Common subjects frequently discussed during HIMSS 2014 were lessons learned and best practices around patient engagement. And in almost all the sessions I attended, the takeaway hasn't always been driving engagement with technology or mobile apps. In fact, out of all the recommendations and success stories, apps are just one piece of this complex, ever-changing puzzle to solve: What activates and engages patients now that it's a criterion in meaningful use stage 2?
The need for a patient engagement strategy comes from the common goal that many physicians and hospitals share around improving patient outcomes, reducing hospital readmissions and overall helping manage population health to address chronic disease.
Success stories from organizations who have implemented patient engagement initiatives and research shows the positive impact when patients are active participants in their care. Organizations such as Geisinger Health System, said its eHealth director Chanin Wendling during one HIMSS session, are seeing significant results. One Geisinger pilot saved more than $50,000 by simply texting patients reminders for their pediatric appointments and reducing the no-show rate.
The group also showed that patients enrolled in a pilot addressing weight loss dropped an extra half point in body mass index over weight-loss patients who did not participate. There were several examples of other patient engagement success stories that involved the use of portals, kiosks, mobile apps and other electronic means. However, patient engagement programs still face some unique challenges and speed bumps that could slow down progress these organizations can make.
The following are some of the top roadblocks some providers face when addressing patient engagement.
1. Too many parameters to consider when measuring patient engagement
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS, commonly referred to as "H-caps") scores are one method providers can use to gauge the level of patient satisfaction. Other organizations use benchmarks such as health outcomes improvement, hospital readmission rates, patient survey results and financial data to assess how they are performing in terms of patient satisfaction and engagement.
For entities looking to implement score cards and key performance indicators, there's no easy way to decide on a measure to use. That shouldn't stop them, however, from selecting two or more other methods based on the objective targeted.
In some of the work I have done in South Carolina's community health centers, one of the patient engagement projects involved health literacy improvements. Patients are asked about whether or not electronic patient education material and online access has provided them with a better understanding of their condition, and statistics had mixed results. There was no clear indicator as to whether those methods did provide adequate results. But even with a success rate of 15% of patients reporting feeling more in line with their care provider can be used as a positive indicator.
The initiative has helped many patients who would in some cases not take all their medications or skip doses from time to time, giving them a better understanding of the prescribed medication, as well as better accountability, and ensuring they are following their caregiver's directive. Their responses were gathered through simple surveys consisting of a few questions.
2. Assuming patient engagement means the same thing to all
I have encountered a number of exciting technologies and mHealth tools that are enabling providers to interact with their patients more frequently. This is helping patients engage with providers in many ways. But there is a set of the population for which an app or portal will not be able to fill the gap and improve communication. Some low-income families face financial challenges; others, language barriers. For still others, the lack of smartphone access simply means that there won't be a quick app fix. Providers may need to consider mobile apps, and Web portals aren't necessarily a better substitute for text messages or automated calls.
3. Skipping patient engagement at the point of care
Hospitals and medical practices tend to be very busy places. Many caregivers go from room to room to help their patient. Having to do that and document their visit can be a stressful at times. This can limit the time providers have to cover many subjects during the short period they have with a patients. A recent JAMA Internal Medicine study showed improved outcomes in patients who received individual attention at the point of care from professionals equipped with training in motivational interviewing techniques. The hospital where the study was performed saw a decrease of readmissions from 40% to 15.2%.
4. Using inadequate or out-of-context data
For the patients already using of some of the available mHealth apps or health vitals monitoring devices, their challenge lies in the lack of widespread interoperability of these devices with each other, as well as their inability to interact with EHR systems.
In order for data to become more meaningful, personal-device data streams must be viewed within the context of the patient's overall health record, which becomes even more relevant when a collaborative care team is involved in a patient's care. Several leading technology vendors and device manufacturers recognize the challenge that patients and providers face with their products and have collectively formed a nonprofit group called Continua Health Alliance, which focuses on establishing interoperability and data-sharing guidelines for sensory devices.
5. Engaging enough to satisfy meaningful use and stopping there
There are still many questions around what stage 3 would bring in terms of measures that would be required. These would play a significant role in requiring eligible providers and hospitals to address the key gaps seen right now around patient engagement.
The question still remains: Out of all the items addressed in the HIT Policy Committee's proposed meaningful use stage 3 recommendations, what measures will be selected, and will they have a meaningful impact across all population sets, or would they be a checkbox to mark off the list?
6. Ignoring the examples of Facebook and Amazon.com
When it comes to reaching out to a patient population for improved outcomes, we may need to recognize that the success of better patient outcomes and engagement differs from one group to another, and that grouping patients does not necessarily mean by income or Medicare patients versus privately insured patients, and so forth. To benefit their outcomes, patients should be grouped according to specific parameters and conditions that identify individuals, regardless of income or who insures them, whether they carry high risk of hospital readmission, or whether they lack follow-through with taking medication or getting needed tests through a care provider.
Yet addressing those risks takes different strategies for different income and insurance strata.
This makes it very hard to pinpoint the right method for the right group. But studying the evolution of traditional online sales techniques may hold the key. At first, merchants blasted everyone with fliers and coupons and then hoped for the best. Then they introduced analytics tools into the process to identify ideal prospects. Now, with evidence-based, focused marketing, the likes of Amazon and Facebook can then target specific individuals with specific ads that match almost perfectly with their needs or wants.
This evolution is beginning to see its turn within healthcare. Organizations such as Kaiser Permanente have made it very clear that they assess patients and define which ones would receive certain types of method of engagement. This helps make the engagement process customized and tailored specifically to the patients based on research and well-defined parameters, which increase the likelihood of success of the engagement portion.
Patient engagement is a two-way street: Patients and caregivers both hold the responsibility of working together effectively. While technology can assist in some ways to address and ease the way of capturing information quickly and allows for wider reach, with 24/7/365 access to portals and apps, we must also consider some of the other nonelectronic means that help providers and health organizations reach their patients and engage them in a way that would help improve their outcome, reduce care costs and help control the continuing threat that our healthcare faces with the rise chronic disease.
About the author:
Reda Chouffani is vice president of development with Biz Technology Solutions Inc., which provides software design, development and deployment services for the healthcare industry. Let us know what you think about the story; email firstname.lastname@example.org or contact @SearchHealthIT on Twitter.