As healthcare has become more digital, it has provided more opportunities for patients to be engaged in their care, whether through patient portals or mobile apps. In the broader sense, as healthcare continues to evolve from a fee-for-service to a value-based care payment model, many healthcare leaders agree that patient engagement is going to play a critical role. The more involved and invested patients are in their own healthcare, the greater the likelihood for successful care outcomes, and this patient engagement piece is paramount as patient care organizations increasingly take on more risk.
The current picture of patient engagement activities and strategies in healthcare organizations is a mixed outlook. The Office of the National Coordinator for Health IT (ONC) reported in 2015 that about 7 out of 10 hospitals let patients view, download and transmit their own health information. A 2016 report from the American Hospital Association found that 92 percent of hospitals offer patients the capability to view medical records online.
In February, CDW Healthcare released its 2017 Patient Engagement Perspective Study to explore the drivers, challenges and influences for patient engagement and that study found that 70 percent of patients say they have become more engaged in their healthcare during the past two years, up from 57 percent in 2016. What’s more, 74 percent of patients said they joined a patient portal offered by their healthcare provider, up from 45 percent in 2016, while 69 percent said they are speaking percentage said they are accessing healthcare information more frequently.
When asked what motivated them to become more engaged with their healthcare, patients said their top two drivers were greater online access to personal healthcare records and access to online patient portals, the CDW study found.
From the provider side, the study also found that 66 percent of providers noted a change in their patients’ level of engagement with their own healthcare. Seventy-one percent of providers surveyed said improving patient engagement is a top priority for their organization, which is up from 60 percent in 2016, and 80 percent are working on a way to make personal healthcare records easier to access, a large increase from 67 percent who said the same in 2016. When examining providers’ motivating factor for patient engagement efforts, 67 percent said it was an important part of improving overall care, while 56 percent cited technology advancements and slightly more than half cited meaningful use requirements.
According to that study, patients noted that communication is key to engagement and technology is a tool that can be used to give patients access to information and expand interaction. Ninety-five percent of patients responding to the survey said they have experienced benefits from engagement with their personal healthcare information online.
However, challenges remain, as highlighted by the survey, as just 29 percent of patients said they would give their healthcare providers an “A” for their use of technology to interact with and engage patients. Additionally, a survey by NEJM Catalyst, which is part of the NEJM Group that produces The New England Journal of Medicine, found that most healthcare organizations are still in the pilot or planning stages for the next wave of patient engagement, such as using patient-generated data, social networks and wireless/ wearable devices.
When asked about the current status of patient engagement efforts among patient care organizations, Doug Thompson, senior director, research at the Washington, D.C.-based Advisory Board Company, says, “It’s better than it used to be. Traditionally, patient engagement was not something that was driven by the health system, it was something that might happen between the doctor and patient. In the last five years or so, health systems have been interested in patient engagement for a variety of reasons and they have improved it substantially. If you ask hospital and health system executives, they’ll say, ‘Yes, we need to have engaged patients, because we’re not paid for really sick patients coming into the hospitals and getting a lot of treatment, we’re paid for keeping patients well. And, if we’re going to do that, it’s essential for us to engage with the patient so they can promote their own good health and have less utilization.’ The state of the industry has improved, but it’s not fantastic.”
Considering the challenges facing healthcare leaders in their efforts to improve patient engagement, Hal Wolf, director, information and digital health strategy at the Chicago-based Chartis Group consultancy, says, “Healthcare systems are moving simultaneously towards strategies to deliver population health and personalization. Understanding that one size does not fit all is a critical learning in patient engagement. Sometimes systems are focused on the individual patient but often there is an extended support system that has to be engaged. Patient segmentation is new to healthcare, so borrowing lessons from other industries, like finance, media and retail, is critical.”
STRATEGIC PATIENT ENGAGEMENT, AND THE ROLE OF I.T.
As health system leaders develop patient engagement strategies, they need to be focused on what they are trying to accomplish and for what reason they are developing their strategy, Wolf says. Health system leaders should ask: “Which patients do they serve best? What cohort is prevalent in my market? Which short- and/or long-term relationships with patients and providers are needed? This is just the beginning of the questions that need to be asked,” Wolf notes. “Gaining a clear understanding of where their market is headed and how they want to be positioned is just as important in patient engagement as it is in every segment of customer relationships.”
As technology and IT are foundational to many patient engagement initiatives, whether patient portals or mobile apps, CIOs will need to offer their expertise in the latest patient engagement technologies.
“Patient engagement initiatives span many areas of a healthcare organization, requiring the participation and support of marketing, patient access, various clinical departments, revenue cycle and others, including IT. The IT function, led by the CIO, can be a point of integration for these stakeholders, helping them to define their goals, and working with them to design IT-enabled solutions,” Alan Perkins, a principal with The Chartis Group, says.
