Patient engagement strategies proliferate, experts pontificate and lay people ponder, but as we wait for the dust to settle, there are few tangible suggestions that truly claim to guide physicians and practice leaders in the steps to take for actually engaging their patients.
Though meaningful use requirements mandate physicians provide secure messaging and patient portal capabilities as a requirement for attesting, but what can those at the practice level actually do to get patients more involved in their care and foster the spirit of meaningful use?
According to Jason Fortin, senior advisor at Impact Advisors, a healthcare consultancy, there may be some simple, more traditional paths to patient engagement.
For example, other than focusing on creating social media campaigns to drive traffic to sites and brick and mortar practices, “But, they shouldn’t abandon regular mailings and telephone calls to patients,” he said. “Don’t abandon all the arrows in your quiver.”
Essentially, patient engagement can be a long a drawn-out process that requires a great deal of investment. Short-term returns may not be what practices hope for, but they’ll pay off in the long run.
For the time being, patient portals are designed to fill the patient engagement voice. Unfortunately for some, adding one more system to their roster and another log in to track, there’s more likely the chance that unless it provides some sort of concrete benefit, patients may not be interested in pursuing a relationship with their physicians through it.
Real change in regard to patient engagement is most likely a generational issue that we don’t see manifest for several years. If patients (now or in the future) are going to be engaged, whatever the tool used to reach them will most likely have to fit into people’s daily lifestyles.
Patient engagement tools will need to evolve beyond bill pay and appointment setting systems. Most likely, they’ll have to be along the lines of a Facebook or a Twitter.
Fortin says whatever the tool and no matter its capabilities, it needs to “transcend” and impact the population. For any sort of system or technology to work long term it needs to be “integrated into people every day lifestyle otherwise folks are going to have a difficult time maintaining their interest in using it,” Fortin said.
But the traditional vendors, those that produce the patient portals to compliment their electronic health records are not spending their time focusing on innovation and advancing the technological offers to clients, Fortin said. On the contrary, most vendors are mired, or choose to be mired, in the technological requirements of meaningful use.
In this regard, meaningful use is quite singular in its focus and is restricting innovation of new technology.
Until we’re able to develop or capture new technologies to engage patients (I trust the free market will come up with something), healthcare professionals need to come up real and tangible strategies for action items that they can put in place to create an environment where patients feel safe enough to engage.
In the meantime, maybe your fingers should do the talking and a postage stamp can be employed to save the day.
The business of explanation deserves its place in healthcare, at least as far as the patient is concerned. In their interactions with their physicians, be in at an office visit or in the emergency room, there’s a great deal more need for those providing the care to walk through the experience with those receiving the care.
Even if it’s a tedious experience for the physician the importance of drawing and engaging the patient can not be understated.
Really, from start to finish, every interaction with every patient should contain some sort of “educational” component at least as far as the care continuum is concerned. During their visits, all patients have questions in which they need/want answers to that ultimately may not be vitally important to the caregiver, but are to those receiving the care.
Even during the documentation process, physicians have a great opportunity to learn more about lives and health choices of their patients, especially if they can get them to speak about the office’s electronic health record system.
Perhaps I’m the outlier given my passion for technology and health IT, but I use my doctor’s use of technology during my office visits to engage my physician. Maybe it’s the reporter in me, but I always seek opportunities to use props or interactions to develop deeper relationships with those around me. Though my physician may think his EHR beyond my comprehension, I like to surprise him and dive right into and ask him about its capabilities.
What can it do?
Why did he choose it?
What does he track the most?
What’s he tracking about me?
Why did he buy it?
Then, when the ice is broken, I dive into more broad-based questions:
Why does he practice?
What is he most passionate about from a care perspective?
Why he chose to practice the field he did, and so on …
Essentially, in the eight minutes he’s taken to see me, I’ve learned enough about him to probably write a profile.
My point is, by taking a peripheral interest in someone even in an extremely short amount of time, there are benefits to be gained. I try to make it an art form and get at people’s stories without them even knowing. Try it sometime. Next time while at a party, observe just how many times someone actually asks you a question about anything. I’ve gone through hours of social engagements without having to answer a single question.
My point is, it’s easy to engage people of all levels even without them knowing it if you get them talking about the one thing they all want to talk about: themselves.
This tactic, if used by physicians, could get all of the information they need out of their patients even if their patients don’t want to be engaged.
According to a new study published by the Journal of the American Medical Association, patients with online access to their medical records were more likely to engage with their physicians, in person and through electronic communication.
Apparently, this is the case for patients of all ages despite whether or not they were diagnosed with a chronic condition.
