Patient engagement is easy, right? Just create a portal and tell patients it’s there.

Of course, no one who puts a little thought into this idea believes it can be so simple. Healthcare isn’t “Field of Dreams,” after all. We can build it. They still might not come.

But, we still need to try and understand why, as this 2014 Health Affairs study found, the increased use of EHR technology has not created a parallel increase in electronic communication among patients and clinicians. In short, if patient portal use is an accurate indicator, how do we get patients engaged and hold their attention?


So, what is patient engagement anyway?

One key issue might be that we’re not in agreement on what patient engagement is and what it is not. Here are some examples of what experts are saying:

Richard Upton, President of UPTONGROUP writes on the KevinMD blog,

“Although highly supported by technology and its significant innovative leadership contributions, patient engagement is not an IT, HIT, regulatory, or vendor-driven initiative, but rather it is a patient-facing, patient driven strategy.”

Patient engagement, says Tom Giannulli, MD, is not the same as a patient-centric model, which would certainly employ a patient portal to enable certain tasks, but it will also do a lot more. He goes on to say, in The Health Care Blog,

“There are lots of other little things a practice can do to provide a positive experience that makes them want to come back and helps them feel more engaged in their own wellness and can even improve outcomes. This consumer-like experience is really what patients want not just a portal.”

Think, for a moment, about your relationship as a consumer with other businesses. You get order confirmations and delivery emails when you buy something from Amazon and other online retailers. Special offers and requests for feedback on your customer experience appear in your inbox. Online sites regularly upgrade functionality and user options to your benefit.

Chances are, the relationship you have with your physician resembles none of these.


The Patient as a Consumer

This enhanced idea of patient engagement often includes the concept of patient as a consumer for very logical reasons. In 21st century America, we are all consumers to a greater or lesser extent. We expect commercial enterprises to earn our business and make us feel valued. Technology simply strengthens this expectation.

But healthcare and medicine are not the same things as selling books online. The patient-as-consumer idea also divides providers, as the following examples demonstrate.

Shirie Leng, MD, writing on the KevinMD blog, says patients are not customers, offering these points:

  • Patients are not relaxed, having a good time and simply comparing available options.
  • Patients often have not chosen to buy a healthcare service and are not paying for it.
  • Patients are not buying a product from which they can demand a positive outcome.
  • The patient is not always right.
  • Patient satisfaction does not always correlate with the quality of the product.

Contrast that stance with the position of David Lee Scher, MD, who argues that, especially with the advance of healthcare IT, patient engagement means consumer engagement for five reasons:

  • Patients have choices.
  • Patient satisfaction counts.
  • All stakeholders in healthcare are looking for market share.
  • Mobile health technology success hinges on social engagement.
  • Most mobile health technologies are patient-facing.

They’re both right. I mean, look at each set of bullet points and imagine a scenario in which it is true. It’s not hard. Some patients have choices and some do not. Some have mobile health technologies, as Scher mentions, and some do not.

Sometimes we view ourselves as patients, including when we await surgery for an acute, inflamed appendix,” writes Robert Pearl, MD, in a Forbes magazine piece that effectively captures the conflicting personas we’ve all embodied at various stages in the healthcare experience. “And at other times, such as when we compare the costs and benefits of different health insurance plans, we’re clearly consumers. But most of the time we are both.”


Can we come up with one set of recommendations?

So, is it possible to come up with a universal definition and a set of recommendations for patient engagement? No, not really. The definition will depend on the provider, the facility, and the patient/client base seeking treatment/services.

Still, most providers can up their game. Hospitals and physician practices need to explain how patients can benefit from a patient portal, then make it easy to enroll in and use it. Clinicians can promote portal usage to each patient on every visit. Administrators should establish policies that define message response times, test result release times and internal processes for routing messages and responses.

Because patient portals aren’t currently wowing anybody, healthcare IT has to up its game, too. For starters, polling data shows patients want the ability to schedule appointments, pay bills, and view records online. Make that the functional starting point. In a broader sense, healthcare IT vendors also have to make EHRs and portals more straightforward and easy to use.

Think of the patient portal as a tool, because that’s all it is, in a broader patient engagement strategy. Yes, the tool has to be functional, but it also has to be used correctly.

As Shahid Shah explains in Healthcare IT News, in some ways EHRs have to resemble customer relationship management (CRM) tools (think Salesforce) and

“…support outreach, communication, patient engagement, and similar features we’re more accustomed to seeing from marketing automation systems than transactional systems.”

The comparison seems apt, especially because CRMs and other marketing and sales-enabling tools don’t close deals, they just make it easier to organize and find information, much like an EHR.

In the end, the implementation of EHRs, changes in payment models, the emergence of new concepts like medical homes and accountable care organizations are all efforts to move toward healthcare based on quality instead of services and fees. If quality is the goal, then patients are going to evaluate that quality; and in the new paradigm, you want that evaluation to be positive.

Can we engage people through the patient portal in a way that appeals to them as both consumers and patients? The lack of strategy for appealing to both personas could prove the difference between the success and failure of portals and other patient-facing technologies.

This was first published on Medsphere on 05/18/16. It has been republished here with permission from the author.

Irv Lichtenwald
Irv Lichtenwald is president and CEO of Medsphere Systems Corporation, the solution provider for the OpenVista electronic health record. He has more than 25 years experience helping technology firms evolve from the start-up phase to public markets, consistently demonstrating a strong attraction to entrepreneurial enterprises and groundbreaking ideas. Prior to joining Medsphere, he served as CFO of Advent Software, a leading provider of investment management solutions. Between 1995 and 2003, Irv led Advent through three public stock offerings. A member of the Healthcare Financial Management Association and a graduate of the University of Chicago MBA program, Irv is also a director of Teratech Corporation and a trustee of the San Francisco Ballet.


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