Dr. Pat Salber and Christina Hoffman

Patient engagement (PE) is healthcare’s latest buzz word. That is not to say it isn’t an important concept…it is. The difficulty is that there is no uniform definition of patient engagement, nor is there an agreed upon way in which to foster it. A recent national study sheds some light on the issue.

Presented at HIMSS15 in Chicago a few weeks ago, “Three Perspectives of Patient Engagement: A National Study” is a collaboration between HIMSS Analytics, WebMD, Medscape and M-Consulting, LLC. The study was partially funded by Genentech. [Here’s a link to my video interview with Christina Hoffman, Vice President of Quality and Strategy at Medscape about the survey.]

 

How was the study done?

Three different stakeholder groups (patients, primary care physicians (PCPs), and hospital Chief Information Officers (CIOs, really?)) were surveyed about their attitudes and beliefs around patient engagement (PE) between July and August 2014. Two thousand five hundred and sixty-seven patients who had visited their doctor within the past 90 days were asked about their expectations and values about engaging with their healthcare provider via the consumer healthcare site, WebMD; and 359 PCPs were surveyed via Medscape about their attitudes, roles, practices, and patient engagement expectations. Finally, 125 CIOs were queried, via HIMSS, about their attitudes, practices, and beliefs about PE.

 

What did they find?

The patients and the doctors agreed: Patient engagement is about relationships. Specifically, I assume, they are referring to the relationship between the doc and the patient, that we doctors fondly call “the physician-patient relationship.” CIOs, on the other hand, think that PE is—are you ready for this—about technology. Further, they believe it is driven by Meaningful Use! For them, PE is transactional (for example, the number of clicks on the patient portal). Because CIOs believe PE requires technology, they think they “own” it. The surveyed providers said that patients need to take more responsibility for their own care while patients felt that providers need to be willing to more spend time with them.

Patient Engagement summary findings from the National Survey Medscape

When it comes to barriers to patient engagement, our techie friends, the CIOs, think the problem is the attitudes and expectations of docs and patients, whereas providers and patients pointed to time demands (a.k.a., the “tyranny of the 15-minute office visit”). Further, although 69% of healthcare providers say patient engagement is effective, only 39% say it is efficient. Sixty-two percent cite “limited time after the visit to follow-up with patients” as the greatest barrier and 59% say “limited time with the patient during the clinical encounter” is the greatest problem. Physicians also feel they needed more training on communication and listening skills in order to improve the engagement.

The good news is that physicians are very positive about patient engagement with 84% saying it is beneficial and 79% and 76% saying it is part of the job and easy, respectively. Only 12.3% said, “the decision to engage patient in their own care is beyond my control.”

The most commonly used patient engagement strategy is in the arena of shared decision-making with 44% of physicians saying, “I provide my patients with the pros and cons of treatment options” and 30% saying they “gather input from the patient and their family in their treatment and care plan.” The negative: 8.4% of docs say that they “rely on other staff to engage and involve patients in their care.”

The news from the patient perspective is less positive as illustrated by the chart below:

Patient Perceptions of Patient Engagement - Medscape Survey

 

My take:

As a physician, some of the results of this survey shocked me, particularly the attitudes of the CIOs. To me, patient engagement is how the patient and the provider find ways to work together to reach the goals the patient has for his or her health. This means face-to-face time (even if it is via technology, such as telemedicine), genuine caring on the part of both parties in the dyad, and trial and error over time.

Technology can provide tools to facilitate engagement, but the tools (and whether or not they are used) is NOT engagement. Having patient portals, even if they are used, is NOT engagement. Apps, platforms, portals, and kiosks are great, but they are NOT engagement. Engagement is fundamentally about human interactions, hopefully, optimized to achieve mutual goals.

Certainly, our current fee-for-service payment model does not help foster engagement. But even employing value-based reimbursement in physician-led Accountable Care Organizations (ACOs) won’t lead to meaningful patient engagement if the human qualities of caring and compassion are missing from the relationship between the provider and the patient. These “soft skills” used to be the primary “tool” that docs had, but, somehow, its importance has become diminished as our technical capabilities have led to wonder drugs, miracle surgeries, and yes, apps, platforms, portals, and kiosks.

Patricia Salber MD, MBA (@docweighsin)
Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare.

82 COMMENTS

  1. Pat,

    Nice post! As I have written about for years now, I am absolutely convinced that truly meaningful patient engagement occurs between people – most often between a doctor and patient that trust and like each other…and have good communication skills. Health IT’s role is to support – not replace such relationships.

    Unfortunately many CIOs and health IT vendors see themselves, and not physicians or patients, as driving engagement. The god-awful results we are seeing in terms of patient adoption of Health IT-driven engagement efforts (with a few notable exceptions) is testimony to this misguided approach.

    What CIOs fail to realize is that they are taking the very same paternalistic “we know best” approach to patient engagement that physicians have employed for years with patients. Beneficent paternalism does not work anymore for physicians …and it clearly isn’t working for CIos.

    It’s time that Medical Directors, Chief Informatics Officers, Patient Experiences Offices and Patient Quality & Safety Officers and Marketing Officers to have a seat at the “patient engagement table.” The benefits of patient engagement extend far beyond Health IT’s limited Meaningful Use mentality. Patient outcomes, diagnostic testing rates, ER visits and rehospitalizations are but a few of the opportunity costs being rack up as CIO’s plod along with their provincial vision for patient engagement.

    Before physicians can take control of the engagement discussion however… they need to clean up their act beginning with their patient communication skills. I estimate that 70% of physicians still employ the same disease-focused (aka paternalistic) patient communication style they learned years ago in medical school. These physicians talk to patients simply for the purpose of reaching a diagnosis and treatment plan….not to get to know the patient behind the disease. There’ nothing engaging about that.

    What needed is a concerted effort by physician stakeholders to help physicians in their provider network learn to “think and speak patient-centered”. After all, most patients are already engaged in the health care …otherwise 83% wouldn’t be visiting their doctor every year. The real problem rather is that physicians are not very engaging in that they lack the communication skills that patients prefer and find engaging.

    By way of full disclosure… my company focuses on assessing/benchmarking physician communication skills…and in providing tailored remediation program.

    • Thanks Steve, you have been an early and consistent voice about patient engagement being what happens between a doctor and a patient. I absolutely agree that we need to have all stakeholders around the patient engagement table before we waste more time and money on unengaging patient portals, apps that no one uses, and kiosks without human beings.

  2. The problem with this whole issue is that patients want more time and physicians do not have the time… even with a new payment model their time will be limited due to the upcoming shortage. One solution is to use a “Virtual Health Assistant” that is a computer agent that acts on behalf of the physician and nurse associated with the patent as the engagement tool to “force multiply” the time of the physician. Lets face it, most of what the doc does is collect data… something that a VHA is very good at and perhaps even better at than a doc. But the doc cannot practice without the data. So a hybrid model is what is likely to be the compromise where an agent is constantly monitoring the situation and the data is fed to the doc when the doc and patient engage making everyone happy and more efficient.

    • Hi Tom, excellent suggestion to use tools to make better use of physician’s time – they need to be doing things that only a doctor can do. I just saw a study that said much of what doctors do could be done by another member of the team. Companies like yours and like Bright MD (uses algorithms) reduce the time docs spend on things like gathering routine data, etc. If we can lean physician practice, I think everyone will be happier, doctors included. Pat

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