Thought leaders emphasize the important of patient engagement in new healthcare delivery models such as accountable care organizations and patient-centered medical homes. It's also a key requirement for showing Meaningful Use of electronic health records. According to the NeHC announcement, the Patient Engagement Framework took into consideration the patient engagement criteria for Meaningful Use in stages 1 and 2 of the government's EHR incentive program.
A public-private partnership funded mainly by the Office of the National Coordinator of Health IT (ONC), NeHC focuses on the acceleration of nationwide health information exchange. It recently expanded its activities in the patient engagement area by creating the Consumer Consortium on eHealth, which includes over 250 organizations and individuals representing all aspects of healthcare.
The Patient Engagement Framework is the result of several months of work by more than 100 individuals in the healthcare, patient engagement, and behavioral science fields. These include members and employees of the Partnership for Women and Families, the Foundation for Informed Decision Making, Healthwise, the Long Term Post Acute Care Association, HL7, ONC's Health IT Standards and Policy Committees, and the Consumer Consortium on Health.
The framework includes several categories of increasing complexity, ranging from informing, engaging and empowering patients to partnering with patients and healthcare communities. Among the modalities of patient engagement within these categories are provider information, e-tools, forms, patient-specific education, patient access to records, and patient-generated data.
Online communications between providers and patients, for example, evolve from secure messaging in the "empower me" phase to full e-visits in the "support my community" phase.
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The framework places a striking emphasis on patient-generated data, ranging from symptom assessments and care experience surveys to shared decision making, advance directives and home monitoring data. The idea of including patient-generated data in EHRs, which is part of the framework, is only a proposal for Meaningful Use stage 3 at this point.
Nevertheless, Leslie Kelly Hall, senior VP of policy for Healthwise and a participant in the project, observed that secure messaging -- which is part of MU stage 2 -- includes a patient-generated component, and that consumers also may fill out pre-visit forms online. So the use of patient-generated data is "not unheard of," she told InformationWeek Healthcare.
The press release stated that some healthcare organizations have been very successful in engaging patients. Hall cited Dartmouth-Hitchcock in New Hampshire, and NeHC CEO Kate Berry, in an interview, mentioned Kaiser Permanente, the VA system, the Cleveland Clinic, and Bellin Health in Green Bay, Wisconsin.
NeHC's Patient Engagement Framework focuses mostly on electronic tools, which leaves out patients -- especially elderly and low-income people -- who lack computer and/or Internet access. However, Hall noted, "A lot of patients are getting access more and more to smartphones and computers in various ways -- through the library and even in their physician's office. This kind of barrier is slowly eroding. Patients get engaged as they find a need."
Another barrier to patient engagement is low health literacy. While the Patient Engagement Framework does not specifically refer to that, Hall said, "We assumed that good quality educational materials are written in plain language that's easily understood and relevant to patients' specific needs."
But do most patients really want to be engaged with their providers online? Although some surveys have found that to be true, many physicians wonder whether they will be able to get even 5% of their patients to view, download or transmit electronic health records in stage 2 of Meaningful Use.
In Berry's view, it's only a question of time and education before patients get involved in their own health on this level. Citing the popularity of online banking, travel and shopping, she said, "I don't know that everyone wanted it until it became very convenient and easy. And those things have transformed how we shop and how we travel and bank."
Today, she said, some consumers "aren't aware of how technology tools can make it easy for them to maintain or improve their health… It may require more educational and awareness building and a dialog between providers and patients to drive growth in the use of these types of tools."
Meanwhile, the Patient Engagement Framework is designed to help healthcare organizations build those efforts and measure their own performance. In partnership with HealthCAWS, NeHC has developed a business intelligence tool to help organizations evaluate the status of their consumer engagement efforts. Called the Consumer Engagement Organizational Assessment, this tool will provide customized progress reports and guidance for improving organizational strategies.
Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)