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Will Healthcare Clear the Engagement Hurdle?

Healthcare organizations are putting many of the pieces in place to move from a system of “sickcare” to healthcare and, in doing so, are applying technology to overcome many hurdles.  IT won’t address all the needs required for healthcare transformation – culture change within provider organizations and by patients, for example. But perhaps the biggest concern regarding the significant investments healthcare organizations are making to achieve this transformation is the areas where health IT trails so far behind the capabilities of IT in other sectors that health IT solutions will not likely catch up in the near term.

One of these areas is patient engagement.

Realizing the goals of preventive care models requires patient engagement in many forms:

Raising awareness of health risks and causes and sharing information on chronic conditions and causes

Activating individuals to manage their long-term health

Answering questions regarding treatment options and likely outcomes, along with questions regarding medication side effects and impacts on lifestyle

Tracking the progression of diagnostic parameters, biometrics, etc.

As individuals, we utilize many sources of information regarding our health, diet, chronic conditions and treatment pathways; the most commonly used are information gained from other people’s experiences, insights from our healthcare providers and information from online or published resources.  Of these three primary sources of health information, we spend the least time engaging with healthcare providers, even though many people value information from these clinicians more highly than information from other sources. At a recent healthcare event, one of the physicians speaking about engagement with individuals about their health lamented the little time he had to interact with individuals – an average of three to four hours over the course of a year.  Realistically, how can we expect the healthcare system to have a significant impact to prevent chronic disease onset when such minimal interactions are the norm, even for those seen regularly for ongoing chronic conditions?

As a result, healthcare providers are making plans to leverage technology platforms to increase contact with their patient panels, especially those at risk for disease onset or catastrophic events that could lead to hospitalization.

There are literally hundreds of solutions that offer predictive analytics that will help identify at-risk individuals.  While there is a wide range of sophistication among these solutions, based on both the algorithms used as well as the types of data analyzed, these solutions today certainly offer some benefit, and the quality of the analytics is likely to improve significantly over time. (This skims over the needed discussion of what data is integrated to support analytics to determine who is at-risk, as well as the needed move from predictive to prescriptive analytics.)

Where the outlook is not so promising is in the realm of “patient engagement” – what we do with that data once we have identified who is at risk.  There are a number of hurdles to successful interactions with at-risk individuals from the healthcare provider perspective.  A significant obstacle is the IT tools that are at their disposal to really engage with patients.  The primary tool available today to the majority of providers is the patient portal.

Over half of U.S. hospitals and nearly half of physicians possess a patient portal, normally as an added feature of their EHR.  Just a year ago, most of the providers who had patient portals available to them had not activated the portal, nor actively sought to make it available to patients. This trend is changing rapidly, as patient portals are a valuable vehicle to meet Stage 2 Meaningful Use (MU) requirements to share medical information with patients.  Beyond clicking the box to receive Stage 2 MU incentive payments, are patient portals really the answer to success in patient engagement?  Not as they exist today.

The thresholds to meet MU Stage 2 requirements are only that 5 percent of patients seen by an Eligible Professional (physicians who are accepting Medicare or Medicaid) or who are discharged from the inpatient or emergency department of an eligible hospital view, download or transmit to a third party their health information.  In any other industry, achieving only 5 percent penetration from an online customer engagement platform would be considered an abject failure.  Yet, in healthcare, providers are worried they may not be able to engage even the minimum one out of twenty patients in this way.

What does that tell us?  Either the tools are poor, the information to be accessed is not considered useful, or our interest as individuals in our own health condition is lacking.  Sadly, the answer is likely some combination of all of the above, and the solution requires a better platform; more engaging tools; content seen as relevant to individuals no matter their condition, age, gender or culture; and a change in attitude by “we the patient.”

We as consumers have adopted a break-fix approach to healthcare. We go in to see a healthcare provider only when something is wrong, and we leave it to them to fix the problem and send us on our way.  Only when we reach a high level of concern do we really engage with our care providers, and even then behavior change is hard to sustain.

Let’s leave that discussion for another day and focus here on the technology solutions supporting engagement with individuals regarding their healthcare.  For the individuals who are engaged, are patient portals the tools they will likely use to seek and find what they are looking for?  All of us as consumers, from the youngest reading this blog to the oldest, have likely encountered any number of portals and IT platforms that would be objectively rated more engaging than today’s patient portals (maybe ALL of the portals we engage with outside of healthcare would be objectively rated higher).  Other than your individual health information, all of us would likely go to other online sources to engage with healthcare content and seek information, support and interaction with others regarding our care.

As a cancer survivor and patient treated by one of the luminary healthcare provider organizations in the U.S. (who I thank greatly for the high level of care provided to me), I can say that today’s patient portals are primarily seen as valuable (by patients) only to access test results and to communicate via email directly with relevant physicians.  Beyond these simple communication channels, patient portals are not the places where individuals go to “engage” or to seek health information.  And, given our experience with other consumer-facing IT platforms, I cannot see that patient portals – at least as provided by EHR vendors – will ever close the continually increasing gap between what we have become accustomed to as consumers and what they can deliver.

The only hope for patient portals is to have the sector morph into what Frost & Sullivan Principal Analyst Nancy Fabozzi has described as “Patient Portal 2.0” – integration platforms that become the basis for bringing together the following:

An individual’s medical information from all relevant clinical sources (not a single provider, or even a single EMR platform)

A platform to search and access content from a variety of trusted sources as individuals seek health information

Engaging and interactive content that is customized to that person based on age, gender, etc.

Social networking interactions that support patient-to-patient connections

Gaming and mobile health applications

Avatars and digital health coaches that motivate and influence patients, leveraging personalized characters

Individual outreach and communication tools based on individualized preferences for communication media

Leveraging intelligent tools that can adapt, learn and support analytics, identify patterns, etc.

Support self service functions, including dynamic scheduling, prescription refills, etc.

Accessibility via a mobile device

Will patient portals evolve in this direction?  Not likely, if the market continues to be dominated by EHR vendors.  Possibly, if the current untethered patient portal vendors can step up to the plate with greatly expanded capabilities.  More likely, if more sophisticated IT vendors get involved in developing integration platforms that can bring together the strengths from a variety of other solutions in the form of content, visualization, analytics, social media, CRM, customer contact and search.

Both within and beyond the development of engaging portals, healthcare has a lot to learn from how we as consumers engage with other industries.  This will involve changing not only the IT tools healthcare organizations leverage in engagement, but also changing the culture within healthcare organizations to “walk the walk” of being patient centric.  That’s a lot of change, but it’s needed to deliver to the goals of healthcare transformation as envisioned, planned and incentivized.  Until we better align engagement with patient experiences and expectations, we will not reach the goals of preventive and collaborative care models.