Patent Portals. PHRs, & On-line Decision-Support Tools Alone Will Not Lead To Greater Patient Engagement

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Patient engagement is getting a lot of attention these days, particularly in the health information technology press.   Anticipation of Stage 2 Meaningful Use criteria is certainly is driving much of the “talk.”  So too are the promises of improved patient outcomes and satisfaction associated with the adoption of patient engagement tools like EMRs, PHRs, web portals, and on-line decision support tools.

But if the mere availability of such health information technology was all there was to engagement…member use of health plan web portals, which have been around for years, would be a lot higher than they are now, e..g., often < 10% of members.

Patient Engagement Begins With The Patient-Physician Relationship Not Technology

If you were to take everything you read at face value, all physicians and hospitals need to to engage patients is patient or member web-based portal.  I guess the idea is if you build it…they will come. But there is a HUGE FATAL FLAW in that logic:

 Successful patient engagement is predicated upon the existence of a strong, trusting, mutually satisfying relationship between the patient and their physician.

Strong, trusting physician-patient relationships are becoming harder and harder to develop and maintain these days…for both patients and providers.   Poor physician communication skills, e.g., physician-directed communications, have been cited in the literature over last 30 years as a major barrier to more satisfying and productive physician-patient relationships. Poor communications also tops the list of patient complaints about their doctors.  Not surprisingly,  many patients find it easier to “get by” in an OK relationship with a primary care provider than seek a provider with a more engaging demeanor

What Are The Three Traits Patients Find Most Engaging In Their Provider?  Check out our latest White Paper

The Link Between Patient Use Of Engagement Tools And The Physician-Patient RelationshipEngagement-Relationship
So What Does A Strong, “Engaging” Physician-Patient Relationship Look Like?

Here’s my short list;

  • Patients and providers like, respect, and trust each other
  • Patients and providers are interested in and take the time to listen to where each other is coming from, e.g., their beliefs, concerns, etc.
  • There is a high degree of agreement between patients and providers as to the visit agenda, diagnosis, treatment, and self-care options.
  • Providers’ employ patient-centered communication skills

 

Imagine yourself in a relationship with a provider who simply doesn’t seem to dedicate much time or place much importance on the above traits. How likely would you be to spend your valuable time-sharing personal health information with someone who has never exhibited any interest when you attempted to share the same information in the past?

The Take Away

Don’t get so wrapped up in the promise of the latest health information technologies that you lose sight of what’s really important to patient engagement, outcomes and patient/provider satisfaction – the physician-patient relationship

That’s what I think…what’s your opinion?

If you like this post you will love my White Paper on Patient Engagement send me your email and I get you a copy.

45 Comments

  1. Pamela Owen says:

    Stephen, great article! I have been an employee benefits consultant for 20+ years. I have felt like the voice in the wilderness trying to explain to employers why managed care networks, cost shifting and wellness plans will not work as they are currently deployed. Data analytics must be used to build Value-Based plans that support physician/patient engagement. The ‘Medical Home’ facilitates this engagement. Then, and only then, will wellness initiatives begin to be embraced, but even then they must be personal and interactive with the physician. Thanks!

  2. I think I must jsut be a low tech guy. Tech can aid the Physcian Patient relationship but will not establish it. Reforming our financial models to provide for an adequate amount of time to discuss problems and get buyin to the treatemtn plans and even an understanding of the problems and trweatment goals are the primary needs of our system. I’m afraid that soon our wonky friends will realize they have wasted a lot of effort to not achieve very much meaningful use.

  3. Jan Berger MD, MJ says:

    I agree with a number of things that have been said, to a point. I am a firm believer in the patient-physician relationship. That being said, doctors are not trained nor do they have the time to give everyone of their patients to address preventative, acute, and chonic issues. Technology needs to support some of these interactions. I do a great deal of work in supportive technology such as automated support communications. If we could convince doctors that they (we) cannot do it all well, nor should we, everyone would be better off.

    • I believe that given a strong physician-patient relationship, health information technology has the capacity to significantly improve patient outcomes, qualiuty and the overall patient experience. Absent such a relationship, patients simply will see technology as just another way for the physician to keep an arm’s length relationship with them…as well as puch more of “their” repsponsibilities on to patients.

