We hear a lot about patient engagement these days. Certainly, the idea is a noble one. And the benefits it could bring when practiced on a wide scale are immense. But a lot of providers are still wondering: How do you do it?
[See also: Patient engagement gains momentum]
With Stage 2 meaningful use mandating that 5 percent of patients view, download, and transmit their own health data, many hospitals and practices are nervous about whether that threshold can be met. (Imagine if it were 10 percent, as was initially proposed by CMS?)
But beyond the box-checking of MU, there's of course a much more compelling argument for getting people more involved in their own care.
[See also: Power to the people! Engaging patients]
At the Healthcare Business Intelligence Forum, April 16-17 in Washington, a panel of experts will discuss ways data can open new paths of communication between patients and providers, enabling care coordination and paving the way toward population health.
Thompson H. Boyd, MD, physician liaison at Hahnemann University Hospital in Philadelphia; Leslie Kelly Hall, senior vice president of Healthwise; and Jan Oldenburg, principal at Jan Oldenburg Consulting, will offer their perspectives on this pivotal new era, where troves of new insight are now readily accessible in electronic health records and patients are creating health data of their own via wellness apps and wearable devices.
The distinction between providers having access to data – using it to pinpoint the chronic patients who need care the most – and being able to provide appropriate data to their patients – which can be used to tailor treatments and drive behavior change – is an important one. To truly spur effective engagement, both must work in tandem.
Boyd's hospital has recently launched a patient portal. "We're really in our infancy right now," he says. "Getting the physicians involved – to tell the patients, 'We want you to do this," is a critical early step. "We're trying to reduce the barriers to getting patients enrolled, getting them signed on. We're changing some workflows: Having the physicians say, 'This is good, you've got to get on,' is going to be key."
But for all the work providers are doing building consumer-facing technology and ensuring it gets used, some onus must also be placed on the patient.
"There should be the thought of accountability and expectations on behalf of the patient," he says. "The patient has to be a contributing member of the care team, not just a bystander."
Boyd points to University of Oregon researcher Judith Hibbard, whose work tracks patient activation "scores." She found that for patients with lower activation scores, the quality of care is lower, the expenses are higher. When patients "are more active and motivated, the quality goes up and the cost goes down."
"One of the keys to engagement is making people feel heard, and that their perspective, their goals, their objectives, their voice is a really meaningful addition to the conversation," says Patricia Hyle, who works alongside Leslie Kelly Hall at Healthwise, which develops health information, decision support and behavior change tools for heath plans and hospitals.
"A patient has to be considered an active and equal part of that care team," says Hyle. "Not just a passive person that we push information out to."
One thing seems clear: The days of patients being passive recipients of care are over.
"The intersection of new models of care, with an emphasis on keeping people healthy, and population health strategies, are really adding a dimension of urgency to patient engagement efforts," says Oldenburg.
"When you combine meaningful use Stage 2's patient-facing requirements with Medicare Shared Savings Program, patient-centered medical home or ACO requirements, the combination is truly driving additional attention to this space."
Data – on both the patient and provider sides – will be an essential driver, she says.
"One of the things that's emerging is that people are trying to figure out how to add both mobile and social dimensions to their patient engagement strategy, so it's not just sort of a traditional means of outreach," says Oldenburg.
Patient-generated health data is another interesting new wrinkle. "I agree we're going to have to pay attention to it, but I worry that it won't be as transformative as it has the opportunity to be," she says.
The only sure thing is that good engagement needs a multi-pronged approach.
"I'm a believer that one of the reasons we often fail is that we try one-off strategies," says Oldenburg. "Engagement is about a whole system. Everyone has to have a piece of the puzzle. It's got to be part staff, it's got to be part physician, it's got to be part caregiver, part community – and obviously it's got to be part patients.
"Too often," she adds, "care management is done to people rather than with people."
In her HIMSS book, Engage! Transforming Healthcare Through Digital Patient Engagement, Oldenburg spotlights many case studies where the right combination of giving and getting patient data has led to better outcomes.
From the physician in Canada who created a game for diabetic kids that increased their compliance, to the VA's OpenNotes pilot, which "found that people seeing their notes correlated with being more up-to-date with their preventive care," the lessons seem clear, she says: "Doing it with – not to – patients" is key to improved health.
