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Who’s Responsible for Patient Engagement?
By Sterling Lanier

As the Centers for Medicare & Medicaid Services weighs feedback from the public comment period of the stage 2 meaningful use proposed rulemaking, industry groups and advocates have come out of the woodwork to contest the ambitious agenda. Their main gripe? The controversial requirement that 10% of a physician’s patients view, download, and/or share their medical records. With big incentive checks riding on this level of guaranteed patient engagement, not all physicians agree that this is part of their job description, begging the question whose responsibility is patient engagement?

Taking a step back and looking at healthcare reform more broadly, we can see that roles are changing. New models of accountability, such as accountable care organizations (ACOs), are making physicians weigh the cost-effectiveness of treatments and test orders. Patients are growing empowered and independent through telemedicine and remote monitoring. And payers are rewarding healthy patient behaviors and good provider care through value-based incentive programs.

In this new model of care, a doctor’s job is to collaborate and design a customized care program, which will empower patients to manage their health outside the care setting. Accountability and collaboration among all parties underpin these healthcare reform efforts, making patient engagement critical for lowered costs and improved outcomes on a global scale.

Historically, HIT initiatives to engage patients have not been very successful. PHRs have seen little to no traction. And compared with the ubiquity of smartphones, mobile health engagement has been low, particularly among lower income and elderly groups. To date, these initiatives have been mostly developed with the provider in mind, seeking to capture patient data and fit the technology seamlessly into physician workflow. But little thought has been given to understanding patient culture and fitting into their workflow.

Just look at the language used. Healthcare is filled with industry jargon and acronyms that alienate patients: ACOs, HIEs, EHRs. And patient communication is riddled with medical language and confusing text, making the experience tedious and boring for them. If healthcare reform is going to stay true to the changing roles of its stakeholders, then it has to start treating patients like consumers, just like in every other industry. That means talking to them in their own language on their own terms.

But appropriate language alone is not enough. To get patients engaged remotely, there needs to be an introduction to the technology ahead of time. Without being exposed in the care setting, where providers and patients can work together to define a context for using the technology, there’s little chance that patients will actually check it out at home, in line with the meaningful use stage 2 rules. It is my belief that when patients are comfortable with technology in front of their doctor, they’ll be more likely to engage with it at home—as long as it appeals to them and meets their needs.

At Tonic Health, patient engagement is the foundation for more robust data capture and stronger physician-patient collaboration. Our model of visually appealing and contextual graphics, combined with simplified language, is just one way to accomplish this. But the issue with the patient engagement clause in the meaningful use stage 2 rules is much more ideological than it is technical. And the important point is that no matter what technology is in place, it should serve as a vital element of the care program and a valuable source of information both inside and outside the care setting.

Patient engagement is the responsibility of all stakeholders in the healthcare community, including providers, payers, and—of course—patients. Without engaging patients in their health data and soliciting their involvement, physicians are not empowering them to manage their own health. Only by working together through new models of accountability, collaboration, and patient engagement will improved outcomes and lowered costs really be possible.

— Sterling Lanier is cofounder and CEO of Tonic Health.