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Q&A: The Opportunity for Patient Engagement in Community Health (Part 1 of 2)

April 18, 2014
by Gabriel Perna
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Jan Oldenburg

To say Jan Oldenburg has written the book on patient engagement wouldn’t be quite accurate.

She has edited the book on patient engagement.

Oldenburg, principal of her own firm, Oldenburg Consulting, edited the 2013 book distributed by the Healthcare Information and Management Systems Society (HIMSS) called, Engage! Transforming Healthcare through Digital Patient Engagement. Before that, Oldenburg worked for a number of organizations including Aetna and Kaiser Permanente developing products that would engage patients through digital platforms.

In March, Oldenburg sat in on a panel at the Health IT Summit in San Francisco, presented by the Institute for Health Technology Transformation (iHT2). iHT2 has been a partner with Healthcare Informatics and its parent company, Vendome Group LLC since December of last year.

 She and a panel of experts discussed the “nexus between and among healthcare system reform, information technology strategy, and culture change.” They talked about the role of providers in communities and the types of relationships that healthcare consumers have with providers and payers.  Healthcare Informatics Senior Editor Gabriel Perna recently had a conversation with Oldenburg on patient engagement as it relates community health.

Below are excerpts from part 1 of that interview.

Why is patient engagement coming into its own? Does a lot of it have to do with meaningful use regulations or are other factors at play?

I think it’s a couple of things. Certainly to a very real degree, if meaningful use didn’t exist, we’d probably have to invent it from a patient engagement standpoint. Even though it only goes a certain distance, it takes a lot of the right first steps. So that’s got the attention of providers, large and small.

But I think the other thing that’s going on is the whole shift from volume to value. It has a huge impact on patient engagement because it brings forward the fact you have to figure out how to get patients to take care of themselves if you are going to be able to successfully care for the health of a population. I think that is the other dimension bringing a lot of focus to patient engagement right now.

Indeed, when it comes to patient engagement, people often talk about those meaningful use stage 2 requirements. But at the Summit, you were talking about a different kind of engagement with a less tangible element. What are the opportunities for patient engagement within the community?

I think it’s substantial. First of all, patient engagement is a systems problem. It’s not a one-dimensional problem. You don’t solve to do it by doing one thing right. It requires a combination of things in order to actually move the dial. That is about touch points across the system and incorporating the community into it. Think about it. Even in the healthcare system, I don’t think you get engaged patients if you don’t have engaged providers. This is part of the culture change, it’s about shifting the mentality truly toward one where providers are interested in understanding what makes patients tick, what are the things patients value, how do they think about illness and disease, and understanding enough about that person to work with him or her to develop a personalized care plan.

First of all, patient engagement is a systems problem. It’s not a one-dimensional problem. You don’t solve to do it by doing one thing right. It requires a combination of things in order to actually move the dial.

We have done care planning to patients for a long time, as opposed to with them. They are making rational decisions given their circumstances that may not look rational to us, but are based on values, circumstances, and even their level of understanding. We need to make sure we are asking them what’s working as opposed to simply dictating a plan that has nothing to do with their circumstances.

When you think about what it takes to move the dial on getting people to understand their health and work around being proactive, it’s a community effort. The doctor is a powerful source of the message, but it’s not just about that. When you think about touch points with the patients, every single one of those touch points represents an opportunity to have a different kind of interaction. Then you extend that out to the community. We know a huge amount of care for chronic disease is provided in the home, in the community; that behavior is reinforced. We now know a lot of things about how, for instance, if your friends are fat, you are more likely to be fat. We know that people are social about these things and they want to involve their communities, families, and friends. We know that when we start getting community touch points (involved) it makes a difference on how people think about their choices, how conscious they are, and what decisions they actually make.

What are the challenges in achieving this?

Figuring out how to come up with money to start the investment, so you can harvest it later is one of the things that are a very real challenge. It’s part of how incentives aren’t completely aligned in the healthcare system. We are always wrestling with some of those choices, it’s good for the system as a whole, but it may not be good in the moment for the part of the system that is initiating the change.

Who is cultivating these relationships that create a system of patient engagement within the community?