Tag: patient engagement

Toward Greater Patient Engagement: The Smartphone Physical

Mike Hoaglin
Mike Hoaglin

Guest post by Mike Hoaglin, a fourth-year medical student at the University of Pennsylvania School of Medicine.

“Patient engagement” is a phrase that reinvigorates the doctor-patient relationship and prioritizes the patient experience. With many designers scrambling to “engage” patients in their healthcare journeys, it is easy to get lost in the chaos. But what lies at its core is simple: healthcare leaders need to find easy methods that better connect people with the environment and the technology.

One way this is already proving effective is with the smartphone physical. Led by medical students from John Hopkins and University of Pennsylvania, quick diagnostic tests using devices connected to a smartphone are changing the face of the traditional physical and begging the question as to why modern medicine struggles to become more patient-centric.

The smartphone physical uses a series of peripheral devices attached to a smartphone to measure and analyze patient data ranging from weight to blood pressure to even heart activity. Patients are then able to receive an overall health picture and potentially electronic health record (EHR)-ready results from the smartphone physical immediately after the experience. Essentially these robust handheld digital devices are re-engaging patients because they promote more personalized, data-driven decision-making at the point of care.

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Five Things to Know About Electronic Health Records

Money magazine offers five things to know about electronic health records. It’s a very high-level overview, mostly for the consumer market, and is a piece designed to get some skin in the healthcare game. The piece pithy and concise, which is good, as the publication is clearly unable to dig into health IT topics like a site like this, but is it worth the ink?

You decide. Let us know. Tell us if it’s a “me too” moment, which I happen to believe is the case. I think the magazine should stick to covering money and leave health IT alone, but that’s a lone opinion.

And so, without further ado, here are five things to know about electronic health records, if you don’t already:

Chances are, patients will see them, if they have not already and will ask about them.

According to Money, “more than half of physicians have started keeping electronic medical records, the federal government announced this year. About 80 percent of hospitals have gone digital, too, with urban institutions leading the way.”

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Patient Engagement Is More of an Issue In Ambulatory Practice than In Hospitals

After having spent several days in a hospital recently caring for a loved one, I can unequivocally say that there is no comparison for patient engagement – in relation to meaningful use and in regard to health IT such as EHRs – between the hospital setting and the ambulatory practice.

Simply put, there is no comparison between the amount of attention given to the topic of patient engagement in ambulatory practice and in hospital care, at least as far as the patient experience is concerned.

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Health IT: A Patient’s Perspective

As a patient, I sat in the exam room awaiting the results of my labs and tests. From my perspective, there was a great deal on the line – my personal health and possibly my longevity.

I sat alone — waiting for the nurse to come in to begin the initial check-in phase — taking in the sterile room, its beach-themed art and the blank flat-screen monitor near me on the counter.

After several minutes alone, pondering my fate and driving myself further into a place of stress, the nurse finally entered the room.

We exchanged pleasantries. Hellos and how are yous.

With that, she turned from her back to me, keyed in a few strokes and began to enter data into the practice’s EHR.

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Patient Access to Electronic Health Records: Should More Control Be Handed Over?

According to a recent Accenture survey, “Patient Access to Electronic Health Records: What Does the Doctor Order?” published on iHealthBeat, 79 percent of surveyed U.S. doctors say that patients should be able to update all demographic information in their electronic health record.

The report suggests that 16 percent of surveyed U.S. doctors say that patients should be able to update some demographic information in their EHR and 5 percent say that patients should not have the ability to update any demographic data.

“Sixty-seven percent of surveyed U.S. doctors say that patients should be able to update all family history information in their EHR, while 21 percent say that patients should be able update some family history data and 12 percent say that patients should not have the ability to update any family history information,” according to the study.

Twenty-five percent of surveyed U.S. doctors say that patients should be able to update all of their laboratory test results in their EHR, while 28 percent say that patients should be able to update some lab test results and 47 percent say that patients should not have the ability to update any lab test data.

On behalf of Accenture, Harris Interactive conducted the online survey of 500 U.S. physicians between November 2012 and December 2012.

This is an interesting topic that seems to have many foes and fans, and I can see the perspective from each side. On one hand, allowing access to a personal record may allow for breeches of information, HIPAA violations and may create a slippery slope to a movement for patients to have full editorial access to their records. Obviously, doing so creates more many more problems than it solves.

The benefits to such a move – allowing patients to input their demographic data into their personal health record – may lead to greater patient engagement, which seems to be healthcare’s sticky wicket, and it may help practices struggling with being overwhelmed administratively to streamline some of their intake and the management of their information and “pass along the cost,” so to say.

It seems as new solutions come to pass and as we as an industry seek ways to moderate, streamline and create new efficiencies, questions such as the one raised by this survey will be asked more and more. As the questions become more well circulated and discussed, the issues they address will move toward the acceptable and standard practice as they gain ground within the society we have created.