To this point, Wolf projects that the development of customer relationship management systems (CRMs) will become increasingly important as the expectations of personalized care and connectivity rises. He adds, “But the successful implementation of a CRM requires workflow changes across the entire organization.”
What’s more, beyond being involved in the implementation of patient engagement initiatives, the health system or hospital CIO can be a change leader, Perkins says, “staying abreast of new developments in patient engagement technology that he or she can bring to executive leadership for consideration.” He also adds, “Failing to engage in these ways puts IT at risk of being sidelined, relegated to merely the ‘nuts and bolts’ of software and hardware maintenance.”
Perkins notes, “A related challenge is understanding the unique needs which these different categories of patients have, and then designing and implementing measures to assist them. For example, for some patients, a portal that enables online bill payment and appointment scheduling may be all that is needed. For others, a smartphone app into which the patient enters their vital signs following discharge from the hospital, coupled with a process for alerting a nurse to contact the patient when those vital signs are out of expected ranges, could be an effective intervention. Different patients have different needs, and thus multiple engagement initiatives are needed.”
Thompson agrees that a “blended portal/app strategy” is needed, as portals are effective with loyal “consumers” of the health system’s services, but apps are more useful for patients who see providers at different systems.
Many clinical leaders believe that giving patients access to their health information is an easy-to-access online format can be pivotal to getting patients more engaged in their own care. At Phoenix-based Maricopa Integrated Health System, Anthony Dunnigan, M.D., chief medical information officer (CMIO), was involved in a health system-wide effort to increase patient participation in the health system’s personal health record (PHR) across its clinics and ambulatory providers. When Dunnigan joined Maricopa health system three years ago, the patient adoption rate of the PHR, which is provided by Epic’s MyCharts app, was around 9 percent, he says.
Clinical leaders worked with the IT team on a project to develop a patient sign-up process that is incorporated into the workflow of medical assistants at the clinics. In 15 months, the health system increased the patient adoption rate to 45 percent.
“The real key to the success of this project, rather it being an IT-led effort or initiative, was to get the ambulatory leadership at the very top permeating three rungs down to really make this a project led by them, and have them drive the consensus on how they were going to get the adoption accomplished via a workflow and that it was reproducible in each clinic. IT took on more of a faciliatory role,” Dunnigan says.
Thompson contends that one of the key challenges facing CIOs with regard to patient engagement initiatives is a lack of clarity on the part of clinical and operational executives as to what the health system wants. “If someone on the clinical side says ‘There is a project to engage with patients and, CIO, help us out and do something with IT to help us engage with patients,’ that’s pretty fuzzy. So, that’s one problem; they are not getting clear enough communication or priorities from their counterparts.”
He adds, “Instead, the CIO should ask ‘Tell me exactly what do you want to accomplish, what sort of conversations do you want to have, and what sort of influence do you want to have over the behavior of the consumer or patient? And, then let’s work together to figure out how IT can help you do that.”
EXPERTS URGE CIOs TO FOCUS ON THREE PRIORITIES
With regard to leveraging technology and IT for patient engagement efforts, Thompson says health system CIOs and other executive leaders should focus on three priorities. The first is establishing a simplified online consumer platform, or, essentially, to be “Amazon-like” in the ease of interaction. Second, creating a ROI for loyal consumers of the system’s healthcare services, such as reward programs or subscription-based memberships. The third priority, he says, is cultivating consumer champions by demonstrating that the health system cares about their best interests, such as offering virtual visits or a money-back guarantee program. “This includes using CRM systems as a database of information about particular consumers and what they care about, and getting to know them in a very detailed way, and giving them what they want,” he says.
There are several leading health systems that are strategically moving forward on patient engagement efforts in many of these areas. In 2015, Geisinger Health System launched its money-back guarantee program, called Geisinger ProvenExperience, to refund patients who reported a poor health care experience. In an article in NEJM Catalyst, Greg Burke, M.D., Geisinger’s chief patient experience officer, wrote that, one year after the program’s inception, the total refund request for the year was about $500,000.
Burke wrote, “Now, a year after the initiative began, we have learned that ‘making it right’ for patients following service failures has increased the amount of grievances received, has cost a relatively small amount of dollars in relation to the system’s budget, and has added to the overall process of care improvement as problems in service delivery have been discovered and addressed.”
Thompson also points to a number of other health systems that are demonstrating innovative and effective patient engagement efforts, such as Oakland, Calif.-based Kaiser Permanente, “they are doing a fantastic job of connecting with patients online”; New Orleans-based Ochsner Health System operating in southeast Louisiana, as well as several health systems that are effectively using IT to support care navigator services for patients.
Kaiser Permanente executive leaders announced last year that half of the health system’s patient visits are done virtually, whether via smartphone, videoconferencing, kiosks and other technology tools. With regard to Ochsner Health System, Thompson says, “They have a digital medicine program that engages patients to participate in their own health, so that’s patient engagement by tracking relevant indicators through digitally connected devices that the patients and consumers have in hand.”