Stage 2 of meaningful use requires at least 5 percent of a given provider's patients to be engaged in their own care either through an online portal or an electronic personal health record. The threshold seems low, but it is the first time that achieving meaningful use is dependent on patient behavior.
The Medicare policy in place since 2011 that penalizes hospitals for certain preventable readmissions is spurring patient engagement as well, since there is a significant financial incentive to keep people with serious cardiovascular and respiratory problems from needing further inpatient care.
In fact, the Robert Wood Johnson Foundation has reported that patients not engaged in their own care can cost 21 percent more than "highly engaged" patients. Obviously, payers have long been motivated to rein in costs, but now, with the growth of accountable care and risk-sharing contracts, so are many healthcare providers.
Some healthcare providers are worried about the patient engagement piece of Stage 2, and perhaps there is reason to be.
According to a survey from consulting firm Technology Advice, published this month, 40 percent of people who had seen a primary care physician within the last year did not even know whether that doctor offered a portal. Only 9 percent said their physicians followed up with them after the visit via a portal, and 48 percent indicated there was no follow-up.
Clearly, there is much work to be done to engage patients, but examples of successful engagement are showing up.
A six-month trial of engagement of recently discharged Medicare patients by health coaches armed with a mobile app to assess readmission risk saved $109 per patient per month and cut 30-day readmissions by 39.6 percent among high-risk patients at Elder Services of Merrimack Valley in Lawrence, Mass.
"During each encounter, the coach uses a tablet-based application that provides suggested questions written in lay language based on the patient's diagnoses, treatment, and risk profile," according to the study, released in July by the federal Agency for Healthcare Research and Quality. "If the answers indicate a decline in health status, the system sends a real-time alert to a nurse care coordinator who uses a different part of the system to help the patient and coach address the issue within 24 hours."
On July 1, Greenwich Hospital, which is part of Yale-New Haven Health System in Connecticut, turned on a secure messaging system at its ambulatory surgery center to keep family members updated during surgical procedures.
"The single most important thing to our patients in that venue is information," says Christine Beechner, the hospital's vice president of patient and guest relations.
Most ambulatory surgery patients have a preoperative telephone call to prepare them for the procedure, according to Beechner. At that point, the hospital offers them the option of using FamilyTouch, an app from Avation Health in Concord, Mass. The app is free to patients and available in English or Spanish. It provides designated family members with a series of timely messages.
Following a welcome message, the first text gets sent as soon as the patient arrives in the holding room. As the surgical team is setting up the operating room, the circulating nurse on duty will prepare a nearby computer to send additional texts at key points in the process. "The minute after they do the time-out in the OR, they send out a message," Beechner says.
Discharge from the ASC triggers another message asking users to evaluate the system. At that point, they can text back any comments as well.
In the first month and a half, staff sent more than 5,600 text messages to designated recipients. That included 325 patients and 502 total contacts. There had been a phenomenally high 56 percent response rate to the evaluation question, and about one-third of contacts have left text comments about the system, according to Beechner.
After six weeks, mean satisfaction was 4.6 on a scale of 5, she reports.
It certainly is not a perfect system, though. For one thing, Beechner does not have data yet showing better health outcomes. "That's where we're headed," she says.
Nor does FamilyTouch integrate with the hospital's Epic Systems EHR or portal, so the program does not satisfy the Stage 2 meaningful use requirement. But Beechner hopes that this small step is what encourages patients to use other electronic tools in managing their health and care. "Patient engagement is so much more than engaging with the medical record," she says.
Indeed, the AHRQ study said that adding features to promote population health could help sustain the gains from engaging individual patients. A July report from Atlanta-based consulting firm Meditology Services expressed a similar thought.
According to Meditology, population health and patient engagement can and should be intertwined as part of a wide-ranging IT strategy. Notably, that report says, well-implemented technology helps clinicians practice more efficiently while also keeping patients informed of their own health status.
"Automate patient reminders for preventive and follow-up care, chronic care reminders, patient visit questionnaires, and appointment reminders by integrating EHR functionality, clinical decision support tools, business intelligence, disease registries and predictive analytics capabilities," Meditology recommends.
"Reach healthy people with the help of systems," saving human case managers for outreach to high-risk patients, says Erin Carey, director of health IT consulting at Meditology and former director of health informatics at Kaiser Permanente.
It can be difficult for the average person to know when to get certain health services. For example, Carey says, recommendations for mammograms have changed several times in recent years. "How is a patient supposed to keep track of that?" she asks.
That is where EHRs come in, reminding patients about preventive care such as routine immunizations and screenings, letting physicians and nurses focus on disease management.
