Tag Archives: doctor-patient communication

Do You Really Believe That 41% Of People Would Switch Physicians To Gain Online Access To Their EMR?

I love survey data as much as the next person. But some of the survey data finding its way into the health care press these days is pure baloney…which is good if you like baloney.

Such was the case with the finding from an Accenture study which was making the rounds of the Health Information Technology (HIT) Journals, HIT Blogs and Twitter feeds during National Health IT Week. You will no doubt recall the headlines which proclaimed that “41% of U.S. consumers would be willing to switch physicians to gain online access to their own EMRs.”

Upon first glance, the question of “would you be willing to switch physicians” to accomplish a social good (access to your electronic medical records) seems reasonable enough. It’s one of those questions that most of us would be inclined to agree with. It’s kind of like asking people if they would be willing to pay lower taxes or pay less to fill up your car’s gas tank. Of course we will say yes.

In the Accenture study literally everyone did! Remember 36% of respondents said they already had full access to their EMR (whatever full access means), 27% said they had limited EMR access and 37% said they did not yet have any EMR access. So if 41% said they would switch physicians to get EMR access we are left to conclude that all 100% of those without EMR access would switch…plus 4% of those who already had EMR access would also switch doctors presumably because they wanted more EMR access.

At face value, this Accenture data does not hold water…and here are a couple of reasons why.

  • 79% of people (patients) are already very satisfied with their personal physician (patients who rated their physician 9-10 on the 10 point 2012 CHAPS survey released recently by AHRQ. Very satisfied patients are not likely to switch physicians unless they have a darn good reason and access to Health IT is not a good enough reason for most people.
  • People’s criteria for selecting a new physician focus on human interaction skills and clinical competencies – not the physician’s Reasons For Changing Doctorsuse of EMRs and other Health IT (i.e., PHRs, web portals, etc.).
  • Similarly, people’s reasons for switching physicians have to do with changes in insurance, relocation, and the physician’s human interaction skills…not the lack of an EMR, PHR or patient portal.
  • 100% of people can’t agree on anything including EMRs – intuitively we know that seniors (who have the highest health care need/use) have a higher trust in their physicians and are less inclined to care one way or another about Health IT, other people worry about personal data security and so on.
  • A 2012 survey by the Markle Foundation found that “79 percent or more of the public believe using an online PHR would provide major benefits to individuals in managing their health and health care services.” Yet actual consumer adoption of online PHRs has been less than 10% for the last several years (with some notable exceptions like Kaiser, Group Health and the VA). There’s a big difference between what people believe or say they are willing to do…and what they actually do.

The Take Away

What people actually do or intend to do (behavioral intentions) are much stronger and reliable predictors of behavior (switching physicians for example) than attitudinal questions about their beliefs or potential willingness to do something in the future in relation to other behaviors they could engage in. The Accenture study would have been more instructive had it asked respondents to rate the importance of Health IT (EMR) in relation to other physician selection factors like the physician interpersonal skills, their knowledge and experience, etc. It would also be helpful for Accenture to inquire as to the respondent’s knowledge of EMRs and what constituted full versus limited access…and which is addresses the consumer’s level of interest and need.

There’s Nothing Engaging About My First Patient Portal…It’s Actually Disengaging

In Fact It’s Downright Disengaging…

Stop the presses!   I now have access to my very own personalized patient portal courtesy of my personal physician.  The big event occurred this last Tuesday.   I have to admit I was a bit excited that my doctor was slowly merging onto the information super highway.  Heck he even sprang recently for an out-of-the box EMR system which he is forever complaining about.

But my excitement was short lived.  Very short lived in fact after reading the e-mail from E-Clinicalworks (the patient portal vendor) which I am sharing with you here.

Patient Portal email

Now I realize that my doctor works in a solo practice as part of a large IPA…not the Mayo Clinic. But this email…and presumably everything associated with this patient portal is…well…very amateurish and totally disengaging.

A couple of things immediately jumped out at me while reading this e-mail invitation to my patient portal.

The patient portal claims to offer me “the power of the web to track all aspect of my care through my doctor’s office.”That’s pretty powerful!

But I read on to discover that my physician’s concept of what I should have the “power” to do and what he thinks I should be able to do is very different. Why am I surprised…?

First there is no mention of any kind of access to my actual health information…and certainly not my “physician’s notes.”But that doesn’t mean I am willing to leave my doctor for someone who offers this capability.

Second…and perhaps most galling…is that I can’t actually communicate with my doctor via the portal.  I can email his office staff…and maybe they will respond and maybe not. In the non-digital world they would get back to me at their own leisure.

