Survey searches for definition of the engaged patient

Proposed meaningful use regulations include the ability of patients to access their records online and email their doctors.

By — Posted March 19, 2012

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Nearly all of the health care organization leaders surveyed by the National eHealth Collaborative said patient engagement was important to health system reform. But there is no clear consensus on what it means to engage a patient.

NeHC's "2012 Stakeholder Survey," published Feb. 27, found that the way organizations describe patient engagement varies greatly. The most widely accepted description involved patients using educational material and online resources to learn about their health or conditions. The percentage using that description was nearly double the percentage of respondents who described patient engagement as face-to-face communication with physicians or direct communication with doctors about a change in health status.

Kate Berry, CEO of the NeHC, a public-private health information advocacy group, said she was not surprised by the variation in what people think is patient engagement, and it's probably appropriate that there are so many opinions.

"Consumer engagement in health care and health IT is so new and we're still so immature as an industry that it doesn't surprise me that people think about it in so many different ways," she said.

Respondents were asked to pick their top two definitions of patient engagement on NeHC's survey. Respondents also had the option of writing their own definitions. The report included the top five definitions chosen out of 10 listed.

Berry said the NeHC is gathering examples of best practices for patient engagement and working with members to develop the optimal model of patient engagement. What could develop is a model that involved several levels that will differ depending on the patient and what he or she wants.

Amir Kishon, PhD, CEO of Wellness Layers, a developer of patient portals for health care and wellness companies, said patient engagement in health care involves three layers:

  • Getting information to the patient about the organizations and their services.
  • Engaging in dialogue with the patient.
  • Producing action by the patient to achieve compliance and/or behavior changes, or by influencing buying decisions.

The Dept. of Health and Human Services' Office of the National Coordinator for Health Information Technology is pushing for more health IT-based patient engagement through its meaningful use incentive program. Proposed stage 2 regulations include several facets of patient engagement, including the ability of patients to access their records online and two-way secure messaging between patients and physicians. More online patient engagement tools are expected to be added in stage 3.

Several surveys have found that patients favor data portability. A survey conducted by Dell in February 2011 found that three out of four people would like their medical records to be shared between physicians and health care organizations, and 61% said they prefer online access to their records. But they also want communication with their physicians: Seven in 10 people said they wanted to be able to email their doctor.

Lucy Reynales, director of sales and marketing for Wellness Layers, said the organization was asked to provide feedback on the meaningful use rules and what elements of patient engagement should be included. She said regulations often focus on specific features as opposed to creating a guided experience that is unique to each patient and his or her needs.

A study published online in January in the Journal of Health Communication, for example, found that physicians shouldn't assume patients will access an online tool. Some patients may prefer paper. The study compared the efficacy of paper-based colorectal screening intervention information to Web-based intervention material. Forty-two percent of patients given paper-based resources reviewed them, while only 24.6% given access to Web-based information read it.

Reynales said behavior modification is very personal for most people and involves social support. This is where social media could come into play. The preferred method of communicating to a patient varies. Social media provides an opportunity to find the connections, conversations and information meaningful to patients.

Berry said the NeHC hopes to advance the use of patient engagement tools -- beyond what are required for meaningful use -- that impact lifestyle choices. They will be even more important as the industry moves toward an accountable care organization model, she said.

"When we go to an accountable care type of environment, where everybody's sharing in the risk of having better quality and better management, it's the individual whose lifestyle choices and the ways they decide to use the health care system that is the biggest driver of health care cost that there is," Berry said.

There are a variety of tools, such as mobile phone apps and monitoring devices, that organizations can tailor and put under their own brand that will give patients the power to get engaged, she said.

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Descriptions of patient engagement vary widely

The National eHealth Collaborative asked health care organization leaders to pick their top two ways to describe patient engagement out of a list of 10. These were the five most often cited definitions and percentage of those who chose them.

64.0%: Patient uses educational material and online resources to learn about better health or their own health conditions.

58.7%: Patient uses tools and resources to manage his or her medical record and other health data.

41.3%: Patient feels comfortable challenging doctor when something doesn't seem right or when explanations are not clear.

38.4%: Patient feels comfortable discussing health issues and questions with doctor or nurse face to face.

38.4%: Patient communicates with doctor about changes in health status in a timely way.

Source: "2012 NeHC Stakeholder Survey," National eHealth Collaborative, Feb. 27 (link)

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External links

"2012 NeHC Stakeholder Survey," National eHealth Collaborative, Feb. 27 (link)

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