DigitalHealth: Patient Engagement Does Not Imply Patient Empowerment

David Scher, MD, DLS Healthcare Consulting

Patient engagement is a phrase that is everywhere now. It is part of the vernacular in advocacy circles, government, health technology companies, and payers. It used to signal a new healthcare ecosystem in which the patient is more of a spotlighted consumer; where reimbursement hinges on patient satisfaction, where the shortage of physicians dictates new care paradigms, and where the cost of healthcare must decrease as well as be redirected to wellness and home care from the more expensive treatments of preventable chronic diseases and institutional care. The Center for Advancing Health defines patient engagement as “actions individuals must take to obtain the greatest benefit from the health care services available to them.”  It is defined by an active role that patients play in their own care.

According to the National eHealth Collaborative, the Five Phases of the Patient Engagement Framework consists of:

1. INFORM ME
2. ENGAGE ME
3. EMPOWER ME
4. PARTNER WITH ME
5. SUPPORT MY E-COMMUNITY

Each of these phases has a process corresponding to a stage of Meaningful Use.  They are also provider-facing, in much the same way the Patient Centered Medical Home is.  I agree fully with the framework of ‘INFORM ME’ preceding ‘EMPOWER ME’.  But the accompanying narrative (“A healthcare provider in this phase demonstrates basic levels of patient engagement with an emphasis on the use of simple tools that make healthcare more convenient and accessible. This also includes providing patients with standard forms, both printable and electronic, and information about advance directives, privacy and specific conditions.”) implies that a patient will become informed if they can use simple technology tools. I would say that the technology is a tool, not a solution to informing patients. The technology itself must be put into a framework which involves human interactions and ‘EMPOWER ME’ refers to “advanced patient engagement activities through substantive use of health IT.”  If the MU directive only requires 5% of patients to have patient portals, how substantive is it?  Do patients need to wait for this third phase to be empowered?  Should Stage 3 of Meaningful Use be a surrogate for true patient engagement?

Physicians and other providers need more than this framework to begin to engage patients. There needs to be a change in the mentality and culture of healthcare on the part of all stakeholders to empower patients before they become engaged. When my practice hired a nurse practitioner 13 years ago, referring physicians were livid that patients were seen (for routine follow-up, not consultations) by a non-physician. That culture has since changed dramatically, but took many years to do so.  Empowerment or enabling will come simply with the realization of how much one can do with lifestyle changes to improve health and maintain wellness.  This need not take years and should be independent of MU schedules and technology. Patient engagement is more  conceptually restrictive and technology-oriented than patient empowerment.  I submit that patient empowerment can come to those even unwilling or unable to use digital technologies. Without empowerment there can be no engagement. Engagement cannot be passively bestowed upon a patient because technology is available.  Patient empowerment should start in schools. Children are always seeking to become enabled in all aspects of life, and I believe that teaching them how much they can do to keep themselves well will, if done appropriately, yield huge benefits.  I applaud the efforts of the e-Health Collaborative. But we need not wait for MU to mature nor depend upon technology to have patients obtain the respect or responsibilities from others to become empowered, which only takes knowledge and a change of culture.  Patient engagement will require technology including mobile health and other tools.  there is no debate about that. Demographics and economics dictate this. I am a champion of technology.  But for technology to succeed as an integral part of patient engagement, empowerment must occur first.  Critics of engagement and empowerment will say that there are many patients and consumers who do not desire to participate in their care. I realize this and that topic is for another discussion.  The above implies to those who wish to.

David Lee Scher, MD,FACP, FACC, FHRS, is Founder and Director at DLS HEALTHCARE CONSULTING, LLC advising digital health companies and their partnering institutions, companies, and providers.He is a former cardiac electrophysiologist with over 25 years in patient care. He leverages his experiences as a major clinical trial investigator, human subject research committee chair, Medicare committee member, and medical device industry consultant and key opinion leader in advising clients on best product and business development practices and adoption of digital health technologies He travels worldwide speaking to professional organizations and the general public on topics related to remote patient monitoring and digital health. Board Certified in Internal Medicine, Cardiovascular Diseases, and Clinical Cardiac Electrophysiology, Dr. Scher was a pioneer adopter of remote patient monitoring. He was named one of the ten cardiologists to follow on Twitter and author of one of the ten best healthcare technology blogs. . He is senior medical adviser at Happtique. As chair of Happtique’s Blue Ribbon Panel, he oversees the certification process of health apps. dlschermd@digitalhealthconsultants.com

Comments

[Jonena]

David, Thanks for your post. As an e-patient advocate and somewhat savvy, empowered patient myself, I appreciate that you consider patients "worthy" of taking responsibility for their own health with the professional assistance of a Doc or NP.

I'm one of the many patients that prefers to see the NP much of the time as they are given more time to treat each patient thus allowing them more face time with each patient to listen to what is really going on with our health.

It will be interesting to see technology keeps up with the new demands of medical professionals and patients and how MU will progress or keep changing in the coming months and years.

[David Lee Scher]

Thanks, Jonena for the thoughtful comments. I don't think MU is going to be the driving force behind patient engagement. I believe it will come from patients, other technologies like apps, and forward-thinking caring providers of all types. Certainly NPs and other non-physician providers will improve patient empowerment as they have more time to spend with patients and can do more education with regards to preventive medicine. I believe that technology can 'keep up' but the tech needs to be useful to providers, mot just address regulatory concerns like MU. In addition, workflows and caregivers must be taken into consideration.

[Jonena]

David, Well now you're talking my language: Workflows and Caregivers. Improved workflows and trained caregivers are definitely now and will continue to play a vital part in the future of medical care delivery.

Additionally, I'd wager that Lean Healthcare and Organizational Development for Lean Leaders will play an even larger role in healthcare process improvement each year.