There’s a mantra in healthcare right now to “drive patient engagement.” The idea is that informed and engaged patients play a crucial role in improving the quality of care our health system delivers. With the right information, these healthcare consumers will be more active participants in their care, select providers based on quality and value metrics, demand appropriate, high-quality, high-value services and choose treatment options wisely after a thorough process of shared decision-making.
This drive for patient engagement often fails to recognize one important truth: Our healthcare system inadvertently, yet potently, discourages engagement. It ignores the fact that the patient is already the most engaged person in healthcare. The patient bears the disease, the pain, the scar – and, ultimately, the bill. In our search for greater engagement, we must realize what the comic strip Pogo said years ago – “we have met the enemy, and he is us.”
As physicians, we expect patients to bring test results to an appointment – because patient information is often not shared throughout our complex and fragmented systems. We expect patients to remember their entire health history, and repeat it ad nauseum as our unconnected systems fail to share. We ask them to recount the complex names of the all the drugs they are taking – and at what doses. And it’s not uncommon for these questions to be asked many times in a single hospitalization, during outpatient visits, and again each time a patient encounters a new caregiver.
The reality is that patients have no choice but to be engaged. They are provided these details in an inefficient way that causes a lot of frustration, worry and fear on top of already stressful medical concerns. The Office of the National Coordinator for Health Information Technology reports that one in three patients experience gaps in information exchange, which we rely on the patient to solve. I suspect this number is a significant underestimate because we are so used to this level of fragmentation and repetition, that we no longer see it for the system failure it is.
We need to think less about the patient being more engaged, and focus on how we can simplify, encourage and automate engagement tools on behalf of the patient.
People are accustomed to integrated, automated, 24-hour customer service in almost every other industry. How does Netflix know what type of movies you like? By analyzing your watch list and ratings against millions of other records in its database. How does Amazon know what you want to buy – sometimes even before you do? By looking at your purchase history and known interests to predict your next purchase. A growing list of best-in-class retailers remember our preferences, our home address and our personal details – and they are only selling us STUFF.
Yet, when it comes to our most important asset – our health – the consumer experience is dependent on fax machines, scribbled notes, hand-carried print-outs and the memories of those most in need of care. If our healthcare system were to implement the automation, connection and coordination that other industries have used to change the face of consumer engagement, boosting patient engagement wouldn’t be an issue. We would instead be easing the burdens on the very patients we are trying to help.
Patients and their families are desperate for improved interactions and engagement tools. A recent story detailed how concerned parents – who were also engineers – figured out how to hack into their diabetic children’s glucose monitors so they could remotely track their blood sugar levels. Should something so essential to managing a loved ones’ health require it to be hacked to make that data accessible?
There are no technological reasons why these medical devices don’t share data, why hospital pricing is so opaque and why electronic medical records don’t share information automatically with all of a patient’s providers. In fact, the hurdles blocking the path to a more seamless, welcoming and user-friendly healthcare system are old habits, proprietary business models and a lack of patient-centered care.
We have to improve how our healthcare system engages with patients by getting the various technologies used to take care of people talking to each other. Additionally, we need to provide transparent pricing information or we won’t succeed in delivering better individual care, managing population health or lowering costs.
Effective patient engagement shouldn’t require patients to bear the burden of remembering all of their previous treatments or creating their own healthcare innovations to access their patient data. An automated, connected and coordinated system is needed before we can reap the benefits of effective patient engagement. Until we have such a model, we’re simply asking consumers to take too much responsibility for transforming a broken healthcare system they didn’t create – a system that should be serving them, not the other way around.
Joseph Smith, MD. PhD (@JoeSmithMD), a cardiologist, cardiac electrophysiologist and engineer, is chief medical and science officer of theGary and Mary West Health Institute (@WestHealth), an independent, nonprofit medical research organization that works with healthcare providers and research institutions to create new, more effective ways of delivering care.