Collaboration, Communication and Connection: Fostering Patient Engagement in Health Care

 

 

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Abstract

Keywords: Patient engagement, physician-patient communication, patient-physician communication, collaborative decision making, electronic health records, EHRs, health information technology, HIT, health apps.
Citation: Finn NB. Collaboration, communication and connection: fostering patient engagement in health care. J Participat Med. 2012 Sept 5; 4:e20.
Published: September 5, 2012.
Competing Interests: The author has declared that no competing interests exist.

 
Engaging patients to manage and monitor their health by using health information technology seems to positively change outcomes, at least according to a recent study of more than 3,500 patients with diabetes and hypertension, conducted by Kaiser Permanente (KP). The findings of this endeavor showed that the use of secure patient-physician messaging in any 2-month period was associated with statistically significant improvements in their chronic conditions. Results included 2 to 6.5 percentage point improvements in glycemic, cholesterol, and blood pressure screening, and control.

The study, which was published in the July 2012 issue of Health Affairs, concluded that putting patients and their data at the center of care resulted in improvements in health care quality, access, and cost. Using My Health Manager, KP members sent over 850,000 secure messages to their clinicians each month of the study. The clinicians logged in nearly 3.5 million messages to their patients between January and April 2011, in email exchanges that were focused on helping those patients empower themselves and better manage their health.[1]

There are reasons why the KP project and similar programs foster patient empowerment and engagement. The availability of a secure portal where patients communicate with their clinicians to ask those questions that they forgot to ask during their face to face visit, or address issues that come up between visits, enables them to stay connected, on top of their health issues, and out of the emergency room. The reward of getting answers quickly and easily without the frustration of telephone tag or the consumption of large amounts of time out of their busy day, encourages patients to engage more.

The concept of patient engagement — patients sharing the power and responsibility for treatment decisions with health care providers — is not new. In 2008, The National Quality Forum (NQF) declared patient and family engagement to be one of the six national priorities to eradicate disparities reduce harm and remove waste from the health care system in the United States.[2]

Health care institutions across the country are experimenting with new ways to involve patients in their care. Columbia University Medical Center, part of New York-Presbyterian Hospital in Manhattan, created a prototype program that gave a small group of cardiology in-patients an iPad, and a proprietary app, that enabled them to access to clinical data from their electronic medical records and to see their medication history as well as detailed information about those medications. The app also enabled them to see photographs of their care providers along with the providers’ names and roles on their care team.[3]

This pilot, conducted in March 2011, was intended to improve patient engagement in the care process right from their bed. The program was based on the premise that “the more informed the patients are, the better the outcomes will be.[4]”

Engaging patients is a collaborative process that begins with good communication. Whether it is maintaining a healthy lifestyle, filling and taking prescribed medications, showing up for a scheduled medical appointment, or using a patient portal to schedule appointments, get referrals, access lab tests and send messages to health care providers, patients and providers need to work together to foster understanding, trust, and acceptance of each other as equally critical to the process.

The Society of Participatory Medicine has developed a Seal Program that would award a Gold Seal to patients and clinicians who meet certain criteria by working together to achieve participatory principles in health care. The criteria are as follows:

For Providers:

  1. Proactively providing patients with health data including laboratory results.
  2. Creating feedback mechanisms, such as Patient Advisory Councils, so that patients can provide input on their care, and giving patients resources to help them maintain and manage their health.
  3. Encouraging patients to be full partners on the health care team.

For Patients:

  1. Using the health data that the clinicians offer to develop health goals, maintain and follow treatment instructions and track appointments.
  2. Providing feedback to clinicians regarding how the care provided is working.
  3. Using the resources offered to better understand health issues and take a larger responsibility for health care.
  4. Encouraging clinicians to be participatory providers[5]

There is a lot of work ahead. Some of the ways that patients and physicians can work on better patient engagement include the following:

Talking Points
Patients need to bring all their questions to an office visit with the doctor. Doctors need to listen and respond with interest and appropriate information to those questions.

Full Disclosure
Patients need to share everything that is bothering them.
Physicians need to make their patients comfortable and build a trusting relationship.

Open Communication
Patients need to ask for all the ways they might contact the doctor in between the face-to-face visits including email, patient portals, and online e-visits. Doctors must make themselves available while establishing the ground rules, e.g. emails are answered within 48 hours, phone calls within 24 hours.

Setting Expectations
Patients need to let the doctor know what they expect from their doctors during their office visit, and in between as well. Doctors need to be clear on what they can deliver and how their specific practice works.

The Holy Grail in medicine today is to put patients along with their data at the center of care. It takes total commitment to move in this new direction and create an environment where patients take a share of the responsibility for their care, supported by their providers. Only when we have engaged patients, encouraged by providers, will we see better quality health delivery, greater efficiency and improved outcomes.

References

  1. Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved quality at Kaiser Permanente through e-mail between physicians and patients. Health Aff (Millwood). 2010 Jul;29(7):1370-5.
  2. A Path to Patient-Centered Care. National Quality Forum. Available at: www.qualityforum.org/Topics/Patient_and_Family_Engagement.aspx. Accessed August 23, 2012.
  3. Vawdrey DK, Wilcox LG, Collins SA, Bakken S, Feiner S, Boyer A, Restaino SW. A tablet computer application for patients to participate in their hospital care. AMIA Annu Symp Proc. 2011;2011:1428-35.
  4. Copyright: © 2012 Nancy B. Finn. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.

Comments

4 Responses to “Collaboration, Communication and Connection: Fostering Patient Engagement in Health Care”

  1. Nancy,

    There’s no question that patient engagement in very important to just about every key stakeholder. I have written extensively on the subject myself. With respect to KP’s My Health Manager, (and I would have to add Groups’ Health’s and the VA’s equivalent) it is true that PHR-like applications along with secure e-mail and convenience services such as RX refills and appoint scheduling have seen higher levels of member/patient adoption and use.

    These examples however tend to be the exception rather than the rule with respect to the kind of adoption rates other providers and provider networks can or should expect. In a recent conversation with John Moore of Chilimark Research, he cited how the vast majority of provider-sponsored patient/member portals report patient/member adoption rates of approximately 7%. According to John, adopt rates for such “portals” (which include PHRs. secure e-mail and convenience services) have remained flat since their introduction.

    Why? The reason boils down to the level to which such a function (portal)is integrated into the care delivery. The portals at Kaiser, Groups Health and the VA, are integrated into the patient visit and are fully integrated into the way these organizations (integrated at so many levels besides web portals) philosophically operate. The same cannot yet be said for the local physician group, hospital network or ACO.

    In my experience, when local providers hear about what’s going on at Kaiser or Group Health their eyes glaze over knowing that these organizations operate much differently than their own. Until we see serious efforts at integration by the average provider groups out there…I am afraid there few if any will see the same level of “engagement” being seen by the Kaisers of the world.

    Steve Wilkins
    Mind the Gap
    http://www.healthecommunications.wordpress.com

  2. Nancy Finn says:

    Steve,

    You are so right about the slow adoption of patient portals with the exception of the groups that fully integrate them into the entire patient experience, not just the visit. I think part of the reason for slow adoption of portals is that even in hospitals where portals have been put in place, physician groups do not buy into them as being useful or friendly,thus do not promote them to their patients.

    I am not arguing that it is easy and I clearly recognize that it is a long tough journey to collaboration and patient engagement in the full population. However, that is where we have to go if we are to see changes to the healthcare system. Tools such as portals, programs such as Blue Button and the SPM Gold Seal and continuous education for both patients and providers will push this agenda forward slowly but surely.

 

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