The tall task of patient engagement

Government leaders, healthcare providers and patient advocates alike have made it clear that engaging patients in their own care will continue to be a top priority in the health industry going forward, particularly as payment models shift to reward improved outcomes over volume.

For instance, National Coordinator for Health IT Karen DeSalvo has spoken extensively about the use of technology to engage patients. In a sit down with several reporters in the District of Columbia last month, she said that as ONC shifts its focus away from Meaningful Use, "there's an opportunity to be more inclusive of data sources"--including patient-generated health data.

Patient engagement, of course, also is a big part of the Meaningful Use program.

Not everyone in the health industry, however, believes that more engagement equals better results.

In a recent post to Forbes, former Allscripts CEO Glen Tullman called engagement the latest "buzzword," saying that he thinks patients--particularly chronically ill patients--want to be less engaged.

"It's ridiculous to pretend that most chronically ill patients don't already have their diseases top of mind," said Tullman, who currently serves as a managing partner for healthcare consulting firm 7wire Ventures. "But asking them to dwell further on conditions that already impact so many facets of their lives is surely a losing proposition."

Instead, he said, such patients want to "think beyond" their burdensome disease and focus on living their lives.

Tullman continued, saying that rather than tools that help with tracking, patients want technology like the pacemaker that "empowers" them by essentially providing a solution and staying out of the way.

"Who wants a device that will require them to spend a half hour every morning sorting through data or clicking around an insurance company's website to determine what they have to do to avoid getting sick?" Tullman said. "Nobody I know."

It's an intriguing argument, to be sure. While consumers (and patients) today are more connected than ever, some of those with the greatest needs might not be.

What's more, some in the healthcare industry have said that large-scale patient engagement will be an uphill struggle. In a Health Affairs Blog post last month, Susan Edgman-Levitan, executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital, and Tejal Gandhi, M.D., president of the National Patient Safety Foundation and the NPSF Lucian Leape Institute, said the current care model discourages patients and clinicians from voicing concerns for fear of seeming difficult.

Ultimately, though, Edgman-Levitan and Gandhi said the inclusion of patients and families in quality improvement and design of care processes will help to "spark ideas that may be wholly different" from the knowledge of clinicians.

Additionally, research published this month in the Journal of the American Medical Informatics Association points to the need for developers to better align technology with patients' abilities, relationships, community factors and daily activities. That seems like a better approach than simply avoiding patient engagement, altogether.

Readers, I'm curious to get your take. Does Tullman make a valid point? Or is patient engagement more than just the phrase du jour?  - Dan (@Dan_Bowman and @FierceHealthIT)

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