May 13, 2014

What Every Provider Needs to Know about Patient Engagement

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Patient engagement applications. Healthcare Analytics. Personal Health Records. With the influx of new healthcare IT options, it’s easy to forget what all this new technology is actually supposed to accomplish. In truth, it all centers on each point of the healthcare triangle: reducing costs, improving outcomes, and better engaging patients. The reality is that the first two are inherently tied to the third.

Engaging patients is at the foundation of nearly every current trend in healthcare. Meaningful Use even lists it as one of its core tenets, with the Department of Health and Human Services saying “the engagement of patients and their families in patients’ health care is a prominent goal of the EHR incentive program.”

Research has reinforced the hypothesis that getting patients engaged in their health and well-being will lead to better results. And though studies examining lower costs as they relate to patient engagement remain inconclusive, the concept of preventative care suggests that adjusting patient behavior to require less invasive care could lead to cost savings in the future.

A recent study by Juniper Research estimates that engaging patients through remote monitoring technology could save the global healthcare system $36 billion by 2018, with North America accounting for 75 percent of the savings.

Patient engagement is also an essential ingredient for accountable care organizations and patient centered medical homes to grow and succeed. By taking on the risk of bundled payments, providers must be able to affect patients’ behavior once they leave the physician’s office or else they’ll consistently exceed the reimbursement rate for their care.

But patient engagement is a broad topic, covering a variety of scenarios and initiatives. What does it actually mean?

Activation before Engagement

Semantically, patient engagement can refer to several different ideas, i.e., medical adherence, participation in health or wellness programs, or direct participation in decision making regarding treatment. While this term works well as an overarching goal, providers must first focus on patient activation, which refers to more specific characteristics of patient behavior, such as their willingness to take ownership over their health as well as their capacity to understand medical information.

Unfortunately, significant barriers exist to patient activation. For example, only 12 percent of American adults are considered proficient in healthcare literacy. And while this may be partially ascribed to the large number of esoteric phrases and terms used by providers, it also signals that a huge portion of the population is ill-equipped to interpret their own healthcare information.

To increase patient activation levels, providers must take on the role of educator as well as physician. Shared-decision making offers an option for better educating patients about their conditions, as does distributing clinical summaries to patients after each visit. The latter of these two options was a prerequisite for Meaningful Use Stage 1 attestation, which further reinforces the prioritization of patient activation throughout the healthcare industry.

Researchers have even managed to quantify patient activation, with Judith Hibbard et al creating the patient activation measure (PAM). Hibbard and her coauthors actually applied PAM to analyze more than 30,000 patients and found a significant difference in healthcare costs between patients with high activation scores and those with lower results.

Patient activation includes four stages:

  1. Believing the patient role is important
  2. Having the confidence and knowledge necessary to take action
  3. Actually taking action to maintain and improve one’s health
  4. Staying the course even under stress

Developing an understanding of patient activation is the first step in developing a more engaged –and consequently healthier — patient population. However, keeping a large number of patients engaged requires the proper application of technology.

Use Technology You Already Have (i.e., your EHR)

The hype around health IT and patient engagement doesn’t have to remain theoretical: some of these technologies actually can contribute to better engaged and activated patients. Though providers may think of their electronic health records as a purely clinical documentation tool, this technology actually has a multitude of features for engaging patients.

The patient portal is an excellent example. Some EHRs come complete with patient portals while other platforms require a standalone application. Either way, this technology is a  foundational element for patient activation, because it creates a direct link between patient and provider.

And while simple portals only allow patients to change appointments or email doctors – which are still excellent features to employ – more complex portals can be used as mediums for patients to maintain their health records or receive educational information about common conditions — which helps increase patient activation.

Introducing the idea of a personal health record to patients offers another avenue for increasing activation. Certain personal health records require a fee to use, but applications like Microsoft’s HealthVault integrate with EHRs and supply patients with a free means of storing and maintaining their health records, and for receiving educational material.

If  new technology is deemed necessary, introducing patients to apps that focus on patient activation skills can help providers create a more engaged population. Patient engagement apps can range from encouraging patient adherence through alerts to simply recycling functionality that’s already available in patient portals. The IMS Institute for Healthcare Informatics releaseda report analyzing the 40,000 plus healthcare apps available on the marketplace. Most are concerned purely with wellness – which may work well for specific conditions – but providers should stay on the lookout for apps like Qstream, which work well for disseminating educational information to patients.

First inspired by the Institute of Medicine’s seminal work Crossing the Quality Chasm in 2001, patient engagement has existed for some time, meaning technology has responded to supply providers with other means of engaging patients besides patient portals. Activating patients’ ability to contribute to their healthcare through technology represents the next step phase of Meaningful Use, and therefore the future of American healthcare.

How are you using your EHR to engage your patients? Share some insights in the comments.

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