Engage!

Transforming Healthcare Through Digital Patient Engagement

Jan Oldenburg,Dave Chase,Kate T. Christensen,Brad Tritle

• Publisher: HIMSS Publishing
• Year: 2020
• ISBN:
  9781000285284
• Edition: 1
• Topic: Business
• Subtopic: Business General
• Index: Business

This book explores the benefits of digital patient engagement, from the perspectives of physicians, providers, and others in the healthcare system, and discusses what is working well in this new, digitally-empowered collaborative environment. Chapters present the changing landscape of patient engagement, starting with the impact of new payment models and Meaningful Use requirements, and the effects of patient engagement on patient safety, quality and outcomes, effective communications, and self-service transactions. The book explores social media and mobile as tools, presents guidance on privacy and security challenges, and provides helpful advice on how providers can get started. Vignettes and 23 case studies showcase the impact of patient engagement from a wide variety of settings, from large providers to small practices, and traditional medical clinics to eTherapy practices.

Chapter 1

Transforming Healthcare Through Digital Patient Engagement

By Jan Oldenburg, FHIMSS

INTRODUCTION

Imagine a future where patients’ daily interactions with the healthcare system are simple, straightforward, and enabled by personal health information technology (IT) that is available whenever they want and wherever they are. Where patients have full access to their clinical and financial data—across time and across providers—and can use it both to educate themselves about their health and to ensure that their medical records are correct. Where patients have devices that provide moment-by-moment feedback to them (and, in the right context, their care team) about the effect their actions are having on their health in real time—rather like the way Prius drivers can tell whether the way they are driving uses more or less gas. A future where patients can take care of health tasks such as scheduling appointments or paying bills whenever it is convenient for them. Where they can enlist family and friends in supporting them, whether they are trying to recover from a hospital stay, provide an update on their medical condition, or include more exercise in their daily routine. And where, when they fall ill, they can seamlessly communicate with their doctors, care team, and hospital. In this imagined future, patients become a key part of the care team, actively participating in decisions about what will work for them and their health—physical, emotional, and financial.

Imagine that when personal health IT tools are used by patients as described above, providers are able to eliminate non-productive parts of their current work and focus more deeply on the things that motivated them to go into healthcare in the first place—spending time with patients—helping them when they are sick, coaching them to get and stay healthy. Now precious clinic resources can be used where they are needed most, because self-service programs allow patients to conveniently manage tasks themselves. Providers can keep track of their patients and manage minor problems through virtual appointments or email exchanges. In this imagined future, providers collaborate with patients to develop plans that reflect the totality of the patient’s health: patients are more satisfied and providers are happier, feel less rushed, and feel less pressure to be perfect.

For the fortunate few patients and providers, aspects of this future are here today. In the health systems in which personal health IT tools are available to patients, the dynamic between patients and providers is evolving, personal health IT tools are helping to drive costs from the system, and satisfaction levels for patients are rising.

For too many patients and doctors, however, this is a distant reality. Many studies (referenced elsewhere in this book) show that patients desire capabilities such as online access to their records, the ability to exchange secure messages with their doctors, and the ability to manage appointments online. A Harris Interactive poll from September 2012 highlighted the fact that despite those wishes, only 17% of patients report having access to their records, only 12% can email their doctors, and only 11% report being able to manage appointments online. The complete numbers are highlighted in Figure 1-1.¹

Figure 1-1. Patient Desire vs Availability of Personal Health IT Tools

This book explores the way personal health IT tools that engage patients also benefit providers and the healthcare system as a whole. The case for patient engagement is a key component of the case for healthcare transformation.

WHAT IS PATIENT ENGAGEMENT?

For all the conversation about patient engagement, the healthcare industry hasn’t agreed on what the phrase really means. A survey conducted in June 2012 by the National eHealth Collaborative (NeHC) on consumer engagement with health IT found a wide range of definitions of patient engagement, as well as a wide range of goals among partner organizations.²

The Center for Advancing Health Behavior offered a good framework for patient engagement in general by defining engagement as³:

“Actions individuals must take to obtain the greatest benefit from the healthcare services available to them.”

The Center went on to further explain their definition in ways that we wholeheartedly endorse:

“This definition focuses on behaviors of individuals relative to their healthcare that are critical and proximal to health outcomes, rather than the actions of professionals or policies of institutions.

Engagement is not synonymous with compliance. Compliance means an individual obeys a directive from a healthcare provider. Engagement signifies that a person is involved in a process through which he or she harmonizes robust information and professional advice with his or her own needs, preferences and abilities in order to prevent, manage and cure disease.”

