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deBronkart: Let the Patients Help

February 23, 2014
by Gabriel Perna
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Dave deBronkart, the famed patient engagement advocate who goes by the moniker, e-Patient Dave, spoke at the HIMSS 2014 pre-conference patient engagement symposia conveying his simple message to providers: "Let the patients help."
deBronkart, who will also speak at the Healthcare Informatics Summit in San Francisco in May, told the audience of patient engagement enthusiasts that data quality is "low hanging fruit for activating consumers to engage with their medical information." He says the best way to get people engaged is when there is not a crisis. "People can get oriented, involved, and when it's crunch time, they won't have to get oriented." 
The advocate told a few stories, including a personal one, where the data quality of a particular patient was inaccurate. deBronkart said his mom's hyperthyroid was incorrectly written as hypothyroid in a record, which would have given her the opposite prescription. Having the patients or their caregivers actively engaged in this and other cases helped the providers give better care, he said.
The mistakes are inevitable, deBronkart says, when practitioners are up to their ears in work as it is. That's where the patients come into play and why these providers should let them in. He used the OpenNotes initiative as an example of when letting patients verify their information in a medical record is proven to be the right strategy.
deBronkart noted that much of the battle in getting patient engagement accepted with the establishment was cultural. He notes how many doctors are concerned that eHealth tools will put them out of business, to which he says, "Are you kidding me?" 
"Patient engagement isn't about patients overthrowing doctors. It's about doing everything they can do to contribute," deBronkart says. 
In a later panel, three doctors shared their experiences with implementing patient portals into a provider organization's workflow. Much of the problems centered around that cultural issue.
Mark Groshek, M.D., a pediatrician and lead on eHealth at Kaiser Permanente in Colorado, said that when the organization first began rolling out their portal, there wasn't a lot of enthusiasm from doctors about getting secure emails from patients and releasing lab results. As a result, the provider brought together doctors, nurses, and other stakeholders to understand the value of this portal. 
Ultimately, they got on board and it's well known within the industry that Kaiser Permanente has been able to launch one of the most successful deployments of a patient portal. One study showed that 90 percent of the messages in the portal, Groshek said, were responded to within a day. 
Daniel Sands, M.D., a consultant, said that one integral aspect to getting physicians in line with patient engagement efforts, specifically around the patient portal, is figuring out where it fits in the workflow. 
"Physicians are struggling from 'queue fatigue,'" says Sands. "Physicians have notes we have to co-sign, notes we have to sign off of, online stuff we have to take. Just all this (information) we have to deal with. This is just one more queue of information. Workflow is crucially important."
Jonathan Wald, M.D., director of patient-centered technologies at the Boston-based Center for the Advancement of Health IT at RTI International, echoed this sentiment when he talked about how when he deployed portals at various physician clinics. He said how one organization had to fix their workflow before they could share medication lists with patients. "Sometimes when there is resistance around physicians, or ideas aren't working in the field, it doesn't mean we're all pulling in the same direction," he said.