  4. southern doc says:

    Excellent, excellent post, and good comments. As we move rapidly into an industrial-corporate version of health care, everything is geared towards devaluing the patient-physician relationship (I would include the NCQA version of the medical home in that). A few of us are going against the tide, but I fear we’re fighting a losing battle.

  5. The battle is not lost but reasonable voices must rise and turn the tide……Too much politics but they can be changed

  6. T. LaRosa-Fernandez, M.D. says:

    I am a firm believer and advocate of patient-physician engagement, have been trained to do so and and always look for the time to be able to give my patients the needed emphatic interaction to enable them to understand and be compliant with my medical management. But of course I also welcome the help current technology will give us both with how we deal with the issues confronting them. More often than not it does help enhance our patient physician relationship.

  7. Ian Worden, MBA, MHI, PMP says:

    I agree with your premise that simply making information available and accessible will not necessarily lead to more or better patient engagement. I also support the idea that a strong patient/provider relationship is an important variable of promoting patient engagement. However, true patient engagement which I define as “a person’s active participation in managing their health in a way that creates the necessary self-efficacy to achieve physical, mental and social well-being,” requires more than information and strong patient/provider relationship. Technologies, clinical practices, behavioral sciences, and care delivery processes need to be engineered to specifically promote patient engagement. There is no silver bullet. Improving patient engagement is a complex, multidisciplinary, multifunctional endeavor. That said, building off of a strong provider/patient relationship isn’t a bad focal point.

    • Ian,

      Thanks for your comments. From my perspective, engagement begins with the patient and is cultivated and facilitated by providers. Absent an interest in their health…or some particular concern, patient engagement simply cannot occur. It’s like the old expression “you can lead a horse to water but you cannot make him drink.” The providers role is limited to sharing information, which may lead to an interest/concern and eventual engagenment on the patient’s part. Similarly providers can build upon the level of engagement which motivated the patient to make and keep a doctor’s appointmnet. But absent a patient interest or concern…providers can do little to create motivation frpm nothing. It is important to realize that engagement is a two-edged sword. Just as patient-centered communication can enable and encourgae continued patient engagement, poor physician communications or a poor physician-patient experience can disengage patients.

      Steve Wilkins

  8. Nancy Riffle says:

    Neither will repetitive measuring of employee’s body metrics be enough to engage employees. Without individual follow up and health coaching behavior change will not automatically materialize.

  9. Excellent piece.Social media as seen allows engagement of patient and the doctor into a conversation.Through social media the doctor is able to express the services he or she provides.This enable patients to seek this services.

    Erick Kinuthia
    Team MDwebpro

  10. Deb Purcell says:

    Communication is the vehicle that drives engagement, turning knowledge into action that improves outcomes. Communication technology by itself is not sufficient, but is a critical element to realizing the goal. As providers are incentivized and embrace the need for strengthening long-term relationships with their patients and work increasingly in collaborative settings to support patients, they can absolutely benefit from technologies that help personalize messaging, automate and streamline delivery, leverage new channels and escalate communication.

    • Deb,

      I agree that communications technology can make it easier for providers to engage, e.g., interact, with patients. I do not agree that such technology is critical for patient engagement. Patient portals, PHRs, SMS Texting, etc. are new channels for communication and are only as effective as is the physician-patient relationship. People have been engaged in the health long before the I ternet came along…just not in the way health providers define engagement.

      You need to convince me how new communication technology will lead to greater engagement by patients with physicians who patients don’t trust, agree with, or even like. If all we do is create new communication channels for poor provider “communications” then what have we accomplished?

      • Deb Purcell says:

        My point is that it is not an either-or proposition. Again, using the vehicle analogy…when the target destination is understood, there are myriad means to reach it. You are right, the most important thing is to understand where you are trying to go, and providers are increasingly embracing their role in bringing patients along on the journey. But why continue to go by foot or bicycle, when new more effecient means are available that allow you to transport multitudes in the same time it would otherwise take to move an individual. An effective solution will enable the relationship building that you are endorsing and, if done right, improve both efficiency and effectiveness.

  11. Garry Welch says:

    Thanks for the post. I think though that it is an error to stay stuck in the old model of the physican-patient as the focus as this will be limited to modest physician skill levels regarding comunication and behavior change (this is not what they have been trained to do, unlike other team members). Better to think of using IT with a full, integrated, care team in the true medical home model and comprising: PCP and other providers, RNs and other key clinical staff, community health workers, caregivers, peers (with social media) and the patient at the center controlling the PHI access and the focus of the care plan. I think the cool technology we now have needs to be used to energize these individuals into a real team but this will only be possible with payment reform and as shift of the river of healthcare cash away from specialists and hospitals fixing broken people on a fee for service basis to global payments that promote wellness and self management, prevention, and team-based primary care.

