There is no app for patient engagement

Physicians, hospitals and other providers are being misled by  industry pundits claiming that more health information technology (as in EMRs, PHRs, smartphone apps, and web portals) is the key to greater patient engagement.   It’s not.

If health information technology were all that was needed to “engage” patients then  patient and member adoption rates of provider and payer web portals offering personal health records (PHRs) and electronic health records (EHRs) would not still be hovering around a disappointing 7% (with several notable exceptions Kaiser, Group Health and the VA).

Part of the misunderstanding concerning the role of HIT comes from how the discussion about patient engagement is being framed.  According to the pundits, patient engagement is the physician or hospital’s responsibility.  And like everything else these days, we can fix it if we just throw more technology at the problem. Can anyone say Stage 2 Meaningful Use requirements?

Here’s why HIT will not solve the patient engagement challenge

The role of physicians, hospitals and other providers is not so much one of needing to engage patients in their care.  Rather, providers need to “be more engaging” to patients who are already actively engaged in their health.

Take the simple act of a trip to the doctor’s office.  Before a person shows up at the doctor’s office they have to 1) have a reason or need (symptoms, a concern, chronic condition), 2) believe that the need or reason merits seeing the doctor vs. taking care of it at home themselves – this generally implies cognition and doing research, i.e., talking with friends, going on line, etc., 3) make the appointment (by calling or going online), 4) show up for the appointment, and 5) think about what they want to say to the doctor.  The point here is that by definition, people who show up for a doctor’s appointment are already engaged.

Now providers tend to not consider the patient’s perspective when it comes to engagement.  For most providers engagement means getting patients to do what providers say is in their best interest. But that approach totally dismisses the fact that patients are already engaged, just not in the same way that providers expect.

Whether patients remain engaged by the time they leave the doctor’s office, and to what extent, are the questions we should be asking.   For example, how “engaged” would readers here find it if they went to their doctor only to have the doctor 1) not ask why they are there (fears and concerns), or worse, ignore the fears and concerns which they describe to the doctor, 2) disagree with the doctor as to the visit priority and how to diagnose and treat it, including for example being prescribed medication when you don’t want to take pills, or 3) found out that you knew more about your problem and how to deal with it than your doctor?

The point is that providers need to be engaging to patients in their demeanor, attitudes, and how they talk with and listen to patients.   Doctors need to know who the patient is, what their fears, concerns and expectations are and what the patient is able and will to do.   Meaningful patient engagement, the kind that leads to long term health behavior change, begins with patient-centered, interpersonal relationships  between patients and their doctors.

As far as I know, we don’t have an app for that.

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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