Tag Archives: Group Health Cooperative

Patient Engagement Is A Physician-Patient Communication Challenge…Not A Health Information Technology Challenge

There is no app for engaging patients in their own health care absent a strong doctor-patient relationship.

Physicians, hospitals and other providers are being misled by  industry pundits claiming that more health information technology (as in EMRs, PHRs, Smart Phone apps, and web portals) is the key to greater patient engagement.   It’s not.

If health information technology were all that was needed to “engage” patients then  patient and member adoption rates of provider and payer web portals offering Personal Health Records (PHRs) and Electronic Health Records (EHRs) would not still be hovering around a disappointing 7% (with  several notable exceptions Kaiser, Group Health and the VA).*

Part of the misunderstanding concerning the role of HIT comes from how the discussion about patient engagement is being framed.  According to the pundits, patient engagement is the physician or hospital’s responsibility… and like everything else these days…we can fix it if we just throw more technology at the problem.   Can anyone say Stage 2 Meaningful Use requirements?

Here’s Why HIT Will Not Solve The Patient Engagement Challenge  

The role of physicians, hospitals and other providers is not so much one of needing to  engage patients in their care.  Rather, providers need to “be more engaging” to patients who are already actively engaged in their health.

Here’s What I Mean…

Take the simple act of a trip to the doctor’s office.  Before a person shows up at the doctor’s office they have to 1) have a reason or need (symptoms, a concern, chronic condition), 2) they have to believe that the need or reason merits seeing the doctor vs. taking care of it at home themselves – this generally implies cognition and doing research, i.e., talking with friends, going on line, etc.,  3) make the appointment (by calling or going online and 4) show up for the appointment, and 5) think about what they want to say to the doctor.   The point here is that by definition, people who show up for a doctor’s appointment are already engaged!

Now providers tend to not consider the patient’s perspective when it comes to engagement.  For most providers, i.e. physicians and hospitals, engagement means getting patients to do what providers say is in their best interest…what I say is right.   But that approach totally dismisses the fact that, as I have shown, that patients are already engaged…just not in the same way that providers expect.

Whether patients remain engaged by the time they leave the doctor’s office, and to what extent, are the questions we should be asking.   For example, how “engaged” would readers here find it if they went to their doctor only to have the doctor 1) not ask why they are there (fears and concerns) or worse yet ignore the fears and concerns which they describe to the doctor, 2) disagree with the doctor as to the visit priority and how to diagnose and treat it, including for example being prescribed medication when you don’t want to take pills or 3) found out that you knew more about your problem and how to deal with it than your doctor?

The Point?

The point is that providers need to be engaging to patients in their demeanor, attitudes, and how they talk with and listen to patients.   Doctors need to know who the patient is, what their fears, concerns and expectations are and what the patient is able and will to do.   Meaningful patient engagement, the kind that leads to long term health behavior change, begins with patient-centered, interpersonal relationships  between patients and their doctors.   As far as I know, we don’t have an app for that.

That’s what I think.  What’s your opinion?

Source:

* John Moore, Chilmark Research

For more information on patient engagement, email me for a copy of my latest white paper on Patient Engagement in Primary Care  or fill out the online form  on my blog.

Patient Portals – What Do Patients Really Think About Them?

There seems to be an inverse relationship between the amount of spin one hears about “the next big thing”…and reality.    First it was EMRs and virtual e-visits, then social media, and now patient portals seem poised to be next big thing.   The drumbeat of vendors and pundits is unmistakable….physician that don’t adapt will be toast.   It can all sound pretty convincing until you ask to see the evidence.  What do patients think?

Take the physician patient portal.   If you read between the lines, patient portals are frequently being positioned as the new “front door” to physician practices.   By signing on to a secure website patients will have real time access to the electronic health record and will be able to communicate with their physicians by e-mail.   Additional patient features include being able to schedule an appointment with their doctor, reading their test results and refilling prescriptions.  But despite these features, according to John Moore at Chilmark Research, “nationwide use of patient portals remains at a paltry 6%.”

Ok… so now we know what vendors and pundits think about patient portals. What about patients – what do they think?

They would love it right?  I mean who at this very moment isn’t at home trying to e-mail their doctor.  Yeah right.

If a qualitative study of primary care patients in Journal of Internal Medicine is any indication, those most interested in using a patient portal were patients who were:

  • Dissatisfied with their physician
  • Dissatisfied with their physicians communications ability
  • Dissatisfied with their ability to get medical information from their physician

Those patients least likely interested in using a patient portal offered by their physician are patients who are:

  • Satisfied with their physician
  • Satisfied with their physician’s communication abilities
  • Difficulty in using the portal

Of significant note, patients who reported good relationships with their doctors were afraid that the patient portal would potentially undermine that strength of that relationship.    In other words, patients were afraid that e-visits would replace face to face visits.  Researchers were surprised that not one patient in the study identified encrypted e-mail communication with their doctor as an advantage of patient portals.

While the findings from this study are not generalizable, the study does highlight a potentially significant unintended consequence of encouraging patients to use a new patient portal.   Patients may interpret the move as a signal from their physician that they will have less face-to-face time with their doctor…which in their mind is not a good thing.

To be sure, there are notable exceptions to the cautionary tale described here.  MYGroupHealth , the patient portal developed by patients and providers at Group Health Cooperative in Seattle, is perhaps the best example.

Take Aways

  1. Patient Portals are not going to go away.  Having a patient portal is expected to be a requirement in the final  Stage 2 Meaningful Use (MU) Requirements (June 2012) and is listed as a condition for advanced Patient Centered Medical Home (PCMH) accreditation by NCQA
  2. Ask patients what they think about a patient portal – what services should it offer, would they use it, how should it be promoted and so on.  After all, it is supposed to be patient-centered.
  3. The real value of the patient portal lies in physicians providing  patient-centered, clinical support to patients rather than promoting products and services.
  4. Integrate the patient portal into the primary care physician’s work flow and practice.  If you collect patient data on the portal then make use the physician actually uses the information during the patient visit.

That’s what I think.  What’s your opinion?

Sources:

Zickmund SL, Hess R, Bryce CL, et al. Interest in the use of computerized patient portals: role of the provider-patient relationship. Journal of General Internal Medicine. 2008;23.