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

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For example, almost every patient portal lets users schedule appointments, but the do-it-yourself organizations that described their efforts hadn't considered how to ensure those appointments were on patients' own calendars. The issue hadn't occurred to those whom I asked about how a patient would remember the appointment set up in the secure, sign-in-required portal. The answer, of course, is to generate a file using the established iCalendar (.ics) standard that users click or tap to add the appointment to add to their calendars, whether in Microsoft Outlook, Google Calendar, Apple Mail, Android Email, BlackBerry Mail, Windows Phone Mail, or even Lotus Notes. Airlines and other travel services use it, but these people were oblivious.

The calendar issue is a small example -- from an admittedly small sample -- but the dozen practitioners and vendors I spoke with at the conference said it was a representative example of the disconnect between those deploying patient-facing technology systems and the real world today. The same phenomenon has led to all those IT-developed apps that business users hate because they "don't get it." It'll be interesting to see if all the personal health apps and devices coming to market will create a similar phenomenon in patient engagement as mobile devices and apps have done in the business world at large (the consumerization phenomenon). Strict privacy rules and proof-of-efficacy mandates may make it harder for a BYOD-like phenomenon to take root in health care.

The (uncomfortable) shift in power
At session after session, doctors and nurses lauded Obamacare's notion of inclusion of patients as partners in their health care. But a survey released at the conference suggested there's a lot more convincing to be done, at least of physicians. Most agreed that patient engagement is a good thing -- to a point. Most wanted to limit what medical information patients could see about themselves, and few wanted to deal with patient-generated data.

Doctors have been treated as deities in American culture since the 1950s, and the "doctor knows best" prestige will be hard for many to let go. To be fair, doctors are ultimately responsible for the care provided, so they, in fact, have to know best. But why that should mean limited patients' information is unclear.

The feds seem to think limited information is a bad idea, so the agency pushing Obamacare rules -- the ONC (Office of the National Coordinator for Health Information Technology, part of the federal Health and Human Services Dept.) -- has been encouraging widespread adoption of the Blue Button, a technology developed by the Veterans Affairs Dept. The VA was a pioneer in electronic health records and continues to be on the leading edge. The Blue Button is a badge on the VA's website that, when clicked, lets patients access their entire medical records, in essentially a data dump aimed for transfer to other providers. A follow-on effort called Blue Button Plus makes the data both machine- and human-readable; it also defines a transmission standard to enable sharing with personal health records systems.

Physicians may want to limit what medical information patients can access about themselves, but Blue Button Plus shares the whole thing under the belief that knowledge is power, and patients will do better when doctors explain the information rather than keep it to themselves. There's talk that the ONC may mandate that electronic health records (EHR) systems implement Blue Button Plus as part of the Meaningful Use Phase 3 requirements now being developed.

Over time, as the economics, technology savvy, and culture all change within the health care industry, we should see more sophisticated forms of technology-based patient engagement. "It will be like online banking: slow adoption at first, but then it exploded," says Mac McMillan, CEO of health care security consultancy Cynergistek. After that initial slow start, "people will likewise rapidly adopt patient portals and at-home technology." As was the case with online banking, the early systems probably won't be that great -- but will get better over time.

This article, "Patient engagement will be tough task for health tech," was originally published at Read more of Galen Gruman's Smart User blog. For the latest business technology news, follow on Twitter.

Copyright © 2013 IDG Communications, Inc.

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