Third, I can’t actually do anything on the portal (as configured by my doctor) other than request that the surly office staff intervene with the doctor to refill my prescriptions. Asking is certainly different than doing in my book. How the heck is this supposed to make me feel engaged?

Finally the email presumes to tell me that up until today my physician apparently does not think that I have been taking an active role in my own health care.   Let me get this right…I am 100% compliant with my medications, exercise, see my doctor regularly and am in good shape…yet I am not actively involved in my own health. Come on now.

In its favor…the email was personalized – it got my first name right. It never did mention my doctor’s name or his office address.

Upon getting this email from my doctor I was immediately reminded of a quote from a recent Dave Chase Forbes article about the value of physician-patient communications in which he said this about patient portals:

“The smart healthcare providers realize simplistic patient portals, however, won’t get the job done. Simple patient portals are like a muddy puddle of water in the Sahara Desert — a big improvement but far from ideal.

Kudos to physicians everywhere that are trying… But please recognize that your patients are not simpletons and that they are already engaged in their health at least from their perspective. For portals like this to be successful – (meaning that patients actually use them more than once) – they need to offer real value (from the patient’s perspective), they need to be relevant to patients (not you or your staff) and they need to respect my intelligence.

Take Aways

Most patients are already engaged in their own health care. The biggest challenge for providers today is not so much engaging patients but rather to avoid disengaging them.

I realize that my experience offers but one example of a patient portal gone wrong.  If you have samples of patient portal experiences you would like to share e-mail me at stwilkins at gmail.com.

The Lack Of Patient-Centered Communication Skills By Physicians in Your Provider Network Will Limit Your PCMH & ACO Performance

 

Betting the Ranch on your physician patient communication skills

The Adopt One! Challenge – The First Step To Better Patient Engagement & Patient Experiences

A journey of a thousand miles begins with a single step.  Or in the case of the Adopt One! Challenge…by encouraging physicians across the U.S. to commit to adopting one new patient-centered communication skill in 2014.

Anyone who has followed my work here on Mind the Gap knows that I am passionate about improving the way physicians and their care teams talk to and interact with patients. My passion stems both from my personal experiences as a health care executive, a patient advocate and patient.  I honestly believe that if we could improve how doctors and patients talk with one another beginning in the exam room we would fix much of what is broken with today’s health care system.

“I have discovered that the biggest problem with physician-patient communications is the illusion that it ever occurred! “

AdoptOneBigButtonMany physicians readily admit that their patient communication skills need work. But when faced with a burdensome daily practice schedule they make do with the physician-directed patient communication skills they learned in medical school. Besides…most physicians operate under the mistaken impression that patient-centered communications – the alternative to physician-directed communications – takes too much time and requires longer visits.

So How Will The Adopt One Challenge Fix Things?

The Challenge, to be launched later the Fall, is designed to accomplish three objective – behavioral objectives modeled after the Health Belief Model. These three objectives are:

  • Help physicians understand that their patient communication skills are not all they could be
  • Show physicians how their lack of patient-centered communication skills is a barrier to their ability to effectively engage and activate patients or to provide exceptional patient experiences
  • Serve as a “Call to Action” to prompt physicians to take action to improve their patient-centered communication skills

Here’s how the Adopt One! Challenge will accomplish these objectives:

Help physicians understand that their patient communication skills are not all they could be

Using audio recordings provided by participating physicians a team of independent, trained professionals will identify, measure and assess the patient communication skills employed by each physician. This research method – called conversation analysis – is the same method used in medical school. Unlike patient satisfaction surveys like HCAHPS which are not very prescriptive, the Challenge will provide participants with objective, detailed and actionable findings and recommendations.

Show physicians how their lack of patient-centered communication skills is a barrier to their ability to effectively engage and activate patients or to provide exceptional patient experiences

In addition to measuring and assessing their patient communication skills, each physician’s patient communication skills will be benchmarked against patient-centered best practices.

Over 30 years of research has linked the use of specific, patient-centered communication skills to more productive visits, increased patient engagement, better patient health outcomes, lower health care use and superior patient experiences.  By comparing physicians’ skills against these “best practices” we show them how their communication practices may be affecting patients, their practice and the organizations they work for or with.  We also show them which communication skills they may want to focus on improving.

Serve as a “Call to Action” to prompt physicians to take action to improve their patient-centered communication skills

The Challenge serves as a concrete call to action to physicians to take a specific action to learn a new patient-centered communication skill over the course of 12 months.  This call to action will require participants to 1) commit in writing to adopt/develop one new patient-centered communication skill of their choosing and 2) provide them with access to online training and resources needed to help them learn that new communication skill.

