Electronic Health Reporter

The term “patient engagement” has emerged as this year’s buzz phrase much the same way “patient portals” were a couple years ago and even similar to “electronic health records” and “meaningful use” before that. Volumes of articles, case studies, white papers and educational sessions have been dedicated to the topic of patient engagement and even at this years’ annual HIMSS conference patient engagement as a topic discussed was the rule and not the exception. With every step through the maze of booths in Orlando it seemed as if the words – “patient engagement” — were whispered and shouted from every direction.

Patient engagement is now synonymous with health IT, yet the topic is proving to be one of healthcare’s stickiest wickets because no matter whom or how many people you ask there seems to be a different response or definition to the term and how it is achieved.

With all of this uncertainty and confusion about patient engagement, I set out to see if I could define the term by asking a number of health IT insiders what they thought “patient engagement” meant, or what it meant to them. Their insightful and educational responses are what follow.

Chris Cashwell, senior vice president of global marketing and strategy, Lincor Solutions

The interest in patient engagement is because of countless studies and empirical data that have confirmed what our common sense has known for years — when people are empowered and have a voice, you have better outcomes. It matters because as fewer dollars chase more patients you have to improve outcomes while doing it more cost effectively. How do you do that? You do that by asking the patient and their care givers to be more involved, educated and empowered.

The second reason patient engagement matters is because of data. It’s everywhere and growing everyday — generated by patients and by healthcare organizations. How is that data accessed? Can it make a difference in care, outcomes, quality and safety? Giving point-of-care access to data for physicians and patients is critical in today’s environment.

Thirdly, and most transcending, is that we now live in a connected, engaged society. Twitter, Facebook, Google, Netflix, etc., all allow us to have what we want on demand in real time. We do not leave those expectations in the “parking lot” of the healthcare facility. We expect to Skype with a grandmother, to research therapy options, to see a movie on demand.

All of these affect our health, our happiness and our wellbeing. If we can do that with technology and improve outcomes at a lower cost — it is a win, win, win.”

Tim Perry, chief information officer, Healthcare Too

Patient engagement comes from several forces pushing for improvement in healthcare (e.g., Triple Aim, PCMH, volume to value) that arguably reflect consumerization of healthcare. Health IT must provide a new experience for patients (and providers) to engage them (e.g., portal, smartphone apps, gamification, care coordination, etc.). This certainly presents an opportunity to develop and sell new products. However, repackaging the same patient experience in a new app or wearable will fail. Patients (whether ambulatory or otherwise) are acting more as consumers and looking for a wellness experience and not simply a volume of treatments that are now better measured and reported. This requires much more than a patient portal and after-visit satisfaction surveys.

John Simpson, president, Digital Health Strategies

What does patient engagement mean for health IT? The bottom line is that health IT skill sets will need to evolve and expand. Effective digital patient engagement requires a new approach to technology platforms, including:

• communications experience and a deep understanding of patient audiences and behaviors to understand how to drive key digital actions
• a specialized focus on front-end development and process
• the ability to craft digital engagement strategy that actually drives
  results and outcomes.

It also means that IT professionals will need to embrace a leaner and more nimble approach to healthcare technology, and be comfortable with adapting strategy in light of testing and analytics data and results.

There is a new model of care emerging — one driven by economic factors and quality of care. Industry regulations are shifting financial compensation for healthcare providers from a fee-for-service model to one based on population health and quality of care.

With these massive shifts in how providers treat patients and manage their businesses, there is no question that patient engagement will become a major priority. When contemplating how they care for their patients, providers must think beyond the four walls of their facilities in order to engage their patients, provide value and build loyalty and retention. It is no longer about an “in and out” approach to procedures and in-patient treatment. Establishing and maintaining long-term relationships is now crucial to providing quality care and maintaining population health – and keeping the lights on.

All of this definitely matters to patients. Providers can deliver a positive patient experience using ongoing care communications and tools that range from pre-care functions like appointment scheduling and procedure preparation through to post-care health management via regular medication reminders and rehab plans. And all of these can be provided using digital platforms to ensure efficiency, customization and real-time monitoring. When done right, these health management solutions can help patients be better prepared for their point of care experiences and increase their recovery and rehab time.

Nancy Hughes, APR, vice president communications and marketing, National Health Council

I don’t represent health IT experts; I represent people with chronic conditions. For them, patient engagement is a major issue and one that the National Health Council has championed for years. The NHC believes strongly that only when the patient community is truly engaged throughout the continuum of the health care delivery system will that system meet the needs of patients. Too often, one patient is interviewed or put on a review panel and the “patient engagement” box is checked off the to-do list. Just as a human being needs multiple dating encounters to understand a mate before committing to marriage, the patient community needs multiple touch points to be an active and involved participant in molding the health care system.

The NHC did focus group work on patient attitudes toward the use of electronic health records and, as you probably know, people with chronic conditions are willing to have their data shared with the research community in order to develop new treatments and cures – if not during their lifetime, then for their children and grandchildren. Because people with chronic diseases and disabilities have a different perspective on health care, their voices need to factored into the decision making process.

