We recently addressed the issue of engagement with modern health IT from the perspective of clinicians. In this second part, we will look at engagement as it relates to patients.
The question of patient engagement is partly about using patient-facing health IT (web portals, mobile devices, etc.), and largely about the impact that such involvement has on the doctor-patient relationship. The presumption is that engaged patients will have better outcomes, as measured by various Clinical Quality Measures – hard data corroborating this is still scant, however, mainly due to this whole shift being relatively nascent.
Stand-alone PHRs don’t really work
The recent news that Google Health is abandoning its Personal Health Record (PHR), which followed the shut-down of Revolution Health last year, show that stand-alone PHRs simply don’t gain much traction.
What has resulted in more traction have been patient-facing portals that connect with their doctor’s Electronic Health Record (EHR). Kaiser has stated that about half of their 6 million enrollees have registered to use their PHR (Kaiser Connect, their Epic-based EHR system).
As witnessed by the experience with stand-alone PHRs, people don’t want to enter their own health data into a PHR themselves – in order for it to be widely practical, it needs to be populated with the data from their doctor’s charts, automatically. And the kinds of things that need to be there – the elements that generate traction – are lists of diagnoses and medications, allergies, immunizations, upcoming appointments, and laboratory results (with interpretation by the clinician). In addition, a secure two-way communication portal between patients and physicians enhances engagement, and reduces demand that would otherwise go through phone calls to the office.
Trusted content
The Internet is a limitless source of “information,” filled with valuable, credible data, as well as every form of charlatanism imaginable. As anyone involved in clinical care in the modern era can attest, patients often come armed with reams of “information” downloaded from the Internet – they come, not asking for facts, but instead are seeking interpretation. People need to digest all the confusing data out there, and find meaning. Finding meaning – putting it all together into a picture that makes sense – is the new nature of the doctor-patient relationship in the Internet era.
Given this, looking to the doctor for recommendations of trusted content is important. This is particularly true when it comes to delivering Health Education content around conditions that the patient has (or might have, or is simply interested in). High quality, validated and curated health education content is an emerging resource that, when integrated into a linked EHR-PHR, can enhance to overall experience, and (best case scenario) result in improved health outcomes.
Mobile health
We are seeing an explosion of offering in the arena of mobile health (often referred to as mHealth). Small, lightweight apps that can be deployed on mobile devices – smartphones, iPads, etc. – are emerging at a breathtaking pace. They run the gamut from patient-centered data collection portals (tracking exercise, pulse rates, calorie counting, blood sugars, daily weights, etc.), to viewing data housed elsewhere (schedule checking, lab test reviewing, personalized health education resource interaction, etc.), to enabling two-way communication (communication in interest-sharing social networks, forums, messaging between peers or doctor-patient messaging, etc.).
As one would expect with such a newly-developing space, there will be many companies that fail, and a number of companies that will be strikingly successful. This space is so new and wide-open that industry leaders have yet to solidly emerge.
Conclusions
There are some emerging themes that will define the role of health IT when it comes to patient engagement with healthcare:
1. Stand-alone technology will not gain traction, and will ultimately fail. What is needed is technology that connects patients to their clinicians, and creates communities.
2. As physician-facing EHRs become unified dashboards, collecting data from all the fragmented locations where health data is found (as we reviewed in Part 1 of this series), this then becomes the hub that successful patient-facing apps tap into. It is the “oxygen” that drives the system.
3. Engaged e-patients want their data. Technologies that facilitate this, so that people can access their health data at-will from anywhere, any time, are becoming a fact of life.
4. The doctor-patient relationship is a trust-based relationship. As such, what patients seek from their clinicians is interpretation – “tell me what all this data means.”
As this new technology landscape matures, and the changes in relationships that accompany this shift become more mainstream, we will have the basis to answer this question: (1) patient engagement in one’s own health, using technology that enables such engagement, is a fact of life; (2) we have Clinical Quality Measures that can be used to measure health outcomes; (3) can we show improvement in individual and population health outcomes as the result of this shift? Every indication points to a resounding yes.
Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR
