Patient engagement will be tough task for health tech

Federal rules encourage doctors to partner with patients, but the systems being designed likely won't deliver

The buzz phrase in health care IT these days is "patient engagement," as medical providers figure out how to meet the May 2014 deadlines set by federal regulations known as ONC Meaningful Use Phase 2 (MU2). The notion is the patients -- rechristened "consumers" -- will take active stewardship of their health, using personal health repositories (PHRs) like Microsoft HealthVault to track information, mobile apps and sensors like the FitBit or Withings blood pressure monitor to adjust their activities into healthier patterns, and patient portals to interact with their doctors and nurses on a regular basis if they have chronic conditions (the ones that cost the health system the most money after care for the aged).

There are many wonderful ideas and pilot projects for such patient engagement tools, as well as slick patient portals in place at advanced providers such as Kaiser Permanente. But as I saw last week at the Healthcare Information and Management Systems Society (HIMSS) conference, there's a huge gap between the vision and what we're all likely to see.

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What you can expect in the near term
As health care providers, their IT staffs, and the vendors work their way through the issues in delivering on the patient-engagement promise, with the ongoing prodding of the feds, all patients can expect to be able to make appointments, see and refill prescriptions, and see most lab tests (though not necessarily with any interpretation of their meaning) in the next year via Web-based patient portals set up by their providers or perhaps insurer. Increasingly, a mobile app or website will also be available for the same functions.

Many people will also be able to have email exchanges within these portals -- but not to their personal email accounts. This is due to privacy rules that impose a higher burden of security on electronic communication than on the paper copies you often get from the doctor, even when the information is the same.

What you likely won't see are online consults (known as e-visits), online diagnostic tools for common maladies, integration with PHRs, integration with your own consumer-grade monitoring apps and devices, integration across multiple providers (primary care providers, medical specialists, dentists, and eye doctors), or full access to your medical records, much less the ability to flag anything for correction. You might be able to add your appointments to your personal calendar on your smartphone or computer; then again, you might not.

There are three major reasons for the gap I expect we'll see between the intent of patient engagement and the reality:

  • An economic model where health care providers lose if patient engagement actually happens
  • A strong ignorance of how apps and websites work today by the health care IT and medical staffs tasked with developing them
  • An aversion to the full concept by a significant percentage of doctors, who now hold the most power in the majority of health care organizations

An economic model that rewards keeping people sick
Through what's popularly known as Obamacare, the feds are trying to change health care delivery so that it focuses on wellness -- preventing injury and illness -- rather than on illness. Problem is, doctors and hospitals are paid to treat illnesses, typically for each procedure they perform. Doctors aren't paid to engage with patients, whether to read emails or look at patient-generated data such as from home monitors. This means the IT systems being designed to encourage patient engagement may often do just the minimum.

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