    • Garry,

      Thanks for your comments!

      The reality is that the physician-patient relationship is the context within which the vast majority of health care is delivered…people are 10x more likely to visit their primary care phsician each year than experience a hospital stay. Poor phyician-communications, beginning in the doctor’s office, is a leading (and most overlooked) cause of poor outcomes, poor quality, patient non-compliance and low patient satisfaction

      Check out the post I did entitled Do Physicians in Patient Centered Medical Homes Communicate Any Better Than Non-PCMH Physicians – the reality is they don’t…only because the focus of PCMH is on HIT, team care, and care coordinators…with very little attention given to patient=centered communication

      .

  12. Deb Purcell says:

    Moreover, an effective communication strategy should consider thepatient’s channel preference. That is, the physician will be better able to engage the patient through the means and at the time that the patient is “listening.” Effective solutions will enable communication through all channels in an integrated fashion.

    • Communication channel is important and so is being able to tailor what is said (content) to the patient’s clinical needs as well as the their health beliefs, expectations, and part experiences.

      By the way thanks for your comments!

  13. Deb,

    Well stated. Too many purveyors of technology solutions would lead you to believe that their way is the only way to achieve engagement, empowerment, or a great patient experience…irrespective of the message.,,,or the patient’s willingness or desire to use the technology. There’s not a lot of 65+ year old health consumers “demanding” more health communication technology…and they consitute the largest users of health care services.

    I personally love technology and believe that it has a great deal of potential if used properly. But becasuse health care professionals want easy solutions…many naively believe they can simply translate their “brochureware approach” to providing patient information to their patient portal and viola they have achieved engagement. That’s not engaging…that’s plain and simply boring and in most cases irrelevant.

  14. southern doc says:

    “As providers are incentivized and embrace the need for strengthening long-term relationships with their patients”

    Seems to me like all the incentives are to weaken those relationships. The physician-patient interaction is increasingly about data collection, and the relationship aspect is delagated to other members of the “team.”

    “leverage new channels”

    What in the world does that mean?

    Thanks

  15. Ha ha…it means that like so many “false starts” in health care nothing good will likely come from it.

  16. Steve
    I agree with your last post. Tech will not establish a physican patient relationship. It will allow Physicians to reach a new generation on their terms. But to be exact, that generation knows how to use google and find information and my job is pointing them at quality sources of information and not the myriad of quacks who infest the internet. This a great discussion but we need to remember that most of “meaningful use” will be meaningless for most people and will probably further degrade the time for physician and patient interaction by filling that time with tech gadgets and emr’s. We also need to realize that much of the reason behind ICD 10 and other government interventions is to allow more data ton be available for the wonks and widgets folks to crunch and torture those of us who are trying to take care of the needs of our patients and interject themselves into the care of my patients. The law of unintended consequences always applies to any chnage and the change here will not necessarily be a good one and could be a good one.

  17. southern doc says:

    ‘that most of “meaningful use” will be meaningless for most people and will probably further degrade the time for physician and patient interaction by filling that time with tech gadgets and emr’s.’

    Amen!

  18. Kerry,
    I suggest trying to figure out how to make lemonade out of the potentail lemons being served up by ONC, etc.

    Take the issue of data you raise… I firmly believe that there is “gold in them there hills” when it comes to leveraging (in terms of increasing productivity, quality and satisfaction) the data physician practices are now or will be amassing via patient registries, EMRs and PHRs to increase incentive payments.

    I’d love to find a medical group interested in doing some serious data mining for such purposes.

    Steve

  19. Deb Purcell says:

    “Leveraging” channels means enabling greater productivity from the same effort. In the case of communication, I am referring to the ability to reach more patients more effectively in less time and at a lower cost than could be accomplished through face-to-face conversations alone. The demands on physicians are great and increasing. Employing broader care networks is part of the solution, but we all know how messages can become diluted or garbled. Tools that help all involved parties understood what has been said and help the care network to reinforece the most important communication will help. Again, a critical component is to understand when and how your audience is listening. As for seniors embracing new communication technologies, I point to cell phone use. At the recent HIMSS conference, it was mentioned that the utilization of smart phones among the senior age cohort is higher today than it was among *any* age cohort just five years ago. Availability of new communication vehicles, or channels, is both empowering and complicating. Hence the need for new strategies that consider how to best employ and integrate new tools.

