Engage! Will patient engagement achieve “warp speed” this year?

A fascinating HIMSS LinkedIn thread started by Brad Tritle (@BTritle) on January 9, 2013, with 100 posts through January 23, 2013 by 46 Individuals (31 single post, 15 multiple posts) – 18 pages. The full thread can be found here. I had great difficulty categorizing and summarizing. I started trying to use the National eHealth Collaborative, Patient Engagement Framework: Inform Me, Engage Me, Empower Me, Partner with Me, Support My e-Community. The exchange was more: Culture/lifestyle, Experience/literacy/diversity/education, Reimbursement/incentives/cost, Community/coordination, Clinician engagement, and Access/technology/interoperability/portals. The thread included 24 links. They are compiled here. The extract can be found below. Here are some pearls:

• ‘Healthcare team’ engagement makes more sense to me: patient, personal caregivers, clinicians, industry caregivers aided by technology.
• Changing culture is not about technology.
• Culture is the values, beliefs, and deeply held assumptions about how the world works that are put and held in place by social structures and practices.
  1) healthcare costs are not my problem, my employer or government pay for it not me, therefore, I don’t care
  2) healthcare is too complicated for me to understand and I must leave it all up to my doctor to figure out
  3) I only value health when I don’t have it, otherwise, I take it for granted and don’t do anything to enhance or preserve it
  4) it doesn’t matter what I do, I will get ill and need help regardless of my behaviors
  5) being overweight or obese doesn’t really matter and I don’t bear any penalty for such behaviors
• The sheer difficulty–not just of accessing the information–but of understanding the jargon, the numbers, the scores, the names of medications, treatments. Until we recognize and accommodate the need for health literacy, meaning the ability to get meaningful information from the medical information given, patient engagement will be possible for too few people. Simple straightforward language, written and oral, meaningful statistics, and explanations that can be reviewed and discussed without intimidating the patient into silence is needed–now.
• ‘However, with our aging population, there are copious related factors, i.e. fixed incomes, education level, technical ability, accessibility, etc., that may place speed bumps in our sprint pathway as well.’
• The healthcare provider and the healthcare givers are not on the same page. The healthcare giver is the friend, family, paid aid, local or long distance caregiver, that is responsible for the patient’s day to day well-being.
• To me, patient-centric sharing is a critical complement to provider-centric sharing.
• Reimbursement model is a clear influence on the hospital/clinic culture of engaging patients beyond the clinical encounter.
• Patient engagement means less unnecessary procedures, picking the most efficient procedure/drug based on cost/quality, choosing your doctor that fits with your personality, ask for what is right for you as a patient, not what is right for the doctor, hospital or insurance provider.
• We break down patient engagement into education, motivation and behavioral support necessary for adherence or other desired outcomes. We think about the four “C”s of engagement. The Channels you are using to communicate, the Content ( what you say, how you say it, when you say it), the Collaboration ( involve all the stakeholders) and the Consideration ( is the reward meaningful for the patient i.e. more quality time with family, recognition or incentives)
• Physician and office staff mindsets need to evolve, procedures have to become more consumer-centric, and expectations should be properly set and met. But it’s also not all “one-way”. In the newly accountable world, patients have responsibility, too.
• The ability for patients with like conditions to hook up with each other to discuss illnesses, exchange ideas and give each other support. I have seen no portals that can do this.
• We can’t help patients until we help the providers who care for them.
• The use of sophisticated technology tools cannot make up for an impersonal experience.
• Technology solutions can help achieve this by fusing inbound and outbound communications that allow a healthcare organization to drive this bi-directional conversation, which can enable them to talk to their patients with relevant information on the right channel, at the right time.
• Patients, on the average, will only engage with ePHI for 1 of 4 reasons:
  a. A provider asks them a diagnostic question they don’t know the answer to
  b. Their kid, spouse, sibling or parent will suffer if they don’t
  c. They must deliver ePHI as a precondition to being seen
  d. They suffer from a chronic illness
• Yet attention strained consumers may be more likely to engage if content, even content about their loved-one (i.e. not them), is pushed all the way to their devices.
• two major things are necessary to make portals or PHRs more engaging:
  •  Access to timely clinical data, with little or no patient action required.
  • Engaging front-ends, which are truly tailored to the individual’s needs/wants

Extract

Engage! Will patient engagement achieve “warp speed” this year?