Stephen Dart, chief product manager for the clinical center of excellence, ADP AdvancedMD

The accelerating pace at which healthcare costs are shifting from the employer to the employee have placed the patient, or more appropriately the “consumer,” at the forefront of health IT. Consumers have gained significant control and leverage of the buying process via the explosion of e-commerce over the past decade. Much of healthcare costs today are because of lifestyle related health challenges. By engaging the patient on their terms via portals, personal health records, personal health devices, and embracing “their” technology, we open the opportunity to change the outcomes of healthcare and reduce costs in a way that the industry can’t affect any other way.

Scott Zimmerman, president, TeleVox

When the Patient Protection and Affordable Care Act was signed into law in 2010, the healthcare industry began shifting the focus away from primarily treating illness to a more holistic approach aimed at keeping people healthy. As a result, patient engagement is here to stay as evidenced by healthcare professionals beginning to embrace a more interactive approach for treating patients. According to a TeleVox Healthy World Report, one in four (26 percent) healthcare practitioners believe it’s their job to keep patients on track with their treatment programs between office visits by sending them ongoing reminders and alerts to take medication, check blood sugars, eat right and exercise. And, although more than half (55 percent) of healthcare practices say they don’t currently communicate with patients between visits to provide care, they want to move in this direction. In fact, two out of five healthcare practices (38 percent) would like to begin providing this level of patient care between visits in the near future.

Today, sadly, only five percent of healthcare professionals gave those in their care “A” grades for adherence to their directions about becoming healthier, which jeopardizes the entire premise of outcome-based care. To achieve success in today’s performance-driven healthcare, physicians must engage patients between visits with information that will help them understand the state of their health and their personal role in becoming healthier. Regular communications offering information, encouragement and ‘just-in-time’ reminders help patients stick with treatment plans between appointments. By scheduling a series of personalized, automated emails, voicemails or text messages that serve to remind, educate and motivate their patients in making the necessary changes to become healthier, doctors are engaging and supporting patients as they form new habits and work to become healthier individuals.

By the time the majority (two-thirds) of baby boomers turn 65 and qualify for Medicare, they are expected to have five or more chronic diseases, see 15 physicians and average more than 40 doctor visits a year. The increase in doctor visits, combined with the industry’s shortage of physicians, has led to medical practices incorporating “virtual” patient interactions involving phone calls, e-mails, text messages and communications through online patient portals to enable physicians to provide care to exponentially more patients. And, boomers want this kind of care. According to a TeleVox Healthy World Report, 82 percent Baby Boomers say communication from a healthcare professional via text message, email or voicemail is as helpful, if not more helpful than in-person or phone conversations, a sign patient engagement is here to stay.

Nearly three in four Americans do not follow doctor’s orders for taking prescription drugs, a problem that is associated with 125,000 patient deaths each year. This is an area where patient engagement truly makes a difference. According to a TeleVox Healthy World Report, more than one-third (35 percent) of Americans who think they could improve their routine of following doctors’ instructions believe they would do so if they received reminders from their doctors via email, voicemail or text telling them to do something specific, like take medication or check blood sugar levels. Consumer demand for patient engagement means it’s a trend that will stand the test of time.

Marty McKenna, vice president of the population health business unit, Allscripts

The future of healthcare is being shaped largely by the patient engagement evolution. Patients are front and center, with providers giving them an increasingly active role in in the management of their own care and treatment. As patients get more involved in their own care, we need to develop innovative solutions that can help them set goals, monitor their progress and become successful contributors. We need intuitive and open technologies that can connect patients more effectively to providers. But as we develop these tools and solutions, it is also important to remember that the patient engagement evolution will require a shift in patient mindset. It becomes impossible to manage chronic conditions without facilitating behavior changes with patients. You can’t have “patient engagement” without engaged patients.

BJ Reese, RN, MHA, CareXcell product manager, Siemens Healthcare

Patient engagement is generally understood to mean the actions taken by patients to gain benefit from their healthcare services. It is an essential component of quality healthcare. To be effective, patient engagement must incorporate patients’ unique health beliefs and preferences. Research has demonstrated this leads to improved outcomes and enables effective self-management, the cornerstone of population health. The health system has finally acknowledged that a paternalistic, provider-centered approach to healthcare is not effective and the secret to changing the system is tapping into the natural human desire for mastery and control. Patient engagement IT, like all IT, offers a variety of tools to efficiently reach more patients using their preferred communication method. However, technology alone will not achieve the desired results and can get lost among all the other technology noise. Effective patient engagement requires patients’ trust that their needs will be considered and confidence in their ability to manage their own health.

Audrey Christie McLaughlin, RN, www.physicianspracticeexpert.com

The sudden attention to patient engagement is less of a fad and more of the field of medicine catching-up to the rest of the business world and recognizing that being a doctor/practitioner/provider isn’t enough to grow a sustainable business. People and patients want and need more and want more from their health provider in the way of information, access and accountability. Providers that don’t deliver will be put out of business by those that meet this demand.