Our definition of patient engagement using personal health IT tools expands on the Center’s definition: Patient engagement using personal health IT tools comprises actions individuals take to obtain the greatest benefit from the health services available to them, using any information technology capability that enables them to:

• Better understand their health and health conditions.

• Obtain access to their own health data in real time or near real time.

• Improve communications with their doctors and providers.

• Take more responsibility for their own health and health outcomes.

• Improve their experience of interacting with the healthcare system.

• Inform and educate their families and caregivers.

• Get support about health and healthy behaviors from family, friends, caregivers, and health professionals.

Capabilities that impact these areas may be offered by a physician, health system or payer, or they may exist as stand-alone tools offered independently of any health system entity. The definition includes mobile and web-based capabilities so that individuals can choose the platform and channel appropriate for them. The question of who owns the data is irrelevant as long as patient data are stored securely, patients have access to their own data in near real time and can choose to download or transmit it, and information about the source of the data is maintained.

Engagement and Empowerment vs. Compliance

When people in the healthcare industry talk about patient engagement, they frequently refer to patient compliance—behaviors they want their patients to do “for their own good.” They want people to exercise more, eat healthier, understand their diseases, take their medicines, and shop for healthcare in a more informed way. By this definition, patient engagement is the Holy Grail of healthcare. If consumers and patients would only consistently behave in ways that are good for them, many of the preventable causes of disease would be eliminated or at least postponed.

As noted in the definition cited earlier, however, engagement is not synonymous with compliance. Many of us in healthcare are guilty of wanting compliant patients rather than engaged, empowered or self-actualized patients because compliant patients are more likely to follow instructions than to ask questions or challenge instructions. Being challenged can be uncomfortable, but for healthcare transformation to occur, it is a discomfort that healthcare professionals may need to embrace for the good of their practice and healthcare overall (see Figure 1-2).

Figure 1-2. Journey of Patient Empowerment

There are many stages of engagement, as depicted in Figure 1-2. People choose ways to engage that feel right and fit their needs, preferences, and personal abilities. Patient engagement offers the opportunity for patients to move toward empowered and self-actualized behaviors. With those shifts, there is also a logical progression from viewing providers as authorities to viewing and working with them as partners.

Providing the opportunity for patients to move toward empowered and selfactualized behaviors does not guarantee that they will behave in healthy ways. There is no single answer to the question of what motivates people to change or why some people succeed and some fail, much less how to sustain behavior change over time. Providing incentives and external motivation can help motivate change, but for sustained change to occur, external motivation needs to be replaced by internal motivation. Patients do not need to become fully self-actualized to see a positive impact on their health, but one important way we can support individuals’ movement toward empowerment is by offering personal health IT tools that support them to the degree they are ready to interact. These tools help us engineer teachable moments that promote behavior change in patients based on delivering information, education, and a call to action at the moment each individual is most engaged in his/her health and most open to change.⁴

Why Now?

It has long been conventional wisdom that people play a role in managing their own health. Mark Twain once said, “The way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d rather not.” Benjamin Franklin reflected the same sentiment when he said, “To lengthen your life, lessen your meals.” Alas, for the same amount of time, people have been ignoring the conventional wisdom and doing what they like, regardless of the impact on their health.

So what is different now? Why do we believe the time is right for patient engagement to come to the forefront?

We are at a historic inflection point where a number of forces are coming together to enable—and perhaps require—doctors and patients to engage with one another differently.

One important dimension of the change is the rising cost of healthcare. The current costs and cost trends are unsupportable. The cost of healthcare in the United States, combined with the relatively low quality of the care provided, is a key driver of change. It has led to healthcare reform, experimentation with new models of practice and compensation, and a renewed energy about changing the interactions between patients and their healthcare providers.

Another major factor is the digitization of health data and the rise of the Internet, which make it possible for patients to see and understand their health records and health history online and on mobile devices. Consumer movements such as the Society for Participatory Medicine (S4PM) are bringing attention to the rights patients have in relation to their healthcare data and the obligations providers have for being transparent about healthcare data. As patients become empowered to see their health records online, providers’ attitudes toward the record must undergo a corresponding shift. Gone are the days when the doctor or nurse walked into the room, clutching your chart tight to the chest, carefully protecting you from seeing anything it contained. This shift, from a record that is owned by the provider to a record that is shared with or even managed by the patient, is the ...