Culture/lifestyle

• I’m cautious with the aspirational nature of patient engagement as a silver bullet. ‘Healthcare team’ engagement makes more sense to me: patient, personal caregivers, clinicians, industry caregivers aided by technology. Changing culture is not about technology.
• Getting people to change their lifestyles enough to make any significant dent in outcomes will be very, very difficult.
• Patient engagement doesn’t just involve lifestyle changes.
• Culture is the values, beliefs, and deeply held assumptions about how the world works that are put and held in place by social structures and practices.
  1) healthcare costs are not my problem, my employer or government pay for it not me, therefore, I don’t care
  2) healthcare is too complicated for me to understand and I must leave it all up to my doctor to figure out
  3) I only value health when I don’t have it, otherwise, I take it for granted and don’t do anything to enhance or preserve it
  4) it doesn’t matter what I do, I will get ill and need help regardless of my behaviors
  5) being overweight or obese doesn’t really matter and I don’t bear any penalty for such behaviors
• Culture Intelligence, which is only one piece — benchmark, track and trend results of culture transformation initiatives
• If patients are provided with enough information and are empowered to “vote with their feet” we may begin to see some long overdue change.
• Because there is no silver bullet, we will need a myriad of methods and processes to achieve sprint status.

Experience/literacy/diversity/education

• I had to pause and check my engagement in my health and adopt some new practices. This has been a great learning experience and is creating new habits in becoming a better-engaged patient.
• The reality is that even this group with all the comments has failed to address the sheer difficulty–not just of accessing the information–but of understanding the jargon, the numbers, the scores, the names of medications, treatments. Until we recognize and accommodate the need for health literacy, meaning the ability to get meaningful information from the medical information given, patient engagement will be possible for too few people. Simple straightforward language, written and oral, meaningful statistics, and explanations that can be reviewed and discussed without intimidating the patient into silence is needed–now.
• ‘However, with our aging population, there are copious related factors, i.e. fixed incomes, education level, technical ability, accessibility, etc., that may place speed bumps in our sprint pathway as well.’
• That is another nice part of this system, you can assign a delegate(s) to your account so that your children, spouse, siblings, care giver, etc. can help monitor your health and converse with your clinical team if you choose and can allow varying levels of access.
• It is a generational thing.
• Confusing “patient engagement” with “patient compliance.” I know a lot of people who are “engaged” but who also choose activities that some would consider dangerous and/or risky.
• The healthcare provider and the healthcare givers are not on the same page. The healthcare giver is the friend, family, paid aid, local or long distance caregiver, that is responsible for the patient’s day to day well-being.
• To me, patient-centric sharing is a critical complement to provider-centric sharing. And document, or maybe document-page, granularity of sharing is the optimal level. Record or chart levels are too clunky. And the data element level is too fine (and fragile).
• Make sure that we are pushing our patient relevant education. Bulletins on diabetic menus and tips for exercise, etc.
• Patient engagement and patient education go hand in hand

Reimbursement/Incentives/Cost

• Patient engagement is critical to controlling runaway health care costs and to improving our health.
• Reimbursement model is a clear influence on the hospital/clinic culture of engaging patients beyond the clinical encounter. Participating in care, whether synchronous or asynchronous, is a new conversation that people are not prepared for either side of the reception desk. Whatever the tools that facilitate this more frequent interaction, the real key is a humane interaction.
• I think the reason healthcare organizations engage patients successfully (or not) is a direct byproduct of their reimbursement model. The majority of the decisions that most influence outcomes are NOT made by health professionals. Rather, it’s the patient (and their family/caregiver) who decide whether to fill/complete prescriptions and lifestyle choices (diet, exercise, stress, etc.). 80% of interactions don’t need to be face-to-face
• Getting patients engaged is a critical element to this technology taking off and having any real impact and improving quality of care while bending that nasty old cost-curve.
• Patient engagement means less unnecessary procedures, picking the most efficient procedure/drug based on cost/quality, choosing your doctor that fits with your personality, ask for what is right for you as a patient, not what is right for the doctor, hospital or insurance provider.

