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Why Patient Engagement Really Does Matter and Why So Many People Are Getting It Wrong

“Patient engagement.”

What is “Patient Engagement?” It sounds like a season of “The Bachelor” where a doctor dates hot patients. It wouldn’t surprise me if it was. After all, patient engagement is hot; it’s the new buzz phrase for health wonks. There was a even an entire day at the recent HIMSS conference dedicated to “Patient engagement.” I think the next season of “The Bachelor” should feature a wonk at HIMSS looking for a wonkettes to love.

Here’s how the Internets define “Patient engagement”:

The Get Well Network (with a smiley face) calls it: “A national health priority and a core strategy for performance improvement.”
Leonard Kish refers to it as “The Blockbuster Drug of the Century” (it narrowly beat out Viagra) – HT to Dave Chase.
Steve Wilkins refers to it as “The Holy Grail of Health Care” (it also narrowly beat out Viagra) – HT to Kevin MD.
On the HIMSS Patient Engagement Day, the following topics were discussed:

-How to make Patients Your Partners in Satisfying Meaningful Use Stage 2 Objectives; Case Studies in Patient Engagement, session #64;
-Review Business Cases for Implementing a Patient-Centered Communication Strategy and Building Patient 2.0, session #84;: and
-Engaging People in Health Through Consumer-Facing Devices and Tools, session #102.

So then, “patient engagement” is:

-a strategy
-a drug
-a grail (although I already have a grail)
-a “meaningful use” objective
-something that requires a business case
-something that requires “consumer-facing devices and tools” (I already have one of those too).

I hope that clears things up.

So why am I being so snarky about this? Why make fun of a term used by many people I trust and respect? I was recently discussing my ideas on a communication-centered medical record with a colleague. At the end of my pontification, my friend agreed, saying: “you are right; communication is an important part of health care.” I surprised him by disagreeing. Communication isn’t important to health care, communication is health care. Care is not a static thing, it is the transaction of ideas. The patient tells me what is going on, I listen, I share my thoughts with the patient (and other providers), and the patient uses the result of this transaction for their own benefit.

But our fine system doesn’t embrace this definition. We indict ourselves when we talk about “patient engagement” as if it’s a goal, as it reveals the current state of disengagement . Patients are not the center of care. Patients are a source of data so doctors can get “meaningful use” checks. Patients are the proof that our organizations are accountable. Patients live in our “patient-centered” medical homes.

Replacing patients as the object of our attention (and affection) is our dear friend, the medical record. We faun over medical records. Companies earn epic profits from medical records. We hold huge conferences to celebrate medical records. We charge patients money to get to see their own medical records. We even build special booths (portals) where patients are allowed to peer in through a peep hole and see parts of their medical records.

This is why I’ve had such a hard time finding a record system for my new practice. I want my IT to center on patients, but medical record systems are self-absorbed. They are an end in themselves. They are all about making records, not engaging patients. They are for the storage of ideas, not the transfer of them. Asking medical records to engage patients is like asking a dictionary to tell a story.

The problem is, documentation has taken over health care. Just as the practice of a religion can overshadow its purpose: the search for God, documentation chokes out the heart of health care: the communication of ideas . It did this because we are paid to document, not communicate. Communication takes time and it is not reimbursed. Communication prevents unnecessary care, which is a revenue stream. Communication eliminates waste, and waste is food that feeds the system, the bricks that build the wings to hospitals, the revenue source that pads IT budgets.

So what’s a doctor to do? I’m not sure. I am still looking for a solution that will meet the central goals of my practice:

Communication – health care is a hassle, with communication relegated to the exam room. I want care to be easily accessible for my patients,using IT in one of its strongest areas: tools for easy communication.
Collaboration – the patient should be engaged, but in a two-way relationship. This means they not only should have access to their records, they should contribute to those records.
Organization – I want a calendar documenting visits, symptoms, problems, medications, past and future events in each patient’s record. I also want a task-management system I share with patients to make sure care gets done.
Education – I want to practice high-quality medicine, care that is informed by good information and the best evidence. Why not do a yearly stress test? There’s evidence for that. Why not use antibiotics for sinus infections? There’s evidence there. Why use an ACE inhibitor to control the blood pressure? I need to be able to support my recommendations with data, not just “because the doctor said so.”

The point of all of this is the moving of medicine from an industry where money is milked from disease to a communications network where diseases are prevented. ”Patient engagement” that is done to the patient for the sake of the doctor or hospital is a sham. Engagement is about interaction, listening, and learning in relationship to another person. Engagement is not a strategy, it is care.

If only I could find the tools to make this happen.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind),where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.

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Kontaktget an account for instagramPatient Engagement FrameworkTameka NordykeMy Daugaard Recent comment authors
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Kontakt
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Patient Engagement Framework
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Tameka Nordyke
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Very good post. I will be going through many of theseissues as well..

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Nathan K
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I think for the most part it’s common sense. Patients are people after all. Engage them, make them feel accepted and special and they will be loyal. I know I miss this with most doctors I visit. I feel like they are looking down on me; which is unfortunate. I’d be loyal to a doctor who lets me take an active role in my health care by showing me how to…take my own blood pressure for instance or real steps to take rather than a blanket you should lose 5 or 10 lbs.

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Rose McClean
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Rose McClean

I enjoyed this article very much! I agree, patient engagement must be at the forefront of attaining meaningful use stage 2 for a successful EMR system. Healthcare practitioners need to understand and emphasize the value of patient engagement since patients are the primary stakeholders who rely on Healthcare IT systems.

Frank Hone
Guest

Entertaining but accurate assessment of how many folks see Patient Engagement. It’s as though technology and the medical record will now enable physicians to finally engage with their patients.

There is way too much emphasis on IT in this arena. The real opportunity will come into scope when healthcare is truly accountable, with proactive providers having the strategy and plan to influence their entire population toward better health and well-being.

Hayley Dunne
Guest

Great article – I agree with you on several of your points. However, regarding you wishing for a tool to help with your points not being available – I certainly believe it is. Using a downloadable smartphone application patients have the access they need to track their health before, during​,​ and after their hospital or clinic visits. Patients need to be able to take control of their own health and with 125.9 million smartphone owners in the US – this is the best (and most convenient) tool out there to help them do just that. Communication – The app allows… Read more »

ARCpoint Labs of Columbia, SC
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I agree about the part where you say that there needs to be better collaboration regarding health records. I feel like it is a huge hassle every time I need to get ahold of them.

Ladyhawk
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Ladyhawk

Let me offer a perspective from someone in the Canadian system. “Quack” Vickstrom and Mighty Casey hit the nail when they pojnt out that the payment system is the problem. But Quack wants a national or state system because he thinks it would help him spend more time on patient education. Think again, and be very careful what you wish for. “Single payer” systems sound great in theory, and they do reduce the paper workload, which the US system needs desperately. But government-run systems always, always result in shortages because the only way they know how to control costs is… Read more »

kiranreddy
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Health is important for all people in world…. this is useful for all people

Health

Fred
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Fred

“I am talking about the IT tools. I cannot use my own brain to share lab results remotely, organize a record, or securely communicate with a patient. There are bits and pieces in different places, but no easy tool to help me do this kind of practice in the way I think it could be done.” What is your ideal? What functions are the most important and how do you want them to work? Ex/ I want my pt to be able to send secure pt msgs to me and receive them in my EHR. I want my pt to… Read more »

Douglas Billings
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Douglas Billings

Fred

There are to my knowledge not any off the shelf tools that will do what you need but there are some currently available tools that will effectively and rapidly allow integration of such different data sources/sets and put that creation of that in the hands of actually users.