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Patient Engagement: Why Now? It’s a Bit of Everything.

September 5, 2012
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Everywhere I turn lately, I see some kind of new patient engagement-centered platform being touted by vendors, providers, and/or payers. Industry people saying things like ‘we’ve got patient engagement’ seems to be the new ‘we’ve got cloud computing,’ a buzz phrase that has taken on a life of its own.

Recently, I had a conversation with Richard Ferrans, M.D., vice president and chief medical officer at Presence Health, a 12-hospital, 29-long-term care and senior residential facility organization, on a variety of topics, related to patient engagement. One of my primary questions was, why now? Why more than ever, do we see organizations trying to improve upon their patient engagement? Dr. Ferrans, who many consider a leading authority in the health IT industry, unsurprisingly had an insightful answer.

“There’s a confluence of factors, but chiefly it is around the recognition that the fee-for-service environment is giving way to fee-for-value. Under fee-for-value, physicians are going to be paid according to patients’ outcomes,” Ferrans says.

“[With patient engagement], physicians are looking at ways to influence patient contribution to their outcomes. Whereas this was always a good idea, now there is a financial incentive for people to do it. In the past, there really wasn’t a financial incentive. You could do the right thing and add costs, but not add benefit, unless you were in a risk arrangement. The risk arrangement has come to fruition at the same time, because of HITECH [the Health Information Technology for Economic and Clinical Health Act], as the rise of EMRs, setting the stage for personal health records (PHRs), makes communicating with patients on a large scale highly probable.”

I would also attribute this to a rise in interest among patients. Some may scratch their heads at this notion, but look at the Department of Veterans Affairs (VA). Recently, the VA announced its Blue Button initiative, which allows VA patients to view and download their personal health information into a single, portable file, reached one million patients. Look at Kaiser Permanente: a lot of praise has been thrown at the integrated health system for its ability to get patients to use its PHR, and rightfully so.

Of course, there are barriers. Ferrans tells me, chief among them, is the trust factor. The concerns about privacy and information security are real, he says. In addition, he says the culture in healthcare and EMRs workflows have prevented providers from getting patient emails and texts as their preferential method of contact, something that would boost engagement, he feels. “People are worried about violating HIPAA [Health Insurance Portability and Accountability Act of 1996],” he notes.  

There are also issues with certification and rapid improvement cycles. Additionally, Ferrans says, he thinks the newness of patient engagement, along with the various requirements that have come into the picture thanks to meaningful use, have over-burdened providers.

“It’s just one more thing on top of an overwhelming situation, and that distracts from the fact that this represents an enormous breakthrough, to bring patients more into equation. We know if a patient doesn’t self manage their condition; they’ll probably have a worse outcome. So it’s a good thing, it’s just coming at a stressful time.”

Stressful? Yes. Nevertheless, patient engagement is everywhere right now, because it’s coming at the right time, as Ferrans and others would say, and the VAs and Kaisers of the world would exemplify. I guess I should get used to seeing more patient-engagement platforms pop up.

I would love to hear HCI readers’ thoughts, concerns, questions in the comment section below!



I am an engaged patient. Today, I went for an appointment with a new doctor, a speciailist to whom I was referred. Through my internist's office, I have all of my medical records available to me at any time via a portal. I printed off my list of medications and my medical history, and when asked to fill out a new patient form, I showed them to the receptionist. She collected them and put them with my folder, telling me not to fill out the medication section. When I was ushered into the exam room, the nurse started asking me about my medications, so I pointed out the records to her, thinking that she could attach them to my other forms. Yet, she started to copy all of the information about my medications onto a "yellow" form. When I asked her about it, she said that she had to have them on that form, and that she had been "blessed out" for attaching such printed records. This seems ludicrous to me, that she would have to waste time copying 12 different meds and dosages just to have it all on a certain form. I was trying to make things easier and simpler. In every other way it was a good visit and the physician was very helpful for this health problem. If patients are going to be engaged in their health, then let us truly be engaged and help make things simpler. Why spend the time asking me about my meds or having me fill out papers, when I can just print them off and hand them over?

Hi there,

Thanks for your comment and I completely agree about letting patients be more engaged and allow them to help simplify the process. I bet next time you won't bother printing out your patient record, which means one less person is accessing their record, and being engaged. The whole thing is very backwards. Many health IT experts I talk to say the industry is ripe with outdated processes, and this seems to be one.


Do you think the reason for the redundancy is to verify the accuracy in the reports? There could be a liability issue involved, which seems to state a lack of confidence in the system.

You were a very considerate patient to think of the wasted time for the nurse. These types of issues are what takes away from the patient experience and the streamlining of visits to the doctor in general.