Community/coordination of care

• The result is multidimensional engagement – when, where, and how it is expected by the patient and/or their family/caregivers.
• These decisions are usually made with ONE of her providers without the input from the other providers who also care for her. One of those med choices might be better for her other conditions that affect her same body even though a different person takes care of it. 🙂 The whole team needs to be engaged.
• True patient engagement goes beyond compliance as it builds a proactive partnership of sorts between patients and the care team, as well as the administrative side of the organization.
• We break down patient engagement into education, motivation and behavioral support necessary for adherence or other desired outcomes. We think about the four “C”s of engagement. The Channels you are using to communicate, the Content ( what you say, how you say it, when you say it), the Collaboration ( involve all the stakeholders) and the Consideration ( is the reward meaningful for the patient i.e. more quality time with family, recognition or incentives)
• That is another nice part of this system, you can assign a delegate(s) to your account so that your children, spouse, siblings, caregiver, etc. can help monitor your health and converse with your clinical team if you choose and can allow varying levels of access.”

Clinician engagement

• Physician and office staff mindsets need to evolve, procedures have to become more consumer-centric, and expectations should be properly set and met. But it’s also not all “one-way”. In the newly accountable world, patients have responsibility, too.
• Physicians need to be more engaging with their patients in the exam room and add the personal touch.
• Patient engagement will not be successful unless there is physician engagement.
• The ability for patients with like conditions to hook up with each other to discuss illnesses, exchange ideas and give each other support. I have seen no portals that can do this.
• We can’t help patients until we help the providers who care for them.
• Nurses have long been the leaders in the holistic practice of patient care, thus identifying the individual’s needs, barriers and challenges. Nurse evaluation of patient readiness to change and knowledge deficits are the starting point for any behavior change initiative. A nurse coach has the skills required to partner with patients to bridge the gap between where they are today and where they want to be tomorrow.

