The Health Information Technology for Economic and Clinical Health (HITECH) Act has set aside $19 billion in incentives to encourage healthcare providers to adopt and meaningfully use electronic medical record (EMR) technology in an effort to provide more patient-centered care. This unprecedented investment in health information technology (HIT) will digitize the medical industry and connect patients to their providers electronically for the first time so they (and their families) can be more engaged in their own care.
Once connected, providers and patients can communicate using new technology in novel and exciting ways.
Patient engagement in its current form is fractured and disconnected from the healthcare team. Patients go online to research their condition after receiving a diagnosis; join online communities with similar patients to learn first-hand experiences; use care management tools, such as online calendars and health trackers, to manage their care; and must enter their medical history into an online personal health record if they want to have their own electronic copy. This requires patients to visit numerous sites and manage multiple accounts, it is not a user-friendly or an efficient experience, and the patients are not connected to their healthcare team.
With the implementation of EMRs and patient portal technology, practices can offer their patients all of these services under their own clinic’s brand. Once connected, providers and patients can communicate important health information to improve quality of care. HIT, and specifically a patient portal, will be mandated to meet HITECH requirements, new medical home models, and American College of Surgeons Commission on Cancer standards. It will be instrumental in helping practices become more efficient while providing quality care, which are fundamental objectives of accountable care organizations (ACOs) and alternative payment models.
Patient portals also offer providers the ability to engage patients in their care and to improve patient satisfaction. For example, providers can deliver physician-approved patient education from trusted experts, saving patients time and anxiety searching for it online and ensuring that they receive the right information. This service can be automated once a diagnosis is entered in the EMR, so there is no additional workload for practice staff.
One of the primary goals of HITECH is to engage patients and their families to improve care coordination. HITECH is split into 3 stages. Stage 1 includes specific rules that map directly to meeting that objective:
Stage 1 is only the start, where 2 objectives are required (“core” set) and 2 objectives are part of a “menu” set that practices must choose from to meet 5 of 10 measures. In stage 2, all patient engagement requirements move to the “core” set and must be met. In addition, the requirements for meeting the objectives increase, and additional measures regarding patient engagement will be added. Although they have already been released, the rules and measures for stage 2 will be finalized in June 2012.
Using Technology to Engage Patients in their Care Technology can enable patients to access their personal health information and provide feedback to their healthcare team, but it is what patients and providers do with that information that matters and will ultimately impact outcomes. Providers can encourage patients to track their treatment side effects in an online health journal so they can be alerted when issues arise and make interventions to reduce patient visits to the emergency department. This is an important element of emerging payer pilot programs to reduce overall healthcare costs through ACO and medical home models.
In addition, by connecting patients to their support network and to similar patients through social media tools, providers can offer psychosocial support to keep patients engaged in their care throughout their journey from diagnosis of cancer to survivorship. HIT can enable this to occur under the clinic’s brand and to be connected to the healthcare team, so patients associate these positive experiences and robust support with the practice. A third example of how HIT can engage patients in their care is using automatic electronic messages to encourage treatment adherence. A 2011 study revealed how electronic messages (SMS, audio/visual, and pagers) improved adherence to medications for patients with a chronic illness.1
Certified HIT will also give patients online, timely access to their personal health information, another meaningful use objective to engage patients in their care. A 2008 study by the Deloitte Center for Health Solutions revealed that 70% of patients want to have online access to their medical records.2 Giving patients the ability to easily review their records for inconsistencies or mistakes can prevent costly errors.
To achieve the patient engagement objectives outlined in the meaningful use rules, practices will need to implement certified EMR and patient portal technologies that connect providers to their patients so they can communicate with them as their health information is updated. This release of patient information will need to be reviewed and triggered by the clinic’s staff, which will require new routines to be adopted as part of the daily workflow. At the same time, new technology will replace inefficient processes, such as printing and mailing copies of medical records and duplicate data entry. Although the initial adoption of new technology will require some time to become part of a new routine, the time and resources saved will outweigh the initial effort.
To be able to release patient information from the EMR via a patient portal will require that disparate internal systems be connected so patient information can flow from one system to the other. Not only will internal systems need to integrate with each other, but key clinical information must also be exchanged among providers during transfer of care, as well as with different systems that are external to your practice (both meaningful use objectives). To truly engage patients, providers will need to integrate their practice management EMR and patient portal technologies so that data can be shared with patients as they are updated. In addition, the patient user interface will need to be simple and intuitive so patients can easily log on to their secure profile to access personal information and personalized resources.
Engaged Patients = Improved Outcomes
A 2012 Navigating Cancer survey revealed that 72% of patients with cancer were interested in using online tools and resources to help manage their care and recovery.3 Patients want to be more engaged in their care; 77% of patients were interested in reading cancer education materials from expert sources, and 74% of patients were interested in having access to their medical records securely online, which was consistent with survey findings from the Deloitte Center for Health Solutions.2
Surveys have also revealed that more engaged patients have better outcomes. In a 2011 study, patients suffering from depression who participated in online messaging through an EMR with their healthcare team had higher rates of treatment adherence (81% vs 61%, respectively), lower overall de pression scores, and greater satisfaction with treatment (53% vs 33%, respectively) compared with patients without online care management support.4
By digitizing personal health information, technology will enable providers to communicate with patients in new and exciting ways to encourage more patient engagement. Although technology can enable this connection and make it easier and more efficient to share critical information, it is the influence of individuals that will ultimately encourage patients to become more engaged. This can come from a patient’s care team, support network, or other patients/survivors, but to be effective, they must all be connected.
When patients are engaged, they complete the feedback loop by communicating with their healthcare team and supporters, which can be as simple as reading patient education materials or as involved as tracking side effects in an online health journal. Technology can help engage patients and providers to communicate the right information at the right time, which will lead to better quality care, improved patient satisfaction, and, ultimately, to better outcomes.
