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Getting to the Bottom of Patient Engagement

April 18, 2012
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One of healthcare’s greatest mysteries these days is patient engagement. It’s a term that’s been thrown around by providers, government agencies, insurers, and pretty much every stakeholder involved in the improvement of the industry. Yet, even though Meaningful Use Stage 2 is loaded with patient engagement initiatives, some, like David Chase, CEO of, a start-up out of Bellvue, Wash. offering patient portal solutions, are trying to get the Office for the National Coordinator of Health IT (ONC) government agency to take the requirements a step further.

Chase recently penned a blog for The Healthcare Blog and wrote up a petition, aiming to drive greater patient engagement in the healthcare community.  His argument calls for greater federal support for start-up vendors, which he says, are well-positioned to meet the patient engagement requirements for providers in Stage 2. He also argues the ONC has been inundated with complaints from large-scale vendors and providers who want to see the patient engagement requirements scaled back.

From the sound of it, this pushback is real. Just ask Healthcare Informatics Contributing Editor David Raths, who in March wrote a blog saying the most unpopular aspect of Stage 2 was the patient engagement aspect. One provider said the threshold that requires 10 percent of a provider’s patients to view their health record is not realistic. Raths also quoted Kenneth Ong, M.D., chief medical informatics officer of New York Hospital Queens, who said the patient engagement challenge seems to be the greatest for standalone hospitals.

My question is, why is patient engagement such a challenge in the first place? Why is that 10 percent threshold unrealistic? (Note: I’m not questioning this assertion from the provider-side, but just wondering why that’s the case). First and foremost, I don’t think it’s crazy to assume people will show interest in their own health. Look at websites like WebMD, which are enormously popular. There are also countless mobile apps, in a burgeoning mHealth market, designed to get patients involved with their own healthcare.

I recently spoke with Deloitte’s senior advisor for health care transformation and technology, Harry Greenspun, M.D., about the opportunities and challenges in mHealth for a two-part interview series. Dr. Greenspun and I also briefly touched upon the challenges of provider-based patient engagement during the interview. Despite the popularity of WebMD and health related web searches, Greenspun says there are no easy ways for patients to take trusted medical information (from providers, medical centers, etc.) and make the right decisions on what to do with their healthcare. Essentially, patient engagement solutions with the ease-of-use of a WebMD search, have yet to hit the mainstream market in healthcare.

Furthermore, with social media and Health 2.0 as a backdrop, Greenspun also suggested providers and other interested parties should be getting patients who are currently engaged with their healthcare involved in the process. He mentions interest in personal health records and engagement will vary for different age groups.

One reason for the pushback that is being tossed around is money and incentives. Some patients can’t afford to be “engaged,” and providers would argue that’s out of their control. For instance, it’s been said those in the rural community use lower-speed internet connections and getting on the web for health interactivity is unlikely. A recent study from The Commonwealth Fund found “patients with below-average incomes were significantly less likely to have been engaged by their regular doctor in their care.” The U.S., the study found, had the widest income-based disparity.

Others have said, while engagement is easy for a physician or a specialist in an integrated health system, what about an ambulatory doc in a standalone hospital (as Ong mentioned in Raths piece)? How does this person get their patients involved?

Like anything else in healthcare that’s relatively new, patient engagement is evolving, and the concerns surrounding it are perfectly valid. This is why it’s important to note the work of groups like the National eHealth Collaborative (NeHC), which has created a patient engagement framework. The framework is aimed at giving a wide-spectrum of providers an outline of sorts on the best methods to engage their patients. Something like this will likely be critical going forward in figuring out how providers can help patients help themselves.

The most important thing to remember is words from a recent NeHC webinar on patient engagement. Leslie Kelly Hall, senior vice president of policy at Healthwise, a patient engagement solutions provider, noted how, “We don’t yet know what a fully engaged health system with a patient will look like.” I think that can be said for everyone including providers, patients and even the federal government.