Likewise, for these same patients, there financial outlay for services was also greater than their counterparts who had no such access to their medical records online.
The Journal suspects a few reasons for this, including: “patients need ‘better, faster, cheaper’ processes of care for diagnosing, treating and monitoring their health. Online access to care may have led to an increase in use of in-person services because of additional health concerns identified through online access. Members might have activated their online access in anticipation of health needs. Members who are already more likely to use services may selectively sign up for online access and then use this technology to gain even more frequent access rather than view it as a substitute for contact with the health care system.”
These results really do seem to mean that there is a verifiable correlation between patient portals and patients’ ability to access records online whenever they want. The findings also suggest that the portals, and subsequent secure electronic communication, encourage patients to interact with their physicians, ask questions, seek treatment and engage.
Even with the spike in expense these folks are adding to the system, this is probably some of the most positive insight to come out, and support the healthcare community, especially as they embark on their role of working toward stage 2 meaningful use attestation.
However, it’s worth pointing out that the one thing that seems to be generating the most buzz in relation to this data are the healthcare expenses the individuals are generating, and I just don’t understand. Someone please help set me straight here. Why is this a bad thing?
If I’m speaking out of turn, please correct me, but here’s how I see this playing out, assuming the information released by JAMA is true.
First, patient portals really do seem to be engaging patients as long as they know to use the system, how to use it and what to use it for. Because they are using the system, they are becoming more concerned about their health and having conversations with their physicians about their concerns.
Next, they want to address their health concerns, so they seek the counsel of their professional healthcare provider. Said counsel costs money and they are paying for the care they seek, therefore, helping build their physician’s practices.
Additionally, because patients are using the system, the practices are meeting the minimum requirements for mandates and will be able to successfully attest to stage 2.
Once the patients receive the care they need, they return to their lives until another ailment shows its head, at which point they return to the portal and continue to engage.
All said, you have an engaged patient population who look to create and value long-term relationships with their physicians and their physicians are able to support and build their practices, and, wait for it … support their patients.
It’s the circle of “life,” if you will. As the population scales beyond those included in the survey, this model is likely going to be the new normal.
Please, please, correct me if I’m wrong, but isn’t this exactly the type of news and headlines everyone with an investment in meaningful use was waiting/hoping for?
Healthcare reform was ignited by ARRA, which became the catalyst for much of the changes currently taking place in the health IT landscape, and though meaningful use is profoundly changing the way data is collected, according to some we’re a very long way away from actually being able to do something specific and positive with it.
Everyone in the healthcare community is focusing on regulation and meeting the mandates of the reform, from a healthcare technology perspective. Things get a little lopsided when the discussion turns to how the information gathered in meaningful use relates to clinical outcomes.
According to Dr. Akram Boutrous, who leads the consultancy BusinessFirst Healthcare Solutions, right now there is simply no way of collecting all of the data available in the healthcare community on a global level.
As far as he and others are concerned, under the current healthcare reform model there’s too much attention being placed on healthcare technology, including electronic health records, when there is still a mighty void between the tools used to gather the data and the tools (which don’t yet exist, he says) used to analyze the data.
“There are still many tools required to predict what is most likely going to happen in a given scenario and the best course of action to take,” Boutrous said.
He describes the current health IT landscape like an iPad without apps to use on it. “You can look at it, but you can’t do anything with it.”
This means we’re back where we have always been – in a land of silos where the information they contain stays contained without any real chance of it going anywhere to do any good.
Without interoperable systems that can communicate on a much larger scale, there’s certainly no room for even discussing the advancement of the ACO concept. “I’m pessimistic that ACOs as defined [in health IT] will provide meaningful change in healthcare,” he said.
The catalyst for change, he thinks, is the payer community and non-government organizations. Even though the federal government set the foundation for health reform, it won’t be able to maintain a successful program, and innovation will fall by the wayside.
“The non-government side of the world has taken the bull by the horns and made some very innovative advancements,” he said, while the public sector sought clarification of the reform mandates through court and legislative actions.
Until better tools can be implemented and adopted, and a culture change embraced, we’re simply not going to see models like ACOs develop according to the timeline many industry “experts” claim.
Until there are actual tools that provide meaningful support to the community and allow for some sort of global analyzing of specific populations and data sets in real time, healthcare will remain a production-based market where accountable care remains nothing more than an idea.
The market needs more than static components and databases, and health IT needs to evolve and incorporate more capabilities to that make possible, and engage in information exchange before we can begin to move to an accountable care model.