Access/Technology/Interoperability/Portal

• The use of sophisticated technology tools cannot make up for an impersonal experience.
• The problem has been that there has been no standard/easy way to send structured clinical data from providers to the PHR. The second reason that PHRs have not taken off, which is also a reason why more provider organizations haven’t engaged with them, is that the shift to patient/consumer-mediated exchange of their own data is disruptive (some would say “scary”). But, in this time of needing to reduce costs while achieving efficiencies, we need to recognize that when you compare two studies by CITL, the cost of implementing provider-led HIE in 200+ geographic regions in the US was estimated at $300B plus (closer to $200B when you subtract necessary EHR upgrades), while the cost of implementing geographically-based PHRs (with necessary provider interfaces) to enable consumer-mediated exchange in approximately the same number of communities was under $4B. One of our major challenges today is that most patient portal providers (EHR vendors) are not readily publishing APIs that would allow authorized apps to provide additional functionality to end users. I’m sorry, but that does not promote the kind of innovation we require. A few forward-thinking companies are participating, though, in the smartplatforms.org project at Boston Children’s.
• If we empower the patients to know that they are in charge and to ask questions and be proactive in their family’s healthcare, it would be a lot more sustainable.
• Technology solutions can help achieve this by fusing inbound and outbound communications that allow a healthcare organization to drive this bi-directional conversation, which can enable them to talk to their patients with relevant information on the right channel, at the right time.
• You can only engage a patient willing to be engaged. Now it’s up to patient-facing software companies to do their part, engage the patients.
• Patients, on the average, will only engage with ePHI for 1 of 4 reasons:
  a. A provider asks them a diagnostic question they don’t know the answer to
  b. Their kid, spouse, sibling or parent will suffer if they don’t
  c. They must deliver ePHI as a precondition to being seen
  d. They suffer from a chronic illness
• Increase the ability of patient’s to reach their health care provider with e-visits, prompt message returns, easy access to making their own appointments. In other words, decreasing communication barriers. We have all seen that a phone call involves at least 2 other people to get the physician a message that they may or may not return within 2 days. If we get replies within an hour or two we are going to be much more likely to use it.
• Yet attention strained consumers may be more likely to engage if content, even content about their loved-one (i.e. not them), is pushed all the way to their devices. For example, having mom’s medical information available where and when we need it (e.g. exam room) seems essential to me. Requiring adult children and other caregivers to anticipate informational needs, remember various logins and pull information seems less likely to work, to improve outcomes and to meet MU engagement metrics.
• Universal concern that they will respond to a patient and that patient will experience a serious outcome due to inaccurate or incomplete information provided. To prevent or limit damages, they all ask the patient to make an appointment.
• Wouldn’t it be nice @Neal and everyone if we had a single source of health information truth on the patient that could be accessed by anyone authorized by the patient or their caregivers – whether this was a mobile app, an online telehealth resources (e.g., urgent care televisits), or in-person treatment by GP, or hospital. @Neal, access to such a source would lower liability in my opinion, but until that is in place, it’s up to every point of care provider – and patient – to ensure that the appropriate amount of information is shared/communicated.
• Building your portal or PHR to be ever evolving and adaptable is key, along with a visionary stance to avoid the statements of ‘that won’t work’, developers and those involved with development need open minds.
• Again, any program must improve efficiency and not just gather data. The person using it must feel there is value in this particular computer /software product that helps with the actual improvement at the point of care, easy learning curve and affordable – and the care giver does not feel forced under draconian rules to purchase a product that will only add to an ever-increasing burdensome and regulated system
• We tend to forget that patient engagement (in terms of meaningful use) really comes down to patient access and data sharing for care delivery. Patient access (portals) and physician (provider) data sharing are the two most critical pieces of meaningful use.
• two major things are necessary to make portals or PHRs more engaging:
  •  Access to timely clinical data, with little or no patient action required.
  • Engaging front-ends, which are truly tailored to the individual’s needs/wants
  • Without efforts either made by the hospital/doctor to increase adoption and then by the technology to sustain usage, engagement may wane. We have found that creating an emotional connection via intelligent virtual assistants improves adoption rates of patients/employees.
  • The portal extracts it’s information from the pts. record, no need to enter your info. after each visit like a PHR. Most routine visits and results are available to the pt. immediately as it is to the caregiver.
  • Making sure it is very user-friendly, as easy as Google or a shopping page. Labs and other data organized in a consumer-friendly way with easy to read graphs and diagrams and lots of big colorful icons.
  • Blue Button was a fantastic interoperability break-through because it combined data, metadata, and presentation into a simple file that soldiers could possess. But it can’t t handle graphics. However, I’ve seen technologies, like blue button wrapped in a jpeg, that can. They can include textable smartphone pictures of symptoms.
  • Technologies that drive Standards/Interoperability, Security, Privacy, Confidentiality, Integrity, Availability, etc. are at one end of the equation while technologies for ease-of-use, Common Portal framework for navigation and one place to do things, localization, costs, training, etc. are at the other side of the equation. However, it is a challenge to keep the patient at the end-device and improve the usage factor.
  • Technology and not as many required face to face appointments can help to engage people more.
  • A win on the physician office side also as it drastically cut their phone calls and shifted them to messaging that could be responded to while helping someone at the desk.
  • Technology that is easily accessible, easy to use and cheap to purchase. Then it will be- what to do with the information, who gets it and how is it followed up? new economic models are mandatory