribed.
Now that patient satisfaction scores literally impact the bottom line, simply providing patients with a comprehensive daily status update can deliver a big impact. After all, being an informed patient is a prerequisite to being an engaged patient.
As the industry progresses through the NeHC Framework, providers will need to determine what patient-centered technologies they will offer to foster increased information sharing and engagement with their organizations.
With meaningful use Stage 2 soon to take center stage, many practices and hospitals are relying on portals and remote access systems for patients who can log into a secure, HIPAA-compliant website and get test results, view doctors' notes, schedule appointments, pay bills or refill prescriptions. Some patient portals are integrated into a provider's existing website, while others are extensions of the organization's electronic health record system.
For example, New York-Presbyterian Hospital's award-winning patient portal, myNYP.org, was built via a joint, agile development model that expanded on its existing EHR. Rapidly deployed, the portal measurably increased patient engagement and satisfaction.
The project led to a 42 percent increase of appointments scheduled using myNYP.org, and it lowered the no-show rate from 20 percent to 12 percent over a period of six months after it was made available in January 2012. Additional applications of the same appointment-alert technology can provide customized patient education material and/or personalized reminders to patients who fit a specific clinical profile, such as patients who missed an immunization.
NYP's joint work teams also created a solution for NYP to send reminder messages to patient phones and other mobile devices, and allow for communication from patient devices back into the information infrastructure. In all, 7,000 patient communication preferences (text, phone or email) were collected, helping NYP stay in close contact with its patients.
Technology Is Only Part of the Equation
From the growing trend toward increased provider-patient contact via mobile devices, portals and personal health records, to novel telemedicine approaches, e-visits and self-care technologies for managing chronic conditions like diabetes, an exciting future awaits us. In fact, several global initiatives already have shown that these technologies and practices hold tremendous promise for engaging patients earlier in the disease process, reducing costly readmissions, and caring for cohorts of patients more effectively and efficiently.
What exactly this future will entail remains to be seen. But, no doubt, the growing number of aging baby boomers who will eventually interact with the nation's health care system will play a key role in shaping what the fully engaged patient experience looks like.
As we move forward, we must ensure that the evolution from a providercentric model to one that is truly patientcentric employs a stepwise approach to technology adoption such as NeHC's Framework suggests. Additionally, we must take great care that we do not ignore the most pressing obstacles to technology-based patient engagement, such as low health literacy or failing to reach key patient groups like the elderly or low-income households. Missteps such as these could have far-reaching consequences for the success or failure of our efforts.
Health reform demands that we keep patients as healthy as possible for as long as possible, thus avoiding expensive hospital stays and excessive readmissions. To remain healthy — or at least to prevent further decline — patients must take an active role in managing their own health, including modifying personal health behaviors. Medical interventions that occur solely through office-based patient/provider interactions no longer will provide the level of monitoring and scrutiny we need on our most challenging populations.
As the industry's focus on patient engagement matures and the body of evidence supporting its efficacy grows, new innovations in tools and care practices dramatically will impact the health care transformation under way in this country. In many ways, the transformation will fall short of expectations if we do not harness the power of technology to help patients help themselves. But, we must also remember that technology is only part of the equation: There can be no patient engagement without the caring and skillful human interactions between caregivers and their patients that remain the hallmark of health care in America.
John Glaser, Ph.D., is the CEO of the health services business unit of Siemens Healthcare in Malvern, Pa. He is also a regular contributor to H&HN Daily.