By Ted A James, MD, MHCM, FACS
October 10, 2018
We live in a digital age of information and innovation, where technological advances continue to make accessibility and independence the norm. Health care, however, has a peculiar relationship with technology. Although we have experienced life-changing advances in medical science, health care delivery systems often fail to meet today’s expectations of convenience, transparency, and choice. Most other industries are far ahead of health care when it comes to engaging with the people they serve (e.g., Uber, Airbnb, Amazon, etc.). As a result, people are less willing to accept the delays, inconvenience, and lack of control traditionally experienced in health care. We are unlikely to succeed in achieving high-value care (i.e., greater quality, lower cost) unless our health care systems can factor patient engagement into the equation. A digital health revolution is coming, and those who prepare and are ready to adapt stand to reap the benefits.
The Power of Activated Patients
Studies suggest that patients who are well-informed, educated about their condition, and involved in their health care decisions not only have greater satisfaction of care, but also tend to have better outcomes and lower cost. The benefits are likely due to healthier lifestyle habits and adherence to treatment plans. Patients who are active participants in their own health care have fewer unplanned readmissions, medical errors, and delays in care. These patients also report having greater confidence in the health care system.
Unfortunately, rather than empowering patients in self-care, the current system leaves patients uninformed and disengaged; providing them with little to no resources, and an abundance of frustrating tasks (e.g., duplicate requests, long waits, and fragmented care). Furthermore, health care organizations and clinical practices no longer only compete with other local facilities, but face new competition on a global scale due to greater access through technology. As disruptive innovators seek to fill the gap in meeting the needs of our patients, proactive health care leaders can leverage opportunities provided through clinical innovations to achieve greater patient engagement. Ultimately, health care delivery systems that are able to better connect with and serve patients will be in a position to achieve sustainability and growth in an increasingly competitive environment.
The Future of Patient Engagement
In simple terms, patient engagement consists of a two-way interaction between clinicians and patients to improve health. In a broader context, patient engagement is a collaborative process in which patients are given the knowledge, skills, and resources to become active participants in their own health care management. This includes improved access to health information, shared decision-making, and greater connectivity with care teams. We can facilitate engagement by integrating technology into our interactions with patients. Many hospitals have already established patient portals allowing people to access their medical records, refill prescriptions, make appointments, and send messages to their doctor. This is an excellent start; however, portals themselves do not create deep engagement or encourage behavioral change. Currently, most patient engagement tools are implemented without understanding how or why patients should engage with them. Greater attention needs to be given to the user experience and interface of these technologies, striving to keep these devices relevant, simple, and seamlessly woven into patients’ daily lives. Interoperability between vendors will also be required to make real advances.
Opportunities exist to apply engagement technology in a more comprehensive and meaningful way. For example, wearables, home monitoring devices, and mobile health technology could support patients in goal setting and provide actionable patient-generated data to improve outcomes. If implemented well, 24/7 online care and sophisticated data analytics could greatly improve timely access to health services and influence healthy lifestyle choices. A growing number of patients express willingness to connect with their doctors digitally.
In the future we may see a reversal where medical records and patient portals are supplanted by robust patient engagement platforms, equipped with collaborative medical documents maintained by the patient who grants access to their health care professionals as needed. Hospitals and practices may subscribe to HIPPA-compliant patient health feeds (think Twitter) to receive real-time, patient-generated data to help manage their chronic conditions. Information from patient-reported outcomes could be uploaded to allow care teams to track patient progress and address concerns between visits. Realizing that a greater proportion of the determinants of health occur in settings outside of clinical facilities, this type of home-based wellness management may allow us to dramatically improve primary care. Instead of waiting for patients to present to the hospital, advanced algorithms could proactively identify care needs, reach out to patients, and connect them to appropriate care. A wealth of information about individuals is already available from social media, online search patterns, and the internet of things, and the technology to interpret this information is evolving rapidly.
Take home points:
As we strive to achieve meaningful and effective patient engagement, it is also important to recognize that in addition to technology, cultural change is required. To be effective, patient engagement requires physicians and other clinical professionals to take on new roles as educators, coaches, and partners with patients in collaborative care. This involves developing strategies to promote positive health behavior and techniques to ensure shared decision-making, where individualized treatment plans are shaped in accordance with patient preferences and priorities. By leveraging the power of partnership with patients and families, and understanding their journey, we can allow health care transformational efforts to be shaped from their perspective. As traditional doctor-patient paradigms give way to new roles, greater accountability will be required of patients to fulfill their part of the care management relationship.
Embracing patient empowerment, along with health technologies that support self-care, will ultimately improve our ability to interact with our patients and enhance the quality of care.
- Patient Engagement. Health Affairs Health Policy Brief, February 14, 2013.
- Chronic Care: A Call to Action for Healthcare Reform. AARP Public Policy Institute April 2009
- Patient Engagement Survey: Improved Engagement Leads to Better Outcomes, but Better Tools Are Needed. NEJM Catalyst, 2016
- Ramamurti R, Govindarajan V. Transforming Health Care from the the Ground Up. Harvard Business Review 2018
Dr. Ted James is a medical director and vice chair at BIDMC/Harvard Medical School. He is an alumnus of the Harvard Health Care Management program and is involved internationally in leadership development and health care transformation. He also teaches through the HMS Office of Executive Education.
Dr. James blogs about health care transformation. To see more of his posts, click on his name in the tags below.
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