Article November 1, 2013 Patient Engagement: Five Guidelines to Prepare for Healthy Online Patient-Provider Interactions Authors ECG Management Consultants Molly Oehmichen Improving health outcomes while simultaneously reducing costs is the primary focus of U.S. healthcare reform efforts, including the 2010 Affordable Care Act. Countless studies have been completed in recent years to assess the current state of the healthcare system and identify the most valuable interventions. One such study, funded by the Agency for Healthcare Research and Quality, concluded that patient noncompliance with provider instructions and treatment plans resulted in costs to the U.S. healthcare system of $100 billion to $289 billion annually.1The key to improving patient-provider trust and patient responsibility, and therefore compliance and health outcomes, is to engage individuals more frequently and directly in their own care. Increasing engagement also improves patient satisfaction and retention. Engagement can take many forms, but due to the high costs and growing patient perception of inconvenience associated with in-person interactions, online patient engagement has emerged as a key strategy for successful healthcare organizations. Although the benefits of engaging with patients online are numerous, significant risks also exist whenever new technologies and their related work flows are adopted. Organizations should consider the following five guidelines in preparation for supporting healthy online patient-provider interactions: 1. Conduct a Readiness Assessment A new generation of patients and providers is pushing the boundaries of online interactions through social media and other platforms, but that does not mean every patient and provider is willing to share and discuss health information online. Prior to implementing an online patient engagement program, healthcare organizations should assess the readiness of specific patient populations as well as providers to manage electronic health information and engage online. 2. Increase Organizational Trust in the Patient-Provider RelationshipThe majority of patient-provider interactions still take place during a traditional office visit where the medical group or health system can dictate specific work flows, tools, and staffing. The patient’s relationship with his/her provider when centric to the brick-and-mortar clinic is well understood. Currently, only 14% of physicians report that their organization supports mobile visit scheduling, access to medical records and test results, or online payments.2 Conversely, nearly 57% of physicians surveyed said they would be interested in applications that enable them to communicate more effectively with their patients. 3 Many organizations have struggled to gain buy-in at the leadership level to support the online engagement that patients and providers are seeking due to a lack of confidence that this new framework for interaction is safe, effective, and consistent. Communication processes and technical tools can be utilized to ensure patients, providers, and administrators are comfortable with the expanded patient-provider relationship. 3. Choose the Right Components of Information to ShareMeaningful use Stage 2 requires that a broad array of standard data be made available online. However, it does not mandate that insurance, appointment, or medical history details be shared online, to name a few. Decisions regarding which data elements to share beyond required standards should be made based on the practice specialty, readiness of the patient population to receive the information, and readiness of providers to share the information. 4. Choose the Right Level of Interaction to Support Interaction describes two-way communication or sharing of information. As shown in the graphic, the level of information shared is not always correlated to the level of interaction supported. Two specific engagement objectives exist for meaningful use Stage 2: More than 5% of all unique patients (or their authorized representatives) seen by the eligible provider (EP) during the EHR reporting period view, download, or transmit their health information to a third party.A secure message was sent using the electronic messaging function of certified EHR technology (CEHRT) by more than 5% of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.These two requirements may be the most difficult objectives to achieve because, in addition to requiring organizational action, they dictate that patients actually engage online. Although these two objectives cover viewing information and sending secure messages, organizations may choose to allow more in-depth interaction in order to entice patients to access online information. Interaction levels can range from basic secure messaging to online appointment booking and eventually to live text or video chat. 5. Choose the Right TechnologyMany organizations choose a technology first and make other engagement-related decisions later. The ideal way to select an engagement-focused technology is to first determine the desired levels of information to share and interaction to allow, as described in Steps 3 and 4. In addition, thought must be given to HIPAA compliance and security, interoperability with existing systems, usability, and existing vendor relationships. The capacity to meet potential future needs, such as image sharing or video chat, is also an important factor. A technology, such as a vendor-supplied patient portal, may meet immediate requirements but fail to grow to meet future needs related to functionality, interoperability, or security. ConclusionLeading healthcare organizations are seeing appreciable and sustained results from improved patient-provider interactions, including the significant financial benefits of meaningful use attestation and competitive advantage. Online patient engagement should be approached as a significant step toward providing better patient care at a lower cost. Conducting a readiness assessment; creating standards and documentation; educating providers, staff, and patients; and making decisions on information, interaction, and technology will lay the groundwork for a successful patient engagement strategy. With a strong strategy, organizations can look forward to increasing productivity and the quality of care while decreasing costs. Footnotes 1. http://annals.org/article.aspx?articleid=1357338. 2. “Physician Adoption of Health Information Technology: Implications for medical practice leaders and business partners,” Deloitte white paper, 2013. 3. PricewaterhouseCoopers report on mobile health, http://www.pwc.com/gx/en/healthcare/mhealth/opportunities-emerging-markets.jhtml.