Marcia Frellick

April 16, 2015

CHICAGO — When physicians talk about patient engagement, they tend to think in terms of the doctor–patient relationship, new data show. And their patients somewhat agree. But when healthcare executives talk about the patient engagement envisioned under the Affordable Care Act, they think in terms of transactions, according to three parallel national surveys that have uncovered a perception gap.

Chief information officers believe they are responsible because patient engagement involves technology, doctors believe patients need to take more responsibility for their outcomes, and patients say they can't because their doctors, who are responsible for engaging them, don't spend enough time with them.

The surveys, presented here at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference and Exhibition, were conducted by HIMSS Analytics, M Consulting LLC, WebMD, and Medscape.

In separate surveys, researchers polled a national sample of 125 chief information officers, 359 primary care physicians, and 2567 patients who visited their doctor in the previous 90 days. Questions centered on beliefs about engagement, the perceived roles of the stakeholders, and barriers.

The chief information officers surveyed "clearly saw themselves as the owners of patient engagement," said Lorren Pettit, MBA, vice president of market research for HIMSS Analytics, who reported on the systems perspective.

When chief information officers were asked who is most accountable for patient engagement in their organizations, 46.4% said they were, but 14.4% thought nurses were accountable for patient engagement, not physicians or patients.

Patients, Physicians Align on Relationships

 
Patients expect more of providers than they are able to give, and providers are expecting more of patients.
 

But patients and physicians look beyond the technical aspect and see patient engagement as being firmly rooted in the physician–patient relationship, the surveys showed.

If the system leaders "don't reach out to the chief medical officers and the CEOs to own that patient-engagement plan, it's always going to be seen through the lens of meaningful use and the transactional piece," said Christina Hoffman, vice president of strategy and quality for Medscape Education.

But there are barriers. "Patients expect more of providers than they are able to give, and providers are expecting more of patients," she said during an interview.

For physicians, time and money are among the top barriers; 42.3% said they don't get enough compensation to promote patient engagement, 59.1% said they have limited time during the patient visit, and 61.8% said they have limited time to follow up.

Because time with each patient is unlikely to change, efficiencies will need to be found during the doctor–patient interaction. In fact, although doctors said patient engagement is beneficial (84%), part of their job (79%), and easy (76%), only 39% said it is efficient, Hoffman reported.

To that end, doctors should look at shifting some parts of the patient experience, she said. Hoffman suggested turning a waiting room into a learning room, and making use of that usually wasted time to educate patients about their chief complaint or to triage the gathering of information. That could mean having patients enter information on a tablet during the wait or using technology to educate patients about prevention, for example, outside of their appointments.

The doctors surveyed asked for training for themselves as well. Most, 73%, said they wanted help communicating with nonadherent patients and with caregivers and family members, as well as help with listening skills.

"That's important for all of us to understand," Hoffman said, "because we're expecting something of physicians that's a little bit different from their training."

Patients Want More Help From Doctors

From the patient perspective, getting help from a provider they trust is most important, said Mazi Rasulnia, PhD, from M Consulting LLC, who is cofounder of Pack Health, a patient-activation company in Birmingham, Alabama.

What they expect most, according to the survey, is a provider who listens to them and helps them understand treatment options before they make a decision.

"Patients want questions answered around the specificity of their own health, not just what generally happens with 'patients like you' or from a population standpoint," Dr Rasulnia said.

"What they don't really care for or expect is for providers to 'give me a website so I can access my medical information'." That, and asking patients about their personal life, ranked lowest on patients' lists of expectations.

They want providers to help them navigate not only their disease, but also the health system. Providing access is important, but that alone won't help patients engage, he explained.

Access Not the Issue

All respondents said they agree that access won't eliminate barriers to patient engagement. One indicator of that is the increase in the percentage of hospitals with patient portals, which soared from 38% in 2010 to 62% in 2014.

"Five years ago, of the 100 applications we monitored, patient portals was the seventy-second most commonly acquired application. This year, it's the third most frequently acquired application in the hospital market," Pettit said.

Moving from access to engagement is an evolving process, but fewer than half of all health systems have mapped out plans for achieving it. Only 41.6% of organizations have a formal plan for patient engagement, although another 42.4% are considering one, according to the survey.

This survey was conducted by HIMSS Analytics, M Consulting LLC, WebMD, and Medscape, and was partially supported by Genentech. Ms Hoffman and Mr Pettit have disclosed no relevant financial relationships. Dr Rasulnia has worked as a consultant for Genentech and for Medscape.

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