Without patient participation, there is no patient engagement

Healthcare innovation companies are just beginning to understand technology challenges that come with engaging patients with chronic diseases in care management and care transition. Many of healthcare IT vendors assumed that a simple access to portals with half-baked information and  fragmented medical records will do the trick. Boy… were they wrong!

For the past twenty years, the HIT industry has focused on developing software solutions exclusively for healthcare providers. These companies understand where the money comes from. HIT executives can tell you that patients will not spend a dime on their products. The great Google Health flop was testimonial to this hypothesis.  Google, and in some extent Microsoft, naively assumed that patients are indeed interested in managing their own health data. The executives in these brilliant companies sat around large tables in large conference rooms and brainstormed about a population they didn’t know much about. They made some very false assumptions.

For example, what patient wouldn’t like to access his/her data? Wouldn’t it be great if patients could have all their data in one place? Why wouldn’t we put patients in charge of managing their own data? How about making patients the custodians of their own information? These questions were logical but uninformed. Google, and again in some extent Microsoft, ignored some fundamental behavioral traits of the patient population.

Under pressure from CMS and private insurers, healthcare organizations are being gently ushered out of the fee-for-service model into the pay-for-performance system which rewards providers for keeping patients healthy and out of hospitals. Finally, after all these years, the concept of patient-centered care model is gaining ground. Patient engagement is big contributing factor to the success of the patient-centered care model. Patient engagement means different things to different people. But whatever your definition of patient engagement might be, one thing is for certain: without patient participation, there is no patient engagement.

Facing stage 2 Meaningful Use compliancy, ICD-10 and HIPAA 5010 requirements, healthcare organizations began to put pressure on their HIT vendors to come up with patient engagement solutions. Healthcare organizations needed solutions that would enable patients to access information online. This was a disaster waiting to happen. So, the executives in these HIT companies sat around large tables in large conference rooms and brainstormed about a population they didn’t know much about. And as a result, patient portals were adopted as the solution to the patient engagement problem. They made the same false assumptions that Google made. For example, why don’t we create patient portals and connect them to our own EMR and PM systems and allow patients to access their medical records, see their lab results, make appointments online, request refills and access patient education materials? Wouldn’t that be greater? We even throw in a mobile app.

Well, here is the problem: small number of patients has access to computers and Internet. Many of these patients will not login to portals. Patients who are computer savvy require the least amount of engagement and intervention. Computer literate patients take good care of themselves, take their medications on time, make their appointments and stay out of hospitals.

Patient portals leave behind those who need engagement the most. Elderly and low-income patients with chronic diseases have the highest rate of hospital readmissions. This patient population will not touch patient portals. They do not use gadgets, do not have access to smart phones, do not have internet and do not own computers. The same is true for many behavioral health patients.  If accessing information through patient portals is our only solution to patient engagement, then shame on us.

Elderly and low-income patients are the most venerable and often left behind when it comes to the use of technology in healthcare. As HIT innovators, it is our outmost responsibility to design products that especially accommodate this patient population. We need to walk away from the concept of accessing information and start thinking about ways to deliver information and education to patients. In addition to patient portals, we must develop products that are simple, cost effective, holistic and easily available to elderly and the low-income patients. We must develop multifaceted technology solutions that connect with patients based on the best method of communication available to the patient. Our patient engagement strategy must be built on patients’ requirements, not ours. The success of the patient-centered care model on the technology side depends heavily on availability of solutions that cover patients from all walks of life without any unintentional favoritism towards certain race, gender, income and age.

Mack Baniameri is CEO, Health Business Intelligence Corp.

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  • http://twitter.com/PortiaChalifoux portia chalifoux

    Sweeping assumptions without any evidence, whatsoever, about various patient populations. This undermines the credibility of your argument and exposes your prejudices.

    Overall, this post has no utility.

  • georgemargelis

    You make some very valid points, especially about the industry players sitting around large conference tables with little or no knowledge about the population they were dealing with. I have seen that occur many times, and as one company learns the lesson the hard way another pops up to repeat the exercise.
    However I disagree that we have not made any progress nor that the population in need is in technically illiterate and unable to use the technology. The reality is, as you note, that we need to develop solutions based on the patient’a requirements, and to do that we need to experiment with multiple formats to see which is most suitable. I suspect there will not be a one type fits all model, but in fact differ by groups, and probably individuals will find solutions that suit them. This provides an opportunity for innovative companies to develop relevant solutions. Healthcare is a big market, so there are opportunities for niche solutions to be financially successful, and for people of all races colors and creeds to benefit from tools of participation, suitable for them in a heterogeneous world.

  • Maura69

    Any assumption is dangerous!

  • Denis Roscoe

    This is very interesting and pertinent. Mark you make a very good point about HITs developing software without knowing or understanding the audience that is likely to be using it. However I wonder if you are also making some assumptions.

    Firstly are you making an assumption on health care as it is currently? High number of elderly patients vs younger, non-tech savvy vs …
    2) Are you assuming that all patients are disinterested in HIT by those that you are exposed to? What about the patients that you are not?

  • http://twitter.com/Alv_Ignacio Ignacio Alvarez

    I think the major problem here is not that HIT companies are not looking at what the patient want, but they are incapable of making the different between what the patient wants and what the patient needs. For example, if today someone asks me: what do you want from the medical system? Well of course I’m going to ask for data. I want a certain control of what is happening to me and what I need to do. But is giving the same data found in a hospital EMR what the patient really needs? Of course not, he needs to understand and to be able to share with his family (this is an assumption which needs to be researched).

    Even if a lot of patient don’t have access to internet or they don’t know how to use a computer, people change their behaviors and may learn if it is simple to use and if it helps him. (sorry for my english)

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