BOSTON -- Hospitals and health systems across the country have not yet seen patient engagement rise, despite next-generation electronic health record (EHR) systems and HITECH
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In its startup days, Amazon.com Inc. founder Jeff Bezos scoffed at the idea of employing old-guard booksellers helping build the business, said Frank Ingari, president of Essence Healthcare, a St. Louis Medicare Advantage plan. That's because, Ingari continued, Bezos didn't want to build a traditional bookselling business on the Web; he wanted to create a new model. His approach was validated a decade later, when Amazon overtook old-school booksellers Borders and Barnes & Noble and went on to sell goods in many different retail categories as well as electronic content such as e-books and music MP3 downloads.
In the same way, health plan patient portals could be a "game-changer" that helps pull the health care system out of its present downward financial spiral and remakes the relationship between patient and provider.
Why would Ingari say that, where other attempts to get all patients -- not just those who are chronically ill and have frequent physician visits, but the 80% of patients who are well and don't -- have failed?
Compared to personal health record (PHR) services, portals not only give patients access to accurate, constantly updated health data but also a direct line to staffers at their doctors' offices.
"Google and Microsoft's approach were completely wrong, because they depended on user-inputted data. I don't need a portal to do that, I could write that down on a piece of paper," Ingari said after his presentation. "It needs to be connected to the health care system, and it has to have the same reliability of information that a doctor would expect….You have to be able to do scheduling, you have to be able to get the letter from the doctor on test results, and be able to see the test results. It has to be a trusted relationship between you and the provider community, not a toy you plug your pedometer into."
Docs, hospitals spur patient engagement
Getting patients on board, however, isn't just an "if you build it, they will come" proposition. Nancy Finn, patient advocate, blogger and author of e-Patients Live Longer, said it's on the providers to get patients started on portals. She gets her health care at Massachusetts General Hospital, which she says offers a robust patient portal.
Google and Microsoft's approach were completely wrong, because they depended on user-inputted data. I don't need a portal to do that, I could write that down on a piece of paper.
Frank Ingari, president, Essence Healthcare
At first, Finn said, it didn't always occur to her to use it to set appointments or email her practitioners. But because MGH provided detailed, simple-to-follow instructions on using the portal and the provider constantly reminded her to go there first, it became natural after a while.
"Once the patient experiences it -- and the speed with which they receive a response -- it's amazing, it's a no-brainer," Finn said in an interview with SearchHealthIT.com, adding that patients, over time, will figure out that time-consuming tasks such as getting specialist referrals, ordering prescription renewals and accessing lab test results take much less time online instead of via phone and fax. "But it takes a leap of faith on the part of the patient to feel comfortable doing that."
Finn concluded by saying she feels that smartphones will also speed patient portal adoption. As phone apps simplify the process of interacting with health care providers, more and more patients will see value in logging on.
Public supports patient portal, in principle
In his conference keynote, Harvard School of Public Health professor, former HIT Standards Committee co-chair and current Veterans Health Administration senior advisor for quality and safety Ashish Jha, M.D., said that, while some aspects of health IT policy might inspire debate inside the Beltway, "you can't do more mom-and-apple-pie" -- politically, at least -- than giving patients access to their clinical data.
Motivating patients to actually access their data in the outside-the-Beltway real world, though, will take some work. But new ideas such as the Department of Veterans Affairs' Blue Button initiative are beginning to prove to patients that access to health data is a useful tool as they move between providers.
"At every stage of meaningful use, [ONC is] going to try to make it easier, and it will get more robust," Jha said. "The challenge is, most patients don't want it."
That will likely change, he said, if and when the accountable care organization (ACO) become the norm in U.S. health care. Jha envisions patients needing to download their health data, Blue-Button style, in order to receive care outside of their ACO -- if, he quickly added, ACOs are willing to make that data easily available. This remains to be seen, since the commercial interests of ACOs include keeping patients within the network as much as possible.