As such, though there may be initial resistance, like all cultures built to change, what was once unacceptable will become standard practice.

Given the issue raised by these questions, I wonder what level of change we’ll see in regard to this in the near term. My hunch is that in an effort to include more people in the process, to streamline and to offload some of the administrative responsibility, we’ll see tactics such as these be incorporated more often, and more “power” given to the patients.

I wonder what your thoughts are on this subject, and what your perspectives are. Do you agree with the survey results? Should patients be allowed to change any of the data in their records or does it make sense to include them in the administrative management of the record?

Results of the 24th Annual HIMSS Leadership Survey: Health IT Remains Strong

Along with HIMSS’ largest money maker of the year — its annual conference — it’s also time for the results of its annual leadership survey.

While the results, which are reflected in the infographic below, are certainly interesting there is one point that seems to raise a flag immediately.

Prior to that, however, let’s take a quick look at the results. Accordingly, about 66 percent of the all health IT leaders say their organization qualified for meaningful use Stage 1 and 75 percent of the same folks expect to qualify for Stage 2. Additionally, nearly 90 percent of those who took the survey say they be ready for the ICD-10 switch later this year.

As such, there’s quite a need to hire new IT folks to carry the torch.

Next, it appears that nearly 20 percent of respondents said their health systems’ security was breech (at least those who admitted as much) and that 22 percent of said security was a priority for the coming year, which should be the case if 20 percent of them faced a security issue.

I understand the scope of the survey and who its respondents are, but doesn’t it strike anyone else as slightly odd that all of the changes to come are related to the IT? All, or much, of the reform is designed to engage patients and bring them closer to their care providers? Shouldn’t it be implemented to help improve outcomes and to drive better results and make the system more fluid? I guess IT is going to be what get’s us there.  But along the way, couldn’t more be done at the care level as well as the IT level? Could some of the hiring take place to serve patients rather than the practice?

I digress. Apparently, for now, we’ll have to be thankful that all of this change is leading to improved job growth and fixes to the breeches that await us.


Regarding Patient Engagement, Don’t Abandon All the Arrows in Your Quiver

Jason Fortin, Impact Advisors

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.

“It’s All Mechanical Now,” She Said to the Silence

From her hospital bed, the little old woman gathered herself beneath her tissue-paper thick blankets and wondered about many of the things she’d face in her future. Though the room wasn’t cold, wringing her hands through the folds of the cheap cloth were all she could do to keep herself calm.

The television blared above her prone body; it made the only noise except for the rasp of her short breath. Occasionally, an orderly passed by but made no effort to breach the curtain door, and made her way down the hall.

A newspaper lay unopened at her side, not a word of it read, mostly because of the glaucoma in her right eye. Thus, the television called out, it being the only thing to steer her thoughts back from the darkness and confusion that seemed to take hold.

A relatively healthy 95-year-old women prior to the automobile accident (that consequently was not her fault), she seemed to suffer the unimaginable at her age and come out alive. Though doctors wouldn’t guarantee her recovery during the first few days, they were more optimistic now that her broken leg, broken arm, fractured wrist, broken shoulder and cracked ribs had not killed her.

She’d made it this far, they reasoned; and if the whole experience didn’t kill her then certainly it would make her stronger.

So alone she sat, except for when the occasional visitor stopped by, much of the time scared and most of it confused.

In came the food, out went the plates. In came a doctor, what was left were his orders. The occasional nurse checked her machines and gave her a pill; conversation was limited to, “How are you feeling today?” or “Are you in pain?”

There’s no surprise she feels out of place. Clearly, thoughts of giving up come to mind and she wonders if she’ll be able to survive the three or four months of required physical therapy for her to recover.

Even worse off, without any real family to guide her through, she sat quietly trapped in her own thoughts.

Finally, at one point, randomly looking at the computers in the room, she said softly, “Everything is mechanical now.” It was a statement, like something said in fear and loathing. She wrung her hands some more and closed here eyes.

When the nurse came in, the old lady requested a pain pill and the nurse left to retrieve it. Upon her return, the nurse handed over the small white pill and a shot of water and said she’d stay until she was sure it had been swallowed.

Thirty seconds later she was gone, again. Alone, the old woman tried to remember her home and its warmth and did her best to recall a lifetime – nearly a full century – in which she’d been engaged lovingly by family and friend.

It’s all mechanical, now, she said again, wondering in silence as her companion, the television, blared on.

It’s Easy to Engage Any One; Just Talk About Them

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.

Then, when the ice is broken, I dive into more broad-based questions:

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.

I’m just saying.

Will Someone Please Tell Me Why Engaged Patients Are a Bad Thing?

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?