Patient engagement in the new healthcare needs to go beyond patient satisfaction and HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores—it's time for consumers to become active members of their care teams, according to Judy Murphy, R.N., chief nursing officer and director, Global Business Services, at IBM Healthcare.
Murphy gave a 45-minute keynote at the Marriott Downtown Hotel in New York City on June 17 as part of the New York State Chapter miniHIMSS (Healthcare Information and Management Systems Society) conference. In October 2014, Murphy became chief nursing officer and director, Global Business Services, at IBM Healthcare. Prior to that, she had been chief nursing officer and director of the Office of Clinical Quality and Safety in the Office of the National Coordinator for Health IT (ONC), from June through October 2014; while from December 2011 through June 2014, she had been deputy national coordinator for programs and policy, at ONC.
During her presentation, "The Blockbuster Drug of the Century: The Engaged Patient," Murphy said that it's time to think about patient engagement beyond traditional ways, as it's been an evolving concept over the years. "Now it's about actively being part of your care team and shared decision making," Murphy said. "I'm starting to see this new 'consumerism.' The idea of 'I'm a patient, I'm going to walk into the hospital and not know what anything will cost or what will be done to me' has to go away," Murphy said, adding that nearly half of insured Americans are on high deductible plans, compared to almost none just 10 years ago. "People want to know the cost, they want to shop. They care now," she said.
Murphy referenced the American Medical Association's (AMA) current, updated Code of Ethics, which says today that "patients share the responsibility of their own healthcare." There is an untapped demand for access and eHealth tools, she said. "We are doing lots of things, all little pilots, giving out patients portals, but we are not yet tapping into the power of using that as part of the solution," Murphy said. "But I am starting to see how the approach is changing," she added. "It's about making it easy for me to to participate in my care," referencing something she heard at a healthcare organization recently: "Know me, care for me, ease my way." As such, Murphy said that a more engaged patient could have more of an impact on healthcare than any other drug or medicine, as noted in the title of her presentation.
Murphy added that while technical solutions to interoperability are "pretty much there, the value propositions and governance structures are not. So we continue to do workarounds," she said. "EMRs are the base, though we need to build on that with mobile apps. Think of where we have come from. It's locked and loaded now, but it's time to maximize that use. Mobile and analytics are the next frontier; these are the things we need to think about beyond the EMR," she said.
All of this, Murphy continued, creates a new business model that is emerging for care delivery, providing people with more transparency and choice. The CVS's and Walmart's are emerging due to the convenience factor for people, she said. "The number one thing my mom worries about when going to the doctor is parking. Retail behaviors are now creeping in," Murphy said.
And these clinics are going beyond urgent care—there is now talk about primary care, said Murphy. "They are creating that experience and convenience that people are familiar with in other aspects of life. It's not done yet, and we don't know where it will go, but it will be a really interesting explosion worth watching," she said. She additionally brought up an interesting example of when a patient has four different doctors and goes to a pharmacy, resulting in five difference places with his or her data. "How can we aggregate it all so it becomes a patient-centric portal? That's the key moving forward," she said.
Murphy also touched on patient engagement and meaningful use during her presentation. "We are now in Stage 2, and patient engagement is one of the [measures] that everyone has complained about. It's hard because it's not just about technical solutions. There is criteria that actually says you need to tell patients to do it, and that's different than having just a technical solution available," Murphy said. "But a lot of this is about more than technology—it's about explaining, teaching, and prophesizing."
Wrapping up, Murphy gave her three "As" approach to consumer eHealth: Access, Action, and Attitude. For access, she mentioned the Office for Civil Rights (OCR), which was once getting complaints from patients who said they couldn't have access to their data because their doctors said that HIPAA (Health Insurance Portability and Accountability Act) prevented it, a comment that drew laughter from the audience. "I'm not sure what kind of HIPAA law people were looking at," said Murphy. "HIPAA modifications in fact encourage access and ensures your right to your medical information," she said.
Murphy said that the next two As, action and attitude, have little to do with technology, but are more about a shift in behavior. "It has to be done in context with trust in sources. Inviting patients in when discussing diagnoses, showing them resources, and discussing with them is what makes sense," she said. "Encouraging that behavior and modeling the trusted sites are the ways we should be doing things."
