Patient engagement refers to the process of encouraging patients, their caregivers, and their supporters to take an active role in the patient’s care. Patient engagement targets healthy patients (by encouraging healthy lifestyles and preventive care) and in particular those with acute or chronic illnesses. Physicians are highly adept at caring for patients sitting in front of them in their office or lying in a hospital bed. However, in general there is a tremendous drop off in care once the patient returns to their normal living situation. Patient engagement seeks to close this gap in care by allowing the patient or their support team to assume a higher level of responsibility for managing medications, blood pressure monitoring, weight fluctuations, exercise levels, medical appointments, ongoing engagements with healthcare professionals and other parameters. Health information technology’s role in this process can be divided into several areas:
Mobile Health (mHealth)
Mobile health information technology is playing a significant role in the patient engagement process. For example, a recent survey conducted by IMS Institute for Healthcare identified over 43,000 health related applications available for the Apple IOS mobile operating system in late 2013. The majority of these were dedicated to patient health issues such as diet and exercise tracking. Only a small number, however, targeted patients with multiple chronic diseases, the population that stands to benefit the most from higher levels of patient engagement. The authors of the survey commented “…many of them (the applications) provide only limited functionality, and that even then they generally serve only very limited patient populations.” Despite this there were over 16,000 applications that address specific health conditions or treatment programs and that number has been growing rapidly since this survey was conducted.
There is a need for additional applications to be developed that will specifically address the needs of patients with multiple chronic diseases. The most common conditions include diabetes, hypertension, hyperlipidemia, obesity, coronary artery disease, chronic obstructive pulmonary disease, asthma, chronic renal failure, congestive heart failure, arthritis, gastric reflux disease, depression, and chronic anxiety. Patients frequently have several of these diseases (and others not listed), with some patient “problem lists” reaching 10 or more active chronic conditions. Applications that help the patient manage multiple conditions need to be able to address how any recommendations to the patient could impact any of their associated conditions. For example, a patient who has hypertension, diabetes, hyperlipidemia, chronic renal failure, may have different dietary requirements that a patient with hyperlipidemia alone. Some diets also need to be able to address their impact on how certain medications are absorbed by the intestinal system and how certain chemicals within some foods can impact the effectiveness of medications. An example of this is the impact of vitamin K, found in green leafy vegetables, on the ability of a blood thinning agent called Coumadin, used to prevent stroke and other blood clotting disorders. Applications that are used by individual to help manage multiple chronic conditions will need to be “smart” enough to know that certain interventions, even those as simple as dietary modifications, need to be addressed in the context of all the patients medical information, including diseases, medications, allergies and in some instances recent lab values.
Sophisticated features such as the ones described above already exist within electronic health record applications designed to support physicians and their decision making processes. Placing these types of tools into the hands of patients is a work in progress, but sophisticated patient-oriented applications than can help patients manage multiple complex medical conditions will eventually appear on the horizon. The safety and effectiveness of these will depend on their ability to streamline the interaction between the patient and their physician.
Patient portals refer to tools that allow patients to, in most cases, access information specific to a single healthcare facility such as a doctor’s office or hospital. They allow for two-way interactions between the patient and the physician or another member of their staff. Patients may log in and ask questions, see lab results, download patient visit summaries, schedule appointments, pay required medical bills, and receive information specific to their condition. They may be able to upload information stored on their home monitoring devices (e.g., glucose levels). Patient portals are an excellent method of reaching out to patients and informing them of needed tests, reminding them to take their medications, and addressing their concerns. Some patient portals also support telemedicine encounters and electronic visits (essentially email visits) between patients and healthcare providers.
Patient portals are limited, however, by their access to only one facility. For example, a patient that has a primary care physician and three specialists will need to have 4 separate patient portal applications. This has limited their uptake to some degree as each of the 4 patient portal applications may have been created by different vendors. Each has specific log in and navigational requirements that may be intimidating to some patients. In general patient portals are increasing in popularity as they facilitate patient engagement by allowing patients to efficiently interact with care providers between appointments.
Personal Health Records (PHRs)
PHRs (also referred to as personal medical records – PMRs) are essentially patient-centric electronic medical records that are under the patient’s control. In the ideal setting the patient will have the ability to import records and data into their PHR and then add additional information as they see fit. Interfaces with electronic health record systems, health information exchanges, laboratories, radiology centers, immunization registries, and other sources of information are key components of a truly comprehensive personal health record, however, in most settings the level of interoperability between these disparate health information technology platforms is lacking. Patients may also be asked to pay fees to obtain copies of their medical records, further creating a barrier to allowing patients to create a truly comprehensive and longitudinal record of care.
Personal health records have not been in high demand in recent years, as patients have not responded well to having to input their data manually. However, the emphasis on patient engagement, the increase in the level of sophistication of these applications, the growing use of mobile technology applications by patients, and the gradual breakdown of barriers that prevent the flow of information from one system to another, are all factors that will encourage more widespread adoption of PHRs. Patients, physicians, and researchers all markedly benefit from giving the patient tools to create their own comprehensive record of care that includes all relevant information over time.
Patient Engagement Social Media Applications
This refers to web-based tools that allow patients to interact with each other and share information about their conditions. Patients often report that other patients with the same condition often provide some of the most useful information about their illness. Interacting with other patients online not only broadens the patient’s exposure to educational resources and potential treatments, but it also provides emotional support. Given that patients are sharing sensitive information on-line that could impact them professionally and personally, each social media application vendor needs to make efforts to protect the identity of its users and the sensitive information they share. Patients also need to be aware of the potential ramifications of sharing sensitive information via on-line forums, as many of the companies that support these applications use the sale of data they collect to fund their efforts.
Disclaimer: The information contained in this article, unless otherwise attributed, represents the opinions of its author: Michael Stearns, MD