Guiding Patient Engagement

I spent some time over the weekend thinking about patient engagement. Specifically, how we assess the effectiveness of programs and ideally gauge the return on the investment for engagement efforts and initiatives.

There are limited resources to create and implement engagement programs, especially in light of the recent hefty investments most organizations have made in EHRs. Assessing effectiveness is crucial to assure proper allocation of limited resources.

The current best way to assess (or at least to categorize) patient engagement programs, activities, and maturity is to use the Patient Engagement Framework developed by the National eHealth Collaborative and HIMSS. The framework lays out stages of engagement, and progression of individuals through those stages. It aligns at a high level  with Meaningful Use stages (and projections of future stages.)

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Below are stages of engagement.

  1. Inform me. As it sounds, this stage is purely information and mostly generic. There is some specification at the level of medication or diagnosis for care plans, but by and large, this is generic and  pre-Meaningful Use. Printable forms also fall into this bucket. I hope that most organizations don’t see this as a major accomplishment.
  2. Engage me. This takes a slightly more interactive approach with tools for tracking data like nutrition and fitness as well as access to interactive forms for prescription refills. It’s largely transactional at this stage and not an integrated approach or platform.
  3. Empower me. As the stage name implies, this is when patients start to get some say and provide feedback as well as ratings and organizations offer patients virtual visits and secure messaging. Patients can share medical records here as well. Fortunately, at least for 14 percent of the population, this is when materials are available in Spanish.
  4. Partner with me. Taking empowerment one step further, the tools here are meant to provide self-care capabilities. Data is largely integrated at this stage and collaborative care is enabled.
  5. Support my e-community. This stage is varied if you look at all the things that are happening. The common theme seems to be around patients working together with broader care teams. Chiropractic, dental, and alternative medicine are integrated into the collaborative team model at this stage (there had to be some lobbies at the table to get this included.)

I’d be curious if any organizations are using this framework. I’ve seen some vendors map their current programs or applications to it.

The framework highlights the looseness and lack of clear definition for "patient engagement," which is all over the place, like throwing stuff at a wall to see what sticks. It looks as though it was created in an effort to capture everything that could be done with digital health data and tech-enabled services, not even exclusively for patients.

I’m all for data interoperability and care team collaboration, but I don’t think it’s patient engagement. The counter argument might be that care team collaboration makes navigating the system easier for patients and, in turn, helps keep them engaged.

Two of my favorite points are:

  • Option to share progress and health milestones on social media.
  • Guides to understanding accountable care.

If I was creating an engagement framework, I’d take a more metrics-driven approach. I wouldn’t define a 5-10 year roadmap of features and services for patients.

In the end, maybe we shouldn’t be modeling out the services and features we think patients will want 4-5 years in advance. Maybe we should instead be focused on talking to patients / consumers and providers to learn what they want and what they need. Start very small. See what features people use and how they use them, then build out additional features. Much in the same way modern tech companies and app developers track usage metrics religiously, let usage metrics for websites, portals, and messaging services drive the patient engagement decisions.

It seems backwards map it all out now. Maybe patients just want to be able to send secure messages to providers, conduct virtual visits, or go to Walgreens for a visit. Maybe they don’t care about having access to a longitudinal record of their health.

Speaking of that, why is data interoperability a part of patient engagement? Why is Meaningful Use driving — or defining, in this case — patient engagement? Maybe patient engagement shouldn’t be part of Meaningful Use. The expression “When all you have is a hammer, everything looks like a nail” is often used as an argument against the super-specialized nature of practice.

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Travis Good is an MD/MBA and co-founder of Catalyze. More about me.

  • Laura K

    Travis – great post. I particularly like your comment “..I’d take a more metrics-driven approach. I wouldn’t define a 5-10 year roadmap of features and services for patients….Maybe we should instead be focused on talking to patients / consumers and providers to learn what they want and what they need.” Like so much of our collective challenge, the answer – or access to it – is right in front of us. Bells and whistles are great, but in essence patients want access to their info, want their providers to interact with them (and not just the PC screen) during the visit, and have the ability to appropriately dialogue about their care and well being via a variety of mediums. As you said, let’s start small and measure success. Keep up the good work.

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