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Tech may facilitate it, but patient engagement remains clinician's job

E-Patient Dave: Plenty of IT tools promise improved patient engagement, but doctors still have some heavy lifting if they want to accomplish it.

BOSTON -- Emerging technologies such as patient portals, personal health records and doctor-patient communication tools are helping to get individuals more involved and engaged in their own care. But presenters at the Partners HealthCare Connected Health Symposium warned that providers should not get so focused on IT implementation that they forget to offer personalized interaction, a lapse that can actually interfere with patient engagement.

Dave deBronkart, a patient advocate also known as "e-Patient Dave," said that physicians need to give patients access to data in their records in order to get patients more engaged in their own care. Secure email is one option that could open lines of communication between patients and their providers. But deBronkart said that a change in culture is what's really needed to make care more of a collaboration between patients and doctors.

"This is not a new idea, and what we've been looking for is recognition from the medical establishment that something real is happening," deBronkart said. "This is an idea that's getting traction. We are succeeding in changing the conversation."

The importance of finding ways to engage patients extends beyond improving patient satisfaction. DeBronkart pointed out that a recent Institute of Medicine Report, titled Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, cited connected patients as one of the four keys to achieving better care results at lower costs.

Sue Woods, M.D., a physician in the Office of Informatics and Analytics at the Veterans Health Administration, said that making communication more bidirectional could be one of the most effective ways to improve treatment outcomes through patient engagement.

Smartphones, physicians can drive patient engagement

Today's patients have data to contribute to their own care. Many have access to applications on their smartphones and other devices that track their vital signs and specific health measures. This data can be valuable to physicians, but doctors need to be more open about bringing this data into their own records, Woods said.

We need to find ways to let this data out and it needs to become our standard of practice.
Sue Woods, M.D.physician, Veterans Health Administration

Additionally, physicians and patients should start to view the sharing of data as a standard practice. Woods compared this to taking blood pressure measures. There was a time, she said, when patients and clinicians did not expect blood pressure to be measured at every encounter, and consequently it often was not. However, both physicians and patients now view measuring blood pressure as a standard part of care. The release of data to patients should come to this point as well, she said. "We need to find ways to let this data out, and it needs to become our standard of practice," she added.

It's the people, not the technology

However, simply offering connectivity tools to patients might not be sufficient to get them to truly engage in their own care. Patricia Flatley Brennan, professor of nursing at the University of Wisconsin-Madison, said clinicians need to do a better job of understanding patients' treatment goals. Many providers get focused on the IT tools available to them and try to make everything the patient tells them conform to the terminology preloaded in their electronic health record system, she said. However, physicians might miss what's really important to the patient by taking this approach, and in the process lose a valuable opportunity to engage the patient. "We need to understand, 'Where do the patients begin?'" she added. "They begin with the observations of daily living. These may not map to some SNOMED term, but they have meaning."

Most of the time, what's important to patients has little to do with disease-specific measures, Brennan said. For example, few patients with diabetes worry about getting their A1c scores down to an acceptable level. Instead, they typically would like to be able to take fewer medications or have more energy throughout the day. Doctors, however, traditionally focus on disease-specific measures. Physicians must work to find more middle ground with their patients, she said.

This approach to patient engagement could do more than simply get patients more involved in their own care. Michael Barry, M.D., medical director at the John D. Stoeckle Center for Primary Care Innovation, said it is likely to lead to more effective decision making and better outcomes. There are many different treatment options for the majority of health conditions, he said. However, doctors typically only offer patients the option that they are most comfortable. "Only by knowing the patients' preferences for those options can we meet the goal of making the right decision for that person," he added. By opening up the lines of communication, doctors can understand patient preferences, he said.

The engagement tools currently available to physicians can facilitate this type of communication. But, the speakers agreed, they are not sufficient. While technology can advance the cause of patient engagement, its effect on doctor-patient relationship remains to be seen.

Let us know what you think about the story; email Ed Burns, News Writer or contact @EdBurnsTT on Twitter.

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