Patient-centered care requires more than online technologies

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Patient-centered care is the mantra of the movement to reform the nation's healthcare delivery system. According to this credo, patients must be able to obtain copies of their medical records and visit summaries; they should have personal health records that they can share with their providers; they should have "patient-centered medical homes"; they should share in medical decision making; and, of course, the security and privacy of their personal health information must be rigorously protected.

All of this makes sense, both for the individual and for the healthcare system. Since about 90 percent of healthcare is self care, consumers must be involved--and must, in some cases, change their health behavior--to become healthier and reduce the overall cost of care. "Patient engagement" is also a key component of accountable care organizations, because ACOs' success depends on keeping patients healthy and out of expensive care settings. Only by educating patients and enlisting their cooperation can ACOs generate savings and remain within their budgets.

Many observers have assumed that online technologies hold the key to patient engagement. So it was a bit startling to read a recent Healthcare IT News interview with Eric Dishman, director of health innovation and policy for Intel's digital health group. Dishman, a staunch proponent of PHRs and mobile health tools, said the impact of the mHealth trend--a key ingredient of consumer engagement--has been overstated. 

"People will say to me, 'There's 65,000 apps for health in the iTunes store,'" he noted. "But I say, '12,000 of them are diabetes apps, maybe six of them have ever been downloaded more than once, and two of them have been used continuously.'"

What's needed to change that, he said, is an evolution in the doctor-patient relationship. Patients must become full-fledged members of care teams that include not only doctors, nurses, and nurse practitioners, but also family members and neighbors. And the full power of social networking should be enlisted in those relationships, he added.

Dishman also believes that social networking can encourage patients to use PHRs, which so far have attracted only about 10 percent of consumers. For example, he noted that people with serious chronic diseases often will join online communities of those who have the same conditions. That might encourage them, he said, to keep track of their vital signs in a PHR and to discuss the data with their physician.

Paul Cerrato, editor of InformationWeek Healthcare, was more pessimistic in a recent commentary. He said that the main reason why relatively few consumers have PHRs is that most people are apathetic about their health. While that's not a reason to give up on PHRs, he thinks progress will be slow in getting consumers to use them.

The Office of the National Coordinator for Health IT (ONC) clearly realizes that the lack of patient engagement is a big problem. That's why ONC's Consumer Pledge asks "data holders," including healthcare providers, to make it easier for consumers to obtain their health records and to encourage them "to access and use their personal health information to meet their personal health goals..."

Similarly, in its Meaningful Use Stage 2 proposal, the Centers for Medicare & Medicare Services (CMS) requires eligible professionals to ensure that 10 percent of patients view or download their health are information or transmit it to others. That provision has generated a lot of criticism from providers who doubt they can guarantee patients will actually view the data. But the pushback itself shows how difficult it will be to build patient engagement.

This is not for lack of technological resources. Besides mHealth apps, PHRs, and social networks, we now have online interactive educational programs, digital coaching, health risk assessments, and much more. The missing link is a concerted effort by physicians to convince their patients that online engagement can be good for their health. - Ken