You can’t travel too far on the Internet without tripping over an article, report, survey, or commentary lamenting the state of engagement in the healthcare industry. A lot of this talk focuses on the poor quality of technology that healthcare organizations (HCOs) use in their feeble efforts to engage with patients. “Why can’t healthcare be like (insert just about any other industry here)?” these pieces ask, listing the various apps, services, and websites that make it swell to be a consumer in 2015.
Sure, healthcare technology leaves a lot to be desired. Most portals serve not as an engagement tool but, rather, as a line item on an RFP or meaningful use checklist. Few healthcare apps serve such a significant purpose that consumers use them as often as they check social media, email, or texts. Few services mimic the convenience of booking travel, ordering pizza, or setting up your 401(k) without having to put on pants.
A recent study in the Journal of Medical Internet Research pinpointed a key part of the problem. Healthcare app developers often assume that all patients have “unlimited enthusiasm” for tracking their data, and that all physicians readily accept that data when neither statement happens to be true. Booking vacation is one thing; tracking blood glucose on an infrequent basis, only to have a physician cast aside that patient-generated data in lieu of what the machine says, is another thing.
The rapid advance of consumer technology has, in a way, hindered engagement efforts. Throw some cool stuff at consumers, HCOs and startups seem to say, and we can call them “engaged.” Tell patients about the portal! Show them how to pay for parking on their phone! Sign them up for our fitness challenge! Give them Schrute Bucks for eating salads!
The problem, as colleague Naveen Rao detailed during last fall’s flu season, is that healthcare’s engagement problem goes much deeper than tech.
A couple weeks ago, it was my turn. I walked into my doctor’s office for my annual physical at 2:45 p.m. At 2:50 I stepped on the scale. At 2:55 I gave up on tying a knot behind my head, leaving my gown wide open in the back. At 3 my doctor walked in (right on time, to his credit). At 3:05 I was making my appointment for next year. I felt less like a patient and more like a widget that had zipped across an assembly line so fast that the foreman and his team might get that performance bonus after all.
Granted, I don’t need the level of engagement provided by a care coordinator, a lifestyle coach, or a visiting nurse. I don’t have a condition that requires frequent monitoring. But the industry has a problem if someone who doesn’t need a reason to get up at 7 a.m. on a Saturday for a 14-mile group run in the humid August sun and then grab some kale at the farmer’s market on the way home nonetheless can’t find a reason to log into a portal, download an app, don a wearable, or rally behind the next “Uber for healthcare.”
Healthcare isn’t bad at engagement because it lacks technological solutions; it’s bad at engagement because it’s bad at engagement. Whatever the reason – the effects of the fee for service system, recalcitrant patients, poor bedside manner, or a general aversion to change – most HCOs struggle to connect with consumers on even a rudimentary level. Rather than feel like partners in the care process, consumers typically associate fear and trepidation with the healthcare experience.
Technology can certainly change this. An equal number of articles, reports, surveys, and commentaries proclaim with no shortage of optimism that healthcare is on the verge of Big Things. Telehealth, mobile health, wearables, genomics, analytics – the list, of course, goes on, each product poised to help achieve the Triple Aim, if not change the world.
Before the industry starts throwing all this tech at patients, though, it needs to better understand how to deliver solutions to those with limited enthusiasm. For a growing number of HCOs, compassion is the key to engagement. This strategy is based on the outrageous notion that patients are more likely to listen to physicians and nurses who show that they care.
Understanding what patients want, instead of telling them what they need, can go a long way toward creating programs that reduce readmissions, cut costs, and improve treatment. It’s important to remember that what patients want isn’t complicated, either – wearable devices that actually work, portals that actually do something, test results that actually make sense, and clinical staff who actually respond to their inquiries. Solutions to these problems may not be as sexy as Uber for healthcare, but they will build enthusiasm, boost engagement, and show patients that they are indeed partners in the care process.
The general patient doesn’t want to engage with healthcare, special cases know that for their own good they must. Clinicians want good experience and outcomes for their patients. But follow the money. Money forces overwhelm compassion and drive. The patient role in the money flow is simply as a trigger. The business of healthcare, money flow, has little impact by the decisions that the patient can make. Hence there is initial interest in helping engage the patient, but that gets overwhelmed by money flow interests. Look at the money, those that decide how the money flows have good engagement in the business of healthcare.
This certainly reinforces what I was saying. My provider knows that it’s pointless to engage with me because I only come in once a year. Unless something catastrophic happens, I’m not going to show up and need a variety of tests for which the provider can get reimbursed. My insurer, on the other hand, is all too happy to keep telling me about ways to stay healthy.
Dramatically improving antiquated electronic test reporting, viewing and sharing processes would make it much easier for physicians and patients to use and share diagnostic test results and could also ensure that engaged and enthusiastic patients can understand their own test results.
This can be accomplished by replacing the variable reporting formats in EHRs, PHRs and HIEs that are displaying only incomplete and fragmented data, with a clinically intuitive, standard reporting format that can display the results of the more than 7,500 available tests as easy to read, integrated and actionable information.
It will be interesting to see if the financial incentive realignments induced by the widespread adoption of value-based reimbursement, FHIR-based public APIs and PHRs that truly embrace the patient as an end user will produce a platform-neutral solution for this important, costly and dangerous clinical data management problem.
I certainly hope that can happen. The critical step will be ensuring that patients — as an increasingly important member of the care team and not just a bystander anymore — get the same access to this information as clinical staff (or at least access to a version of this information that makes sense to them and/or is relevant to them). Otherwise engagement efforts will continue to suffer.