Because the Adopt One! Challenge is expected to become an annual event, participating physicians can measure their year-over-year progress as they add new patient-centered communication skills.

In future posts I will share more about the Adopt One! Challenge. In these future posts I will profiling members of the Adopt One! Challenge Advisory Board as well as the Partners that are making the Challenge possible.

The Adopt One! Challenge is Free To Individual Physicians.

If you are interested in offering the Adopt One! Challenge to all the physicians in your provider network?  E-mail us at contact@adoptonechallenge.com.

Is The CEO Of The Cleveland Clinic Serious When He Says “No More Passive Patients”?

If a recent blog post by the CEO of the Cleveland Clinic is representative of how health care executives (and physicians) really think about patients – aka consumers –aka people like you and me…we are all in big trouble.  In it Delos Cosgrove, MD, talks about how under health care reform there will be “No more passive patients.”

Here’s my a quote from the post by Delos Cosgrove, MD:

“For too long, healthcare has been something that was done to you. Now it’s going to be something you do for yourself in partnership with your doctor and care giving team. You’ll need to monitor your food input, get exercise, and avoid tobacco. ”

Let’s examine what’s disturbing about comments like this particularly when made by high-profile leaders like Dr. Cosgrove.

First, this statement is factually inaccurate.  Here’s why.  82% of US adults visit their PCP every year at least once a year (often more) for their health.   Think about the trip to the doctor’s office from the patient’s perspective… 1) chances are they have discussed their health problem or concern with family members or friends, 2) they may well have looked up information on their condition to see if it merits a doctor’s visit, 3) they make the appointment, 4) they show up for the appointment and 5) wait in the waiting and exam room thinking about the questions they want to ask their physician.

What about any of this suggests patient passivity?

Second, this statement misrepresents the true nature of the patient passivity of which Dr. Cosgrove speaks.  You see patients (aka people) are socialized by physicians beginning in childhood visits with Mom to the pediatrician to assume a passive sick role.  We are supposed to be passive! Otherwise the doctors gets irritated and ignores or dismisses what we have to say.  While it’s true that patients (even the most empowered among us) ask very few important questions during the typical office exam…the reason isn’t that we are passive.  Rather it’s because we don’t want to be too assertive, confrontational, and argumentative or are simply afraid.

Rather that blaming patients for not being more engaged…why don’t doctors try and become more engaging (e.g., patient-centered) to patients?

Third, patient non-adherence is often not the patients fault…but rather the result of poor communications on the clinician’s part. One recent study found that 20% of medication non-adherence is the direct result of poor physician communication with patients. Poor patient communication skills top the list of complaints people have with their doctor. Poor patient communication is also the leading cause of medical errors, non-adherence and poor patient experiences.

AdoptOneBigButtonFourth, how exactly are patients going to learn all the skills necessary to “do everything” for themselves?  The work of Lorig et al. has shown that simply providing patients with information – the “what” of self care – is not enough to change patient health behavior.  Patients also need and want to develop the skills and self efficacy for self care management – the “how” of self care.   Right now for example clinicians spend on average <50 seconds teaching patients how to take a new medication…and we wonder why patients are non-adherent.

Given the poor patient communication skills of physicians today how exactly are patients supposed to learn how to do it all themselves?

Finally, the Dr. Cosgrove reminds us of the kind of paternalistic, physician-directed thinking and communications which has gotten the health care industry into the mess it’s in.

The following statement says it all:

“If your doctor prescribes a medication, preventive strategy, or course of treatment, you’ll want to follow it.”

What if I don’t want the medication or don’t believe it will help me? Why should I be forced to do something I don’t want to do? Will you drop me as a patient?
What happened to the IHI’s Triple Aims?  What about the need to be more patient-centered as called for in Crossing the Quality Chasm and the ACA reform legislation?

I am sorry if I seem to come down hard on Dr. Cosgrove. But my original point remains…too many health care leaders still think and talk like this.  While they may “talk the talk”…employees, patients and physicians all see how such leaders “walk the talk.“  And as Cosgorove’s comments suggest we have a long, long way to go.

I would like to extend an invitation to Dr. Cosgrove and the physicians at the Cleveland Clinic to see just how “patient-centered” their communication skills really are by participating in the Adopt One! Challenge.   You will not only be able to assess the quality of your team’s patient communication skills but also see how their skills compare to industry best practices.

All physicians are invited to participate in the Adopt One! Challenge.

That’s my opinion…what’s yours?