Patient Engagement: A Primer

I love engaged and happy patients. It’s the long-term future of health and wellness.

Despite all the talk of patient engagement these days, I think much of the current mandated (carrot and stick) push in HIT — and corresponding IT department workload — around EMRs and eRx doesn’t advance patient engagement. Obviously there are aspects of Meaningful Use (MU) that require a small percentage of patients to access medical records and use secure messaging between patient and provider, but, that’s just the tip of the iceberg at best.

Patient engagement is the holy grail of patient care, and more appropriately, the holy grail of health and wellness. It holds immense potential because it breaks down historically confined paradigms in care, moving to more continuous care and continual thinking on the part of individuals about health and wellness.

Like all holy grails, it’s exceptionally challenging to attain. The journey to find patient engagement nirvana is still in its infancy. That said, many organizations, vendors, individuals, and funders realize the real power of patient engagement and are making strategic decisions related to patient engagement.

I’m one of those people thinking about patient engagement. When considering patient engagement strategies or planning solutions targeting engaging patients, I’ve landed on four key ideas that I believe are essential.

1. Patients don’t want — or don’t know they want — to be engaged. Said differently in startup- and funder-speak, patient engagement is not a problem that users (patients) are seeking to solve with solutions. That makes adoption and continued usage hard. Creating solutions to problems users don’t know exist is hard but possible. Pinterest, for example, grew despite people not realizing they didn’t have great options for image-based content sharing and discovery. But acquiring and engaging users is harder if the solution is not a serious problem to which the users are aware.

2. There is no “one size fits all” solution for patient engagement. I’ve written about this before. With the amount of money, time, and energy going into patient engagement strategies and tools, we’re going to see a lot of different approaches and services. Most will fail, and hopefully we’ll all learn from them. A few will succeed. Over time, we’ll likely see many different types of solutions, channels, and approaches that have some degree of efficacy in terms of cost reductions, care improvements, and overall patient satisfaction. Organizations and providers will need to incorporate multiple approaches as they try to scale patient engagement to broad patient bases.

3. Patient engagement is dependent on provider engagement. I’m know I’m a broken record with this. I’m old school in my steadfast belief in the power of the doctor-patient relationship. Providers need to care and be vested in patient engagement strategies — incorporating it into standard care — if it’s going work. Exceptions to this rule are PatientsLikeMe and Healthy Labs, but these services are tapping into clusters of patients that are already engaged, such as patients with ALS and those with Crohn’s Disease. Engaging diabetics, the holy grail of holy grails, is much, much harder. Omada Health is the best example I can think of to watch as it attempts to engage patients without engaging the provider.

4. Start very, very small. Health and wellness have mountains of problems that could be improved with more engaged patients. What we need more than anything, however, are small, targeted, and sustainable programs from which we can learn. A big long-term patient engagement strategy is great, but the immediate and critical path is the major challenge. The here and now — the tangible part — is always the hardest. The focus needs to be on getting it right very small before expanding. What I mean by small is one disease and probably one subset of the population with the disease. And in terms of targets, it’s the same. Focusing on one part of the disease, maybe nutrition, activity, or some other biometric variable. I hear about outreach programs that launch with multiple apps and devices patients that are supposed to start using. I’d be less concerned about mass generalizability and more concerned about getting it so, so right for even a very small group.

What are the common elements you’re finding or insights from exploration into patient engagement? I’d love to hear from you.

Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Mildly disgruntled

    With the word “primer” in the title, I expected more of a “how to” or “key points relevant to MU” type of content. Disappointed to find it was just some musings on the topic.

  • Until we change behavior BEFORE people become patients, I just don’t see the future of health and wellness changing. I’d prefer the millions being invested on trendy mHealth apps be spent instead on teaching the next generation how to prepare natural food instead of abusing manufactured foods. How to live a lifestyle that takes care of their bodies with moderation and exercise. We’re just treating the wrong end of the problem with “patient engagement”. I agree with you that most of these will fail – it is very fragmented. There is very little demand for mHealth. I think there is higher demand for personalized medicine but we’re headed in the wrong direction their too. Perhaps that’s where a savvy entrepreneur should spend their time.

    The government could have made a difference AND saved money by just giving every citizen a gym membership and a nutritionist. But that would require personal responsibility which is old fashioned.

  • I agree with your points Travis, especially #3. mHealth will be challenged to reach it’s full potential without a strong Patient Doctor relationship. Patient engagement will not be achieved through technology alone.

  • I have come to believe that the best way to get the physicians to change is by getting the patients to change and force the physicians to change. Here is a great example I came across in San Diego. The healthcare system tried many times over years to get their physicians to become more educated on genetics and to use more genetics tests but every attempt failed. Nationally, only 10% of physicians have ever requested a genetic test.

    So what the health system did is offered the 23andMe genetic test for free to all their patients. Then patients began to get the tests and walked into their physician’s offices with their test results and asked their doctors to explain it. This is what I call “creative tension.” It is a tension that forced physicians to become educated on genetics in a way that the healthcare system never could do from a top down approach. The bottoms up approach was much more effective.

    We see the same thing now going on with mHealth. This is NOT a physician led approach to transforming healthcare, it has been an organic and bottoms up approach. But as patients have run to adopt this it has put pressure on physicians as patients start asking their doctors which apps they should use to manage their healthcare problems.

    If you are a believer of complexity theory, which I am, you realize that complex systems, like healthcare, transform through as agents at the bottom of the system create tensions that force adaptation and transformation of the system.

  • Guest

    How many of you wondered about the purple pill?

    This has to be one of the worst examples ever Christopher. Mass marketing to patients aka pharma does work in driving patients to ask their docs about this or that test or drug with NO improvement in health care outcomes and an increase in cost.. Can you give me any examples of patients who were able to catch a disease early as the result of the “genetic testing” they received?

    yes patients are a key part of their health care team and can drive change but they are clearly easily swayed by marketing vs science.

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