Health IT is Essential to Patient Engagement

Patient data, a longitudinal patient record, and patient identifiers remain valid goals of healthcare reform, despite unhappiness with Meaningful Use.

Last week I spoke with a former CIO who assembled a longitudinal patient record dating back 12 years from seven different healthcare organizations her system didn't own, all of which had agreed to use a single patient ID defined by her system's master-patient index. She made this record accessible via the Web to providers and patients.

This wasn't a recent development. The system went live in 2004 with 700,000 patients.

But then that CIO received a fateful phone call from a patient.

"The patient was crying," says the former CIO, Leslie Kelly Hall. "She said, 'I just read my record, and it said that I'm morbidly obese. I just looked it up…I had no idea I was killing myself with food. So tomorrow, my family and I are meeting with a doctor and we're going to find out how I can live to see my children have children.' "

Even now, years later, Hall gets emotional recalling the story. It was also the moment that Hall realized that patient engagement was a very big thing. After she left the CIO position, she essentially devoted the rest of her career to that belief.

More than a decade later, the U.S. healthcare system is still struggling to provide a longitudinal view of patient data. A common patient identifier is still a dream. Even though Hall and many others have championed patient engagement, today the industry is in a time of retrenchment, when grandiose plans hatched in the meaningful use incentive/penalty program, to verify that patients are being engaged, are on the chopping block.

Hall, now a nationally known expert on patient engagement, understands the pushback from providers on engagement-by-regulation. "For those that want to check the box, it will never be meaningful, and everyone has a choice to do something in a meaningful way, or to check that box," she says.

How important is the health IT component of patient engagement?

After speaking with Hall and other health IT leaders such as CHIME CEO Russ Branzell, I now believe that only when the current push for the longitudinal patient record succeeds will America's healthcare cost curve truly bend.

Getting there will require breaking down the technological and business barriers that prevent interoperability. We shall need more examples such as Hall's, which occurred at Saint Alphonsus Regional Medical Center in Boise, Idaho. She points to more recent efforts at Tenet Healthcare, as well as at Taconic Independent Practice Association in upstate New York. A technology key at both organizations has been the Direct message format, which has had a troubled adoption curve nationally despite being a mandatory part of meaningful use EHR certification, Tenet used Direct messaging to connect long-term post-acute care facilities to its hospitals, Hall says.

These days, Hall is the senior vice president of policy at nonprofit Healthwise, which supplies patient education materials for use by healthcare payers and providers.

The financial foundation for patient engagement

As 10,000 baby boomers per day continue to turn 65, and CMS turns incentives away from fee-for-service and toward value-based care, the business rationale for patient engagement in the Medicare population is efficiency, Hall says. "How do I reduce my rate of growth? How do I reduce my readmissions? How do I reduce my length of stay? And how do I reduce the acuity of the patients presenting, so that I can manage my revenue growth, so that I am making less money slower?"

Patients who participate in decisions with a provider make more conservative choices, which that can mean real savings for providers.

"People talk about coordinating care," she says. "I think that's still transactional. How do we get to the point where we're all 'co-producing' health together with our patients?

"Value-based care totally aligns with that. Population health totally aligns with that by adding certification to long-term post-acute care, to home health agencies, maybe payers."

A hospital of about 300 beds has between 9 and 11 FTEs in the preadmission office, Hall says. "They do testing and they do gathering of information," she says. "Eighty percent of the information they gather is patient-generated. Now if I have 11 FTEs, and 60 percent of my patients coming in my door are Medicare, and I could perhaps get patients to generate that data and present with a fuller and more complete information, and I haven't had to enter it or interview, what would happen if I reduce that from 10 to 11 FTEs to 6 FTEs in the next five years? That's a real savings."

At one of the many hearings Hall has participated in on patient engagement at the national level, a provider speaker spoke of a patient engagement pilot that she did not want to participate in, because she thought adding patient-generated health data would be a waste of time.

"She said, 'What I found out is I'm a better doctor,' " Hall recounts. "She said, 'I have now a really good knowledge of the drugs they're actually taking, not the drugs I prescribed, including over-the-counter. I actually have a better record now, because the patient has found errors. So if I believe information is at all valuable to me, isn't it better to have accurate information?' "

As CMS and ONC struggle to redefine the regulations of patient engagement this summer—and possibly the entire meaningful use program—let Hall's words echo throughout this debate.