Gabriel Miller; Richard Schilsky, MD


June 25, 2014

Medscape: You mentioned that technology is allowing physicians to respond to emails at their leisure, for example, but it also seems like there is more education required and increased communication. So you are getting more emails, you're getting more text messages, etc. Will there be an increased workload, and is this a potential concern as one barrier to patient engagement?

Dr. Schilsky: I have a couple of thoughts on that. Number one, a lot of the communication and education doesn't necessarily have to be done by the physician. It can be done by other members of the healthcare team -- nurses, nurse practitioners, physician assistants. Many doctors' offices are relying on these nonphysician practitioners to, if you will, extend the reach of the doctor because doctors are very busy and oftentimes are very busy with patients who are very sick and need their attention. But a lot of what many patients need doesn't have to be conveyed by the physician.

Second, over time there will be more and more strategies to communicate and educate patients, whether that's going to your patient portal, where you can receive educational information, or being directed to a Website to get more information. Patients who feel comfortable enough using a computer to log in to a patient portal are probably going to feel equally comfortable clicking on a link to a Website to get some relevant information.

I do think, though, that the other element is this I don't want to divert us from the main focus of the story, but doctors and their staff are and will be spending a lot more time in these sort of patient engagement activities that at the moment are largely unreimbursed. It gets a little bit into the issue of how doctors are paid and what they're paid to do, and so on. If you've seen ASCO's payment reform model,[1] it is a proposal that oncologists should be paid differently from the way they are paid now. The only way a doctor gets paid right now is for the patient to show up in their office with a complaint. Doctors, unlike lawyers and other professionals, don't get paid for phone calls, emails, or really anything other than the evaluation and management of a patient sitting in front of them in their office, but that could change.

It's part of the ASCO proposal that doctors do receive compensation for this universe of activities that they do that requires that they engage with patients, even if the patient isn't in front of them. This has to be proven, of course, but it's possible that this ultimately reduces the cost of care because patients actually are spending less time going to the office, which is an expensive way to get information. It's less time that the patient has to take away from their work, if they are still working, or their family, if they have family responsibilities. So, it's a complex and evolving ecosystem that we’re in. But I have to believe that the more the patients are equipped with information and the easier it is to communicate with their healthcare team, that's going to result in better-quality care, more cost-effective care, and patients who are more informed participants in their care.

The other reason that patient engagement is going to be so important going forward is that, as you know, there's more and more of a push in medicine for sharing clinical data and using real-world observational datasets to make clinical inferences about all sorts of clinical problems that cannot easily be addressed through doing clinical trials. At the end of the day, it's the patient who has to be willing and comfortable in sharing their data, and even has to become an advocate for sharing their data, because they will be the beneficiary of that data sharing. This is another critical element in the multifaceted area of patient engagement -- the patient as the advocate for the sharing of their health information, not only to improve the quality of their own care but to improve the outcomes of other patients like them.


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