After a detailed conversation recently with a practicing physician, my long-held suspicions about meaningful use may be coming to fruition.
You see, though I’m a believer in meaningful use from a data collection perspective and for the benefits it provides the healthcare community in being better able to track outcomes and measure results, I’m also concerned with the amount of regulation and oversight required of the reform. Additionally, I’m concerned about how the overbearing amount of added reform is affecting the thousands of small businesses that are private practices.
With the added mandates and with the continual burdening requirements of the physician as educator to patients, there’s only so much room left for them to take on their tasks as caregiver.
All of that said there is some growing resentment in the healthcare community that suggests physicians are growing resentful of their educational assignment.
“Our job is not patient education,” the physician I spoke with said, asking that his name be withheld. “We’re on the precipice, teeter tottering on the verge of collapse and the system is going to fall down. We’re being pushed to the extreme with patients. We need to see more patients per hour just to cover our expenses because the margins have disappeared.
“We’re forced to focus on getting more patients through the door; we don’t have time to focus even more on patient care,” he said.
Besides meaningful use, there are other issues to address in healthcare, he said, like 5010, ICD-10, Medicare and Medicaid changes and insurance hurdles.
On top of these issues, physicians struggle with internal operations because of the financial cuts to their practices. With ever-changing reimbursement rates affecting the amount of money they can bring into their practices, practice leaders also have to worry about making payroll. Certainly, physician salaries are declining. Gone are the days when physicians were guaranteed lucrative careers.
The more likely model now will become the one where physicians become employees.
“Healthcare reform essentially is putting the private practice out of business,” he said.
In the long run, the only successful private practice model will likely come down to where large practices dominate the landscape. Anything less than a 300-physician group probably won’t survive, he said.
“This is the reality of what we’re seeing in the outside world.”
Add all of this to a physician shortage that’s only getting worse, and the healthcare community is indeed embarking on a tumultuous road ahead.
With the patient engagement quandary hanging its head over the next phase of meaningful use, healthcare leaders of all kinds continue to wrestle with how to meet mandates that are beyond their control.
Previously, the assignment was simple: do this, get that. But here, in stage 2, there’s a little outlier – required patient engagement – that has some physicians worried about how they are going to handle their second attestation.
Even though there are rumblings that CMS may look the other way when dealing with patient engagement, or decides not to enforce it, at least in the beginning, or chooses not to audit this measure, it’s still a mandate and it’s being taken seriously for all providers seeking the second set of financial incentives.
Some practices are taking measures that they haven’t had to in the past or at least with as much passion as they are now. They are marketing and advertising directly to patients, even if the campaign extends only to the interior of their own practices.
Such is the case for Dr. Stephen Bush, of Fox Valley Women and Children’s Health Partners in St. Charles, Illinois.
The first step in the process, Dr. Bush said is the implementation of a patient portal, which is though to help get the practice’s patients engaged or, in the very least, getting them more involved in their care protocols.
“The problem is, patients have to sign up to use the portal,” Bush said. His worry, though, is when pushing patients to engage, that if patients are pushed too hard, patients push back and essentially disengage.
“We receive significant push back from patients who get upset when trying to engage too much,” Bush said. Examples include posting too many times on Facebook or posting too many tweets to Twitter. According to Bush, patients will stop liking the practice on Facebook and stop following on Twitter if they feel the practice too involved socially.
Bush said his practice is working to implement new marketing and educational strategies to prepare for the patient engagement mandate, just to be safe, even though there’s little that can be done to audit how often patients use the portal after they have signed up.
There also may be too much attention put on patient portal’s capabilities, he said.
“They are not education tools, and they’re not meant to provide better healthcare, and in no way does it educate the patient,” he said.
Despite the patient engagement portion of the Stage 2, Bush said meaningful use is needed and ultimately, will help patients become more informed and get them involved in their care, which may help reduce costs overall. “The management of healthcare for patients is important, and can make lives better and healthier,” he said.
“All physicians are concerned about their patients are being taken care of and informed. Meaningful use gets patients involved. Patients now deal with things when there is a problem occurs rather than managing a healthy lifestyle.”
Physicians are trying to engage patients, and always have. Eventually, a change will come to the landscape, but as long as patients remain laissez-faire, there will be some push back when they are pushed.
Perhaps one of the easiest ways to engage patients in the patient engagement process, especially as it relates to meaningful use Stage 2, is to let them know that you are trying to engage them.
Since CMS announced the patient engagement requirement as part of meaningful use, physicians and practice leaders who hope to attest and receive federal incentives have voiced their concern over the requirement since it’s the one element beyond their control.
