Health care providers want their patients to have the best outcomes possible. They know that for this to happen that the patient must be engaged in managing his or her condition, whether it is an acute or chronic condition. Patients need to follow the provider’s directions and orders. If they do not, then the outcomes will be sub-par.
For instance, if you the provider give a patient a prescription then they need to have it filled and use it. Various studies have show that about 20% of all prescriptions are not filled. Without the prescription the patient is not going to “get better.” If you knew that the prescription was not filled then you could probably do something about it. However, doctors do not always find out if the prescription was filled and picked up. Unfortunately, other physician directives are sometimes misunderstood or patients choose not to follow them and the physicians will not find out in a timely manner.
Providers who are working at being patient-centered are working to improve the communication between the provider and patient. By engaging patients in meaningful dialogue better outcomes are achieved (“A National Action Plan to Support Consumer Engagement Via E-Health,” Health Affairs, February 2013). Certainly, there needs to be effective communication during a patient visit. If communication between patient and provider or a patient care coordinator is provided after the visit, then the patient engagement is extended and the outcomes are likely to be better.
Consider the following scenario. A patient newly diagnosed with hypertension comes into her physician’s office because her new medication does not seem to be helping much. She has been monitoring her blood pressure daily and not much has changed. During the visit the physician discovers that she has not been taking the medication as he has directed and as the label directs. He goes over the directions for her again carefully and then asks her to repeat them back to him so that he is sure that she understands. She does a good job of explaining the directions back to him, supplying details about when she will take them and how often.
The physician in this scenario is certainly being patient-centered during the office visit. He is engaging her effectively in this communication. He does not merely say, “Do you understand my directions?” Rather, he asks her to explain back to him what she has heard and understood. The effectiveness of the visit would be significantly improved if he had a way to communicate with the patient after the visit that was both convenient for him and for her.
Starting in January 2014 for physician offices and in October 2013 for hospitals, those providers who are a part of the EHR meaningful use program must supply patients a portal for secure email communication and provide patients with a way to view, download and transmit their health information to a third party. This may seem like huge chore for some providers but for those who are striving to become more patient-centered it is an opportunity to improve communication and improve outcomes.
Secure electronic communication will enable other patient-centered activities, according to the Health Affairs article. It will be possible for patients, especially those with chronic conditions, to give feedback on side effects of medication and on outcomes from physician directives and to leave observations about quality of life
It will take some significant restructuring of office processes to accommodate these new forms of communication. It will be necessary to have office staff trained on how to use EHR’s with secure electronic communication. Also, new processes will need to be designed and adopted so that the capabilities are efficiently used. For instance, an office team including physicians will need to determine who should monitor secure electronic feedback from patients. Patients will need to be informed and will need to know what kinds of information to provide. You certainly do not want a flood of useless information.
Another capability of electronic communication from patients is the ability to add relevant information and data to patient histories that can be used to help manage population level outcomes at a provider site. With better patient engagement and enhanced communication, population level outcomes for classes of patients, such as those with type II diabetes, should improve. Electronic communication will add another source of data and information to help the provider organization become a better learning organization.
E-health initiatives that focus on patients can improve outcomes for patients as they become more engaged in their own care. Secure email communications focusing on follow-up questions from patient or physician are a good starting point. Adding other capabilities such as long-term monitoring of chronic conditions and patient interaction with their personal records should improve the outcomes for patients and provider alike.
Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.