Keywords: Patient engagement, physician-patient communication, patient-physician communication, collaborative decision making, electronic health records, EHRs, health information technology, HIT, health apps.
Citation: Finn NB. Collaboration, communication and connection: fostering patient engagement in health care. J Participat Med. 2012 Sept 5; 4:e20.
Published: September 5, 2012.
Competing Interests: The author has declared that no competing interests exist.
Engaging patients to manage and monitor their health by using health information technology seems to positively change outcomes, at least according to a recent study of more than 3,500 patients with diabetes and hypertension, conducted by Kaiser Permanente (KP). The findings of this endeavor showed that the use of secure patient-physician messaging in any 2-month period was associated with statistically significant improvements in their chronic conditions. Results included 2 to 6.5 percentage point improvements in glycemic, cholesterol, and blood pressure screening, and control.
The study, which was published in the July 2012 issue of Health Affairs, concluded that putting patients and their data at the center of care resulted in improvements in health care quality, access, and cost. Using My Health Manager, KP members sent over 850,000 secure messages to their clinicians each month of the study. The clinicians logged in nearly 3.5 million messages to their patients between January and April 2011, in email exchanges that were focused on helping those patients empower themselves and better manage their health.
There are reasons why the KP project and similar programs foster patient empowerment and engagement. The availability of a secure portal where patients communicate with their clinicians to ask those questions that they forgot to ask during their face to face visit, or address issues that come up between visits, enables them to stay connected, on top of their health issues, and out of the emergency room. The reward of getting answers quickly and easily without the frustration of telephone tag or the consumption of large amounts of time out of their busy day, encourages patients to engage more.
The concept of patient engagement — patients sharing the power and responsibility for treatment decisions with health care providers — is not new. In 2008, The National Quality Forum (NQF) declared patient and family engagement to be one of the six national priorities to eradicate disparities reduce harm and remove waste from the health care system in the United States.
Health care institutions across the country are experimenting with new ways to involve patients in their care. Columbia University Medical Center, part of New York-Presbyterian Hospital in Manhattan, created a prototype program that gave a small group of cardiology in-patients an iPad, and a proprietary app, that enabled them to access to clinical data from their electronic medical records and to see their medication history as well as detailed information about those medications. The app also enabled them to see photographs of their care providers along with the providers’ names and roles on their care team.
This pilot, conducted in March 2011, was intended to improve patient engagement in the care process right from their bed. The program was based on the premise that “the more informed the patients are, the better the outcomes will be.”
Engaging patients is a collaborative process that begins with good communication. Whether it is maintaining a healthy lifestyle, filling and taking prescribed medications, showing up for a scheduled medical appointment, or using a patient portal to schedule appointments, get referrals, access lab tests and send messages to health care providers, patients and providers need to work together to foster understanding, trust, and acceptance of each other as equally critical to the process.
The Society of Participatory Medicine has developed a Seal Program that would award a Gold Seal to patients and clinicians who meet certain criteria by working together to achieve participatory principles in health care. The criteria are as follows:
- Proactively providing patients with health data including laboratory results.
- Creating feedback mechanisms, such as Patient Advisory Councils, so that patients can provide input on their care, and giving patients resources to help them maintain and manage their health.
- Encouraging patients to be full partners on the health care team.
- Using the health data that the clinicians offer to develop health goals, maintain and follow treatment instructions and track appointments.
- Providing feedback to clinicians regarding how the care provided is working.
- Using the resources offered to better understand health issues and take a larger responsibility for health care.
- Encouraging clinicians to be participatory providers
There is a lot of work ahead. Some of the ways that patients and physicians can work on better patient engagement include the following:
Patients need to bring all their questions to an office visit with the doctor. Doctors need to listen and respond with interest and appropriate information to those questions.
Patients need to share everything that is bothering them.
Physicians need to make their patients comfortable and build a trusting relationship.
Patients need to ask for all the ways they might contact the doctor in between the face-to-face visits including email, patient portals, and online e-visits. Doctors must make themselves available while establishing the ground rules, e.g. emails are answered within 48 hours, phone calls within 24 hours.
Patients need to let the doctor know what they expect from their doctors during their office visit, and in between as well. Doctors need to be clear on what they can deliver and how their specific practice works.
The Holy Grail in medicine today is to put patients along with their data at the center of care. It takes total commitment to move in this new direction and create an environment where patients take a share of the responsibility for their care, supported by their providers. Only when we have engaged patients, encouraged by providers, will we see better quality health delivery, greater efficiency and improved outcomes.
- Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved quality at Kaiser Permanente through e-mail between physicians and patients. Health Aff (Millwood). 2010 Jul;29(7):1370-5. ↩
- A Path to Patient-Centered Care. National Quality Forum. Available at: www.qualityforum.org/Topics/Patient_and_Family_Engagement.aspx. Accessed August 23, 2012. ↩
- Vawdrey DK, Wilcox LG, Collins SA, Bakken S, Feiner S, Boyer A, Restaino SW. A tablet computer application for patients to participate in their hospital care. AMIA Annu Symp Proc. 2011;2011:1428-35. ↩
Copyright: © 2012 Nancy B. Finn. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.