Patient engagement solutions

Oct. 22, 2014
P. Nelson Le, M.D., Clinical Advisor, InterSystems

Since the release of Meaningful Use Stage 2 objectives, the need for patient engagement solutions has been a hot topic. The stimulus package ignited healthcare IT vendors to accelerate development of patient portals to solidify their customer base. However, despite the initial market frenzy, the adoption of patient engagement solutions has been lackluster at best. 

What went wrong? As consultants and analysts ponder why yet another “field of dreams” failed – i.e., the presumption that, “If you build it, they will come” – vendors have licked their wounds and revisited their marketing strategies, branding and messaging. Unfortunately, the real problem is that these solutions have been aimed at the wrong market. The focus should have been on the physician-patient relationship. If physicians can champion this cause, then patient engagement has a shot at success.

Historically, the physician-patient relationship was skewed toward the physician perspective, with communication limited to a one-way monologue. It wasn’t until the 1970s that medicine started to shift the focus toward the patient. This was much more than just a matter of conversation and education; it was a fundamental change in care delivery that called for more active patient involvement. Patient-centered medicine was born. 

As these models were introduced in medical curricula and became more widely accepted and adopted, the physician-patient relationship started to change as well. Patient contribution of data and opinions, and participation in the medical decision-making process, became more common. Although the concept of patient engagement long preceded the Affordable Care Act and Meaningful Use, it wasn’t until it became a mandate attached to financial incentives that it was elevated to an issue of national importance. 

So we have a patient-centered care model that is widely accepted. We have financial incentives supporting patient engagement technologies. Yet the technologies to support these efforts have met with little success. What is the reason for this disconnect? More importantly, what is the solution?

First, patient engagement solutions need to be mutually beneficial to both patients and physicians. To achieve this, these solutions need to be fully integrated with the patient’s comprehensive medical history. One of the failures of many current patient portals is that they only provide visibility into one segment of the patient record, forcing patients to access multiple portals to get all of their data. This would be akin to going to a doctor’s appointment, but only being able to ask questions about one problem, forcing patients to make multiple appointments to access complete care. Unless a one-stop shopping experience can be created for patients, where they can enter one portal and see their medical, pharmacy, laboratory, insurance and other information, patients will have little incentive to use them, and physicians are unlikely to recommend patient engagement technologies.

Second, patient engagement solutions need to be fully integrated with existing workflows and tasks. In most physician practices today, physician-patient interaction outside an office encounter is still predominantly telephone-based. Messages are triaged by a skilled nurse whose sole job for the day is addressing patient calls. Returning phone messages, playing phone tag and engaging the patient in live conversation are time-intensive tasks. Some issues are handled over the phone immediately, while others occur intermittently as the nurse chases down physicians between patient visits. Outstanding patient issues end up in a pile on a physician’s desk at the end of the day. Each message requires looking up the patient record, reviewing the history, completing the specified request and documenting the actions taken. 

This process is inefficient because there are too many unnecessary steps, and the data needed to take action is not easily accessible. The simple task of completing a prescription refill request could require multiple phone calls, messages and live interactions among nurse, physician and patient. Multiply this paradigm by 20 to 30 messages a day per physician in a clinic with four or five physicians, and the inefficiencies increase exponentially. There are two issues with this existing approach: 

  1. The need for synchronous interaction between the phone triage nurse, patient and physician; 
  2. Lack of integration between the task and the data needed to complete the task. 

The ideal solution would allow for patients and clinicians to interact asynchronously. This would mitigate wait times and decrease the turnaround time for completion of tasks. The completion cycle could even be tracked and displayed to inform the patient of his or her progress. By integrating the patient request to a comprehensive patient chart, decisions can be made faster since workflows are streamlined and efficient. Creating asynchronous pathways for completing mundane tasks frees up time for meaningful physician-patient conversations when necessary. If physicians were convinced that patient engagement solutions improved workflows for patients and physicians, they could confidently advise patients that this was the best way to get quick service on their requests.

Another benefit that patient engagement solutions can offer is the ability for patients to contribute data. This could be achieved through device integration with the patient engagement platform or direct manual entry. The obvious benefit is extending the physician-patient interaction beyond the encounter by sharing data that can impact therapeutic decision-making. Some applications of this could be response to new therapies, side effects, symptom diaries, nutrition logs and exercise regimen. Being able to log this data immediately after the event increases the accuracy of the entry. 

Example: A physician prescribes a new medication for high blood pressure management. The patient is asked to log symptoms of dizziness and record a blood pressure with each episode. Currently, most patients make mental notes of how many dizzy episodes they have and may or may not record their blood pressure. Using patient engagement solutions, a reminder could be sent to the patient’s smartphone at timed intervals to ask about dizziness. If the patient answers “yes,” there could be a prompt to perform and record a blood pressure. All of this data is logged and immediately available to the clinician. This improves the accuracy and timeliness of data capture and sharing.

As physicians, access to timely and accurate data is critical for medical decision-making. And this data not only applies to other systems such as laboratory, pharmacy and radiology, but also to patients. Unless they are prompted and reminded, it is extremely difficult to solicit feedback from patients. Oftentimes, the feedback is so delayed that the quality of care can be negatively impacted. Better data allows for better decisions. Better decisions lead to better patient care.

The question of whether physicians want their patients engaged with their health is not the issue. Physicians have championed that mission for some time. However, physicians have remained silent dissenters on the patient engagement solutions discussion. Their silence is a testimony to lackluster products that do not resonate with the clinical community. 

To garner the clinical community’s support and advocacy, the industry must focus on how patient engagement solutions benefit the physician-patient relationship and not just the patient. The goal for any vendor building a patient engagement solution is to have physicians evangelize the product to patients by saying, “This is the best way for you to get all of your comprehensive medical history in one place. This is the most convenient way for you to contact me and get a prompt reply on services you need. This is the most timely and accurate way for you to let me know how you are doing with your medications so we can collaborate on how to manage your therapy.” 

If the industry can provide a patient engagement solution that is comprehensive, convenient and collaborative, then clinicians will finally care. Until then, the industry is just lost in that magical field of dreams.

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