The results of an instant audience poll on Wednesday of the audience at the Health IT Summit in Denver, sponsored by the Institute for Health Technology Transformation (iHT2, a sister organization to Healthcare Informatics under the Vendome Group umbrella), were revealing.
During the panel discussion, “Developing a Path to Patient & Consumer Engagement,” panelists asked the audience the following question: “Who is engaged in patient engagement at your organization?” Thanks to smartphone technology, audience members were able to participate in that instant poll, with the following results: 18 percent said, “Marketing”; 6 percent said, “Nursing Services”; 24 percent said, “Information Services”; and 53 percent responded, “Unique Collaboration” (meaning, a more customized approach that didn’t fit into the other categories).
Now, of course, the question could have been interpreted a few different ways, as is typical in polling situations. But how I interpreted it was this: who from your patient care organization is strategizing around patient engagement, and who is executing that strategy? (And that interpretation itself could reflect different levels of activity, and different understandings of what patient engagement looks like, of course.)
The results I’ve just referenced reflect what appears to me to be a broad set of issues and challenges in the U.S. healthcare system right now. On the one hand, the concept of patient engagement is one that’s being talked about more than ever, and indeed, a very large plurality, at least, of patient care organizations nationwide are trying to do something in this important area. And that is very good. On the other hand, in the absence of any practical, applied definition of “patient engagement,” as well as a lack of templates for action, things to be very clouded indeed. Is it patient engagement when a physician’s office tries to intensify its patient education on the individual patient level? Is it patient engagement when patients are encouraged to participate in their patient health records (PHRs)? Is it patient engagement when patients are encouraged to join social support networks, either online or in person?
And, per the instant poll conducted during the patient engagement session on Wednesday in Denver, who should be developing and executing such activities? The results of that instant poll speak to one of the core challenges, it seems: that there is no obvious, automatic locus for the strategizing, direction, or execution of patient engagement activities, either in medical groups, or at the hospital or health system level. Is patient engagement work the responsibility of the individual physician office? Of the case management nurses in the inpatient hospital? Of the marketing department? IT? One can easily see how the capabilities and involvement needed to execute on this important concept are ones that are difficult to bring together across the heavily balkanized operational silos of patient care organizations.
Ideally, as the leaders of patient care organizations move forward in developing accountable care organizations (ACOs), population health management, and care management strategies, that they will find in each organization the right locus for strategy, development, and execution around patient engagement.
One of the core problems that members of the patient engagement panel mentioned is one that should be underscored here. As Heather Haugen, Ph.D., health information technology director at the Denver-based UCHealth, put it, “We [as an industry] tend to think tactically about patient engagement, but we really need to think about it strategically.” That is particularly true in the context of another statement she made during the panel discussion Wednesday, which was that “The reason we do patient engagement is that we want to help patients, but we also want certain outcomes.”
Haugen’s point was further amplified during the discussion by fellow panelist Wayne Arvizu, telemedicine administrator in the Evans Army Community Hospital (Fort Carson, Colo.) informatics department, a facility within the Colorado Springs Military Health System. “We want the freedom to empower clinicians and the entire care team,” Arvizu said. “With regard to the clinics within our hospital, there’s been a lower level of satisfaction on the part of patients and higher acuity; but when we look at the office, and the way we empower the staff to communicate and the way families are able to access care in those communities, leads to a dramatic improvement in patient satisfaction within a couple of months. And that happens when we put full communication and a full team into this.”
What’s more, noted Colonel Kathy K. Prue-Owens, chief nursing officer at Evans Army Community Hospital, “Convenience improves both patient satisfaction and military readiness, so that the soldier doesn’t have to go so far” for care, and therefore is in a better position in terms of readiness. What’s more, she notes, “The fact is that our patients are younger people,” and therefore healthcare consumers who need a different kind of connection with their providers.
All of these comments made during Wednesday’s panel discussion—led skillfully by Al Villarin, M.D., CMIO and associate CIO at Staten Island University Hospital, a member of the NorthShore-LIJ Health System—underscored the odd combination of opportunities and challenges facing the leaders of patient care organizations when it comes to patient engagement.
On the one hand, the opportunities to create and/or enhance patient engagement are everywhere. On the other hand, it is precisely the kind of activity that patient engagement is, that falls into the cracks in between a very broad range of operational capabilities and activities in medical groups, hospitals, and health systems. Just like the personal health record (PHR), patient engagement belongs both to everyone and yet formally and explicitly, to no one. Is it care management? Well, kind of. Is it patient-physician communications? Sort of. Is it marketing? Well, it’s not marketing, exactly, but there definitely is a marketing element to it.
What is clear is that the most progressive medical groups, in particular, and especially those involved in accountable care and population health management, are pushing forward to figure out how to “do” patient engagement. There really are no templates for this, yet. But as odd and amorphous as patient engagement is as a phenomenon in healthcare, it is also something that is quite real, both as a need and as a potentiality.
Ultimately, money and policy issues will push all this forward, as employers who foot the bill for their employees’ healthcare continue to push more and more people into high-deductible health plans, and as those people begin to look more closely at what they themselves are paying more for, in their healthcare; and as the federal government and private payers push providers more and more to connect on a deeper level with their patients, finally bringing them into the care team, as has so often been talked about.
Right now, the leaders of patient care organizations are finding themselves to be extremely early in their development of functioning, successful patient engagement efforts; indeed, if one were to apply the infancy-to-old-age conceptual metaphor to the journey, one would have to say that patient care organizations are still in their infancy in this arena.
But things are beginning to happen. And over time, patient care organization leaders, at the medical group, hospital, and health system levels, are going to make progress in this important area. The light will dawn, functional templates that others can emulate, will begin to appear, and the confusion over who should do what and in what context, will eventually lift, like a morning fog. In the meantime, patient care leaders will remain eager to hear from the progress of their peers, as things move forward.