“The push back from providers is because it’s the one thing they can’t control; they can’t make patients ask for a patient summary and force them to download it,” said Amit Trivedi, healthcare program manager at ICSA Labs, which is a vendor-neutral testing and certification firm that works with EHR vendors. “Originally, I thought it would be upheld. I still don’t think they’ll drop it, but it’s possible they (CMS) may modify it or choose not to audit it.”
Essentially, the patient engagement portion of Stage 2 most likely won’t be dropped, but, according to Trivedi, enforcement of the mandate may not happen right away.
Still, Trivedi says the healthcare community shouldn’t walk away from the patient engagement debate simply because patients don’t seem interested in or accessing their health record. On the contrary, now is the time to begin moving in the direction of creating more awareness with the consuming public.
By taking the approach that if patients don’t ask for something because they don’t want it is faulty, Trivedi said. The same arguments were made by technology vendors prior to meaningful use who he said claimed certain enhancements just were not important to physicians and their patients. However, once incentives were announced and mandates issued, vendors quickly jumped on board to upgrade their systems to meet the new need.
Patient portals are an example of one such tool. Prior to meaningful use, they were considered Cadillac-like add ons that were wanted only by a few practitioners. With meaningful use, they are necessary and required component of the systems.
“You may never be able to make patients download their records, but you have to advertise and make the data available” said Trivedi.
Healthcare is entering the age of a new demographic and though there may be little desire to engage with the current generation, upcoming users are not going to be so patient in seeking their health information. For many, having access to their records will be a right, Trivedi said. Making data available to the public and encouraging patients to access and use it is nothing more than a cost of business.
Other than advertising to patients about the capabilities, Trivedi suggests taking the message to those who truly need access to it, for example, parents of young children and caretakers of the elderly. Though there’s simply no way that a majority of consumer patients will be engaged patients, at least in the short term, it’s much more likely that targeting specific population sets, like those mentioned, will help move the population forward and get people to take greater ownership of their care (or at least the care of those they are caring for).
After all, even with all the data collection and its analysis, its potential for improving greater health outcomes across the population and the move toward structured and transportable data, it ultimately we won’t find the results we’re looking for if the patients are not engaged.
Help me understand, if you will, where the soul of meaningful use lies. I’ve seen the rules that have been made final and I’ve heard the stories of folks in the field that have had their lives and practices changed because of it.
But all of this just doesn’t seem to lead to a very innovative end.
Sure, the technology is needed in healthcare as the antiquated use of paper continues to overwhelm, but what’s the real proposition here? As far as I’m concerned, some of the real questions remain unanswered, and I am slightly suspicious as to why the feds are so heavily involved.
Granted, I shouldn’t be surprised given all the money that’s been spent in numerous non-government areas (like cars, banking and solar), but let’s peel back here a little and ask why the industry really needs the incentives. Let’s agree that on its own, the healthcare industry would have adopted the technology and was doing so; the incentives just moved adoption along much more quickly. So, why are the feds involved? Agree with me or not, they want our data.
This is the coup d’état. Collected data leads to predictive analysis and evidence-based treatment protocols. This leads to the dissolution of independent care protocols and removes independent will and turns healthcare into committee care.
Getting care is going to be similar to applying to government grants and scholarships. I’m oversimplifying the matter here, but please, let’s admit that there is a price that’s going to be paid for the federal incentives.
That said, my soap boxing out of the way, I’m back to my original question: Where is the soul of meaningful use?
Let’s take a look at the upcoming Stage 3. In large part it’s a lot of increased measures and new “patient engagement” provisions such as: giving patient the opportunity to request amendments to their records online, requiring electronic health records to receive, generate or access appropriate immunization recommendations, and requiring EHRs to be able to query other entities for outside records.
(Yawn.) (Wipe my eyes.)
These are valiant efforts and worthy of exploring, certainly. But, where is the real innovation that we’re supposed to be seeking? Where’s the game-changing approach to healthcare information that blows our minds? This is a technology based process after all and I think we need to begin demanding more of the technology we employ.
The technology is not holding us back, either. It’s us and our continually lowered expectations. If we’re going to take some risks then those risks need to be real risks and not some marketing speak for a data grab slight of hand.
From my perspective, about 90 percent of the technology vendors in the space do just enough and nothing more. Their investments are in sales teams, not in research and development.
But how can you blame them when the one leading body of the mandated changes is asking so little of the community.
What this is beginning to feel like a bunch of self-appointed “decision” makers trying to affect change of a program that’s been in place for decades, in the end, no matter the tinkering, may be nothing but waste having been accomplished.
