Patient Engagement Gets Going

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doc-patient_1334781275.jpg - doctor and patient
The federal government’s healthcare reform efforts have an ongoing theme of patient engagement. More and more patients are on board with data exchange, but clinicians must change long-held practices. Also, both clinicians and patients must embrace health IT to get to true patient engagement and the healthcare benefits that can be achieved.

“The government is hand and hand with the healthcare community in engaging the patient,” says Mary Griskewicz, senior director of health information systems for the Healthcare Information and Management Systems Society (HIMSS). Engaging the patient is a “value proposition for everybody.”

She cites the government’s e-Health Initiative in which organizations were asked to pledge how they would help data holders allowing users of this information become more informed and educated on the value of using health IT. There are now 400 pledges on record. HIMSS has pledged to align with the government by educating its members. HIMSS also recently created a new task force on personal health IT, she says.

One of the biggest challenges, Griskewicz says, is conveying the potential benefits of health IT to providers. Because primary care providers see a patient every 15 minutes, they need to use technology to their benefit. “We have to prove to them how these tools can improve patient care, decrease workflow challenges and reduce costs.

“The revolution that is health IT is contingent on patient demand, as well as provider acceptance and use,” Griskewicz says. “The technology is there. Now it’s a matter of consumers and providers continuing to learn to use the technology and adapt to it.”

CMIO spoke with two others leading patient engagement efforts.            

RSNA Image Share

Patients can control the sharing of their medical images and reports with their physicians and medical providers through the RSNA Image Share network. Some data suggest that as much as 20 percent of imaging studies in the U.S., are inappropriate and that unavailable images and/or reports are one of the primary causes of unnecessary repeat imaging, says David S. Mendelson, MD, chief of clinical informatics at The Mount Sinai Medical Center in New York City and member of the RSNA Radiology Informatics Committee.

The project was launched in 2009 through a $4.7 million contract with the National Institute of Biomedical Imaging and Bioengineering to build a secure, patient-centric medical image sharing network based on a common standards-based architecture that would enable patients to control access to their information through personal health records (PHRs) without relying on CDs.

Participating sites educate patients on establishing PHR accounts with selected providers enabling them to retrieve, view, archive and share images and reports, creating a detailed longitudinal medical history accessible through any secure internet connection.

“Imaging is absolutely a good gateway for patient engagement,” says Mendelson, who is principal investigator for the Image Share network. Broader efforts for PHRs have failed, he says, because they tried to bite off more than they could chew. The advantage with this network is that it involves a targeted patient group with a specific need. “If these patients have relationships with early image-enabled PHR companies, it may serve as a gateway to adding another piece of information. This is a bottom-up approach instead of top-down.”

Mendelson is working on a survey for patients who have signed up for the Image Share network, hoping to find out how they like the service, how their physicians responded to it and whether the network drives down utilization. It will take more than the 500 enrolled patients to get a handle on the answers to those questions. For now, Mendelson considers satisfaction measurements the “low-hanging fruit.”

The anecdotal response to date has been very positive, he says. He has heard patients say ‘it’s about time’ for such access. Those experiencing technical problems are referred to Mendelson and even those patients want this to work and are willing to spend the time with him to work through problems. “But we need to acknowledge that this is a self-selected group of patients who wanted it when they heard about it.”

The network effort has uncovered other opportunities, Mendelson says. For example, pediatrics provides a good playing field for this type of network because patients and their families often go back and forth between big academic, tertiary medical centers and community providers. “There is an ongoing exchange of information between hospitals and clinicians.”

“It’s very clear to me that part of the [patient] population hungers for [having access to their images and data],” he says. “The comment, ‘it’s about time’ says it all.”

One major obstacle is security and confidentiality. Mendelson says the security levels of the network are extreme—probably too extreme—so the goal is “finding a balance between safe transfer of information and ease of use. That will help more patients embrace it.”

Innovate 4 Healthcare Challenge

Another U.S. effort focusing on patient engagement is the Innovate 4 Healthcare Challenge, launched by the Center for Health Information and Decision Systems (CHIDS) at the University of Maryland’s Robert H. Smith School of Business in College Park. This nationwide initiative challenges students to develop a patient-centered, process innovation enabled by IT and with a sustainable business model to improve interaction between patients and their providers, says P. Kenyon Crowley, MBA, director of health innovation at the University of Maryland Center of Excellence in Health IT Research.

Crowley is following in the footsteps of several other health IT challenges. For example,, an online challenge platform administered by the U.S. General Services Administration, resulted in the Meducation SMART App, which processes medication lists from the patient record and then enables viewing and printing of simplified medication instructions in any of a dozen languages. The first-place winner of the U.S. Surgeon General’s Healthy Apps Challenge, Lose It!, is a mobile application and website that has helped millions of users lose more than seven million pounds since it was created in 2008. Lose It! combines a medically sound approach to weight loss, mobile technology, social networking and game dynamics to engage people to become more healthy.

The Innovate 4 Healthcare Challenge is an “opportunity to think creatively about how we can merge better processes, technology tools, and strategy to deliver solutions that seek to improve patient-provider connectivity,” says Crowley. The entries will employ technologies, such as digital platforms, smartphones, social media and remote monitoring targeting a use case such as the management of chronic conditions, exchange of information before and after acute events or major life-stage conditions, such as pregnancy.

Several factors are driving patient engagement efforts, says Crowley. For one, providers understand how important a patient engaged in his or her care is to understanding and adhering to treatment, and with the increasing adoption of EHRs, more health information is available in a digital form thereby allowing it to be more easily shared with patients and complimentary systems. Medicare and Medicaid are rewarding providers for better quality care and care coordination and this is increasing with the support of new programs such as accountable care organizations. “There is strong evidence that being more engaged and understanding how well a patient is responding to and complying with prevention and treatment reduces unexpected complications and ultimately leads to higher quality care.”

Another driver, Crowley says, is patients’ increasing comfort with sharing data online. Each state now has one or more health information exchanges in the works, and many of these organizations are developing patient engagement tools, such as PHRs hosted on the exchange.

The Innovate 4 Healthcare Challenge is the “first challenge effort to develop a health IT-enabled solution that also has a market strategy,” says Crowley. “The winning solution will have a compelling value proposition to improve health outcomes with a business model that provides for long-term sustainability.” Fifteen teams registered for the challenge in its first week.

Crowley says that making healthcare tools more fun will make them more attractive to patients. For example, “applying social gaming to health management has interesting prospects.”

Many tools already exist but he says “we have yet to see a truly breakthrough solution that can radically improve health outcomes and make the process of physician-patient engagement easy, seamless and effective.”

That’s a tall order, but we’ll see if that challenge is met when the winners are announced.