Patient engagement is the catch-phrase right now, as providers incorporate more and more health IT tools to put patients behind the wheel of their healthcare while the government paves the road to get there.
With several components of Meaningful Use (MU) Stage 2 requiring patient engagement, providers must get up to speed or face lower reimbursement. As providers fill their arsenal with more sophisticated health IT tools, they are learning many lessons on how to engage patients and improve their outcomes in the process.
The Federal Push
Patient engagement “truly has the greatest potential for benefit in terms of not just health outcomes, but really transforming the system and improving the satisfaction of all of us in our interactions,” says Erin P. Siminerio, policy analyst in the Office of Consumer eHealth at the Office of the National Coordinator of Health IT (ONC).
In February, ONC unveiled its three-pronged patient engagement strategy: (A) to increase patients’ access to their health information; (B) to enable consumers to take action with that information; and (C) to shift attitudes so that patients and providers think and act as partners in managing health and healthcare using health IT.
“Our work has just begun,” says Siminerio. “There are a lot of people saying that patient engagement is the blockbuster drug of the century. I happen to agree with them. It’s the cornerstone of a high-quality, cost-effective healthcare system, so it’s an exciting time to be in this field.”
Stage 2 requires providers to use secure email with patients and to provide patients with a way to view, download and transmit their health information to a third party. These requirements are “really, really key, because they get this vital health information out of these siloed EHR systems, and put it in the hands of the consumer, so he or she can mediate his or her own health information exchange [HIE] and be an HIE of one,” says Siminerio. “It’s really important work to build the information highway and get different systems to connect with each other. In the meantime, patients can play a really important role of aggregating that information.”
Geisinger’s Data Geyser
Greater access to information can bode well for EHR accuracy, according to a recent ONC-funded pilot study. At Geisinger Health System, based in Danville, Pa., patients with chronic conditions at 42 clinic sites in 31 rural Pennsylvania counties were given an opportunity to go through the patient portal to review an online form pre-populated with their EHR medication list. Pharmacists reviewed and processed patient feedback, updated the EHR and notified the physician if shared decision-making was required.
“The results were astonishing. Far more patients than we expected were interested in doing this. The feedback that they received for the most part was accurate,” says Siminerio, noting that participants—on average—discovered two errors or omissions/corrections in the medication list. In total, 89 percent of patients who reviewed the form requested changes.
Even though Geisinger is a closed system, many patients were getting prescribed medications from outside the system, she says.
“That pilot really highlighted the valuable role that patients can play and also debunked the myth that patients aren’t interested in engaging, that they’re too busy and have other things to worry about. Actually, the research has proven that that’s not the case,” she says.
Kaiser’s Keen Patient Perspective
As medical director of internet services at Kaiser Permanente (KP), Kate Christensen, MD, is a key driver of patient engagement through health IT.
“My philosophy is that we need to approach heath IT from the perspective of the patient, with the interest of the patient in mind primarily over everything,” says Christensen. “There may be the needs of marketing, a particular department, careers, budgets or physician concerns, but the primary North Star is what is going to work best for your patient.”
Kaiser developed an online portal “with the primary principle of transparency that we want to give people as much of their record as we can within the constraints of the law,” she says.
The online portal allows patients to set appointments, access lab results, refill prescriptions and contact physicians through email. Approximately 30 percent of Kaiser refills occur online, which drives better care because patients who use the refill service tend to have higher rates of medical adherence, Christensen says, citing a two-year study published in the March issue of the American Journal of Managed Care.
Viewing lab results is the most popular feature. “Many people look at the same test results over and over. And if you think about it, you can really see why. It’s so personal. This is not general information about diabetes. This is my blood sugar, my hemoglobin sequence graphed over time,” says Christensen.
Kaiser also has a common practice where physicians prepare patients to see the results, which she says is especially important for tests that are outside the reference range but normal.
“For example, if you are on a blood thinner, and I test your clotting, I’m going to expect and hope for it to be abnormal because you are on the blood thinner. If patients are prepared for that result then they are reassured that it is where it’s supposed to be,” Christensen says.
The numbers really tell the story. In 2012, Christensen says, 33 million lab test results were viewed across the Kaiser system; 4 million people registered on the website; and 12 million prescription refills were processed through the website (i.e., patients ordered medications, which shipped to their home).
Also popular for patients is the ability to communicate with their doctor. Christensen admits it creates a greater workload for the physician, but says it is important to drive better patient engagement and quality of care.
Patient Engagement in Color
Putting patients more in control of their healthcare and health is a gradual process. Christensen describes three levels of patient engagement:
- Give patients access to their medical record and medication lists.
- Link patients to educational resources about their conditions. For example, their online record would contain links to articles, available in multiple languages and health literacy-appropriate, that explains the condition and is free of abbreviations and other confusing terminology.
- Patients take the reins of their health through action (e.g., weight management, smoking cessation and 10,000 steps programs).
Much work remains to climb these levels to better patient engagement. “All of these levels are very important, but I’d say taking action is the cutting edge,” Christensen says.