  20. I agree. My point is that if all providers do is move their current physician-directed (vs. patient ecntered) patient communication style to new channels…nothing will change other than the fact that we will have more suboptimal communication that will serve to disengage rather than engage patients. We need to improve the quality of what is said as well as the channels we use to distribute the message.

  21. Changes in data that lead to prodcutivity increases are often offset by the decrease in productivity required when physicians have to enter the data. We are squeezing the balloon and when compressed in one area it bulges out in another…..
    We need fundamental changes in the “system” before meaningful use is even possible. We need to restore quality as the determiner of patient care rather than time. The first idgit who started paying physicans based on time caused the problem and now everything is centered around time and prodcutivity….its insane and right now without other reforms….lemon juice is all we have….great discussion Steve congrats

  22. southern doc says:

    How much more data entry, meaningful usage, channel leveraging, and juggling of multiple communication technologies can we expect the individual physician to do, and still leave her with the personal resources and strength to interact one-on-one with patients in the office? I don’t want to become more productive, I want to have more time to treat my patients. So far, all the IT innovations are making that more difficult, not less.

  23. Sounds like what you really need is the equivalent of a “universal TV remote” to facilitate and control all the functions you discussed. One tool to help you be able to spend more time with your patients..and very little on all the extraneous functions.

  24. Southern Doc
    What we need is basic reform of our systems and movement away from the insurance centric system we have and back to one where patients and Doctors contract and contact with each other. We spend too much time worring about checking boxes and documentation to support coding etc. And now they want us to become data entry facilitators so they can have more data to mainpulate to “help us” help from wonks is about like help from the IRS…………..Hopefully Steve will not mind me plugging my blog but I don’t really want to reinvent the wheel with my comments.

    http://tbd-consulting.typepad.com/healthcare_talent/2012/05/im-your-huckleberry-mr-president.html

  25. Garry Welch says:

    I think one way to deliver better care and reduce burn-out of docs and others working in primary care is to allow some tasks to be delegated to others without the usual turf disputes around payment and roles. So, docs must let go of the routine med changes for many of their diabetics and hand over to supervised RNs using chronic care dashboards and protocols, and the nurses let go of some of their duties to paid community health workers (such as basic self management education). I think many people in primary care are hopeful that global payments and the medical home/accountable care model really does take hold so we can break the current dysfunctional payment system. I think a lot of the comnication training we discuss here will follow if there is some cash flowing into primary care and the idea of training providers in communication skills makes perfect business sense.

  26. Garry,

    Team care is great if…

    - non-physician providers don’t overand can opt out if they don’t step their roles
    - patients accept it
    - we don’t see the same communication handoff problems in the doctor’s office that we now see in hospitals

    Steve Wilkins

  27. Thanks to ypu all for such a great discussion and exchange of thoughts.

    Steve Wilkins

  28. Garry
    Would you accept your care or the care of your family being managed by a nurse based on a protocol?

  29. southern doc says:

    “Team based care” sounds great, but the physician is still ethically and legally responsible for all the actions of her team. What this means is that the doc spends less time with patients and more time reviewing charts, signing prescriptions written by others, handling problematic pre-auths, etc.

    In the “Future of Family Medicine” documents that are the basis of the medical home movement, it is stated specifically that the doctor will have a larger patient panel and that appointments with the doctor will be shorter and more limited. Is this what any of us want? And, to go back to the original point of this thread, will that do anything to improve patient engagement?

  30. Teamcare wasn’t a part fo the orginal PCMHG concept and was added by the wonks

  31. southern doc says:

    True. It’s a way of devaluing the doctor-patient relationship (and is enthusiastically supported by the AAFP!).

  32. My wife was “pawned off” on her IM’s Physician Assistant at the time she was presenting with symptoms of Vena Cava Syndrome. My wife was complaining of “difficulty swallowing” which the PA interpreted as my wife being a “crock.”. Turns out she had a 9 centimeter medistinal tumor that was diverting her esophagus , e.g., Stage 4 Non Small Cell Lung Cancer.

    Needless to say I am not a big fan of physician extenders in diagnostic or screening roles.

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