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Posts made in January 2016

Achieving Patient Engagement: No Easy Task

EngagingPatientslogo I wrote this for was launched in June, 2013, led by the belief that patient engagement is central to the transformation of healthcare. Their Guiding Principles include:

We are a purpose-driven organization that makes information readily accessible to the healthcare community.

We aggregate disparate information i.e. news, learnings and best practices in order to inform, engage and align the broader healthcare community in our common mission.

The focus of the community is guided by our Advisory Board and the content by the members, is powered by Standard Register Healthcare

My work in the e-Patient movement through my writing and speaking aligns directly with and I am delighted to share this blog.


Sandra, a retired teacher with hypertension, has been Dr. Clarke’s patient for twenty years. When she arrives for her annual visit, she is given a clipboard with a paper form that asks her to list all of her medications and fill in her medical history, the same form she filled out last year. Sandra has brought with her a list of blood pressure results that she has tracked over the past several weeks to discuss with the doctor.

During the 15 minute visit they briefly discuss headaches that Sandra has been experiencing.  After a quick but thorough examination, Dr. Clarke asks Sandra to continue tracking her blood pressure and send a weekly email to the nurse who will review the data for anything unusual. The doctor prescribes a medication to help with the headaches and suggests that Sandra schedule another appointment in six months, or sooner if the headaches persist, or if there are any other problems. Dr. Clarke encourages Sandra to email her if she has further specific questions about the treatment plan.

What is  Patient Engagement?

Is Sandra an engaged patient?   Is Dr. Clarke an engaged clinician?  Does the arrangement that asks Sandra to track her blood pressure and send weekly reports to the nurse involve her more integrally in her care?  Does the fact that Dr. Clarke has opened the communication pathway by encouraging Sandra to email her at any time portray this patient/doctor relationship as a partnership that fosters collaboration?  Should Sandra have access to the visit notes from her health record?  Does any of this change the quality, efficiency, and cost of care for Sandra?

This case study represents a typical scenario of a 2016 office visit where patients do not yet have full access to all the information about their care, and where many clinicians are trying to involve their patients in managing their health. It reflects a gradual transition to patient and clinician engagement, which is becoming more common in health practice today.

The Institute of Medicine (IOM) issued a ground-breaking report entitled Crossing the Quality Chasm in 2001 in which they outlined 10 simple rules for the 21st century health care system, including these examples: Rule 1: Care Based on Continuing Healing Relationships; Rule 2: Customization Based on Patient Needs and Values; Rule 3: The Patient as the Source of Control; Rule 4: Shared Knowledge and Free Flow of Information. Fulfillment of each of these rules would bring us closer to engagement by patients and clinicians.  However, today, a decade and a half later, we are still grappling with how an open, and collaborative patient/clinician relationship, that engages both parties interactively, can succeed in fostering best practices that results in consistent high quality medical practice and lower cost of care.

Participatory Medicine Fosters Engagement

The Society for Participatory Medicine was founded on the premise that e-patients — empowered, engaged, enlightened, educated patients– promote the concept of participatory medicine, a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.

There is significant evidence to suggest that patients who are more actively involved in their health care experience better health outcomes and incur lower costs.  However, it is not enough for patients alone to actively manage their care. Engagement involves engaged clinicians who empower their patients with information, education, and a team approach to care that includes all of the stakeholders including family caregivers, nurses, therapists and others involved in the care process.

There are several specific and achievable goals to foster patient engagement including:
1. Open dialogue and full information at the point of care, where the clinician and the patient discuss in detail the elements and options for treatment, based on medical evidence, patient preferences and clinical judgment.
2. Shared decision making, where the patient and clinician collaboratively weigh the options and make decisions on the best treatment choices that takes into consideration the patient’s values, personal circumstances, lifestyle and preferences.
3. Patient Activation: providing the patient with the skills, ability, and willingness to manage their own health and health care, and supporting their actions with secure communication options, viable user-friendly apps and devices and educational resources.

Shifting the Paradigm, When?

The truth is that in an ideal world every patient would have the knowledge, technical experience and desire to engage and take charge of their health care.  Every clinician would truly commit to working with their patients to help them succeed.  However, we do not live in an ideal world.  As a result, the transition to full participatory health care is going to take additional time, energy and effort by everyone involved.

2016: Opportunities and Challenges in Health Care

2016In 2016, mHealth technology will occupy center stage in transforming clinical care and clinical research.  Smartphone-linked wearable sensors will turn science fiction into reality as these mobile diagnostic tools provide the in depth information that enables    patients and clinicians to experience more accurate, continuous streams of information that will help them make better informed health choices.

In 2016, Telemedicine in combination with wearable sensors, robotics and advanced diagnostic and surgical capabilities, will enable physicians and patients in under-served and remote areas to experience top quality medicine. Additionally, many more eVisits, based on telemedicine technology will change the dynamic of the patient/clinician relationship

Big Data, currently in its infancy, will expand and begin to supply the analytics and storage of information needed to enable precision medicine which specifically takes into account individual variability in genes, environment, and lifestyle and tailors medical treatment to the individual characteristics of each patient.

Robotics will continue to radically change the way many surgical procedures are conducted and will expand into healthcare tasks of all kinds from helping patients cope with illness at home, to dispensing drugs, supplies, food service and more throughout the hospital and other health care sites.

Wearable Sensor Technology

There is increasing clinical evidence that continuous physiological monitoring using wearable technology to manage chronic diseases and monitor patients’ post-hospitalization, will be ground-breaking.  The market for wearable technologies in health care is projected to exceed $2.9 billion in 2016, and transform medical care in unimagined ways.

Devices, including glucose monitors, ECG monitors, pulse oximeters, and blood pressure monitors, worn on or close to the body are expected to produce the most ground-breaking innovations. Textiles that incorporate sensors within the fabric that seamlessly deliver patient data to doctors will see expanded usage.  Solutions that use Bluetooth technology to track elderly patients’ movements and send health measurements to caregivers will also be widely used.

Expanded use of digestible sensors, (approved in 2011), a swallowed pill that transmits information about a patient to medical professionals to help them customize care, will continue to provide healthcare professionals with more information about the human body and how various treatment solutions affect each system of organs. Digestible sensors have the potential to replace the face-to-face office visit exam. They are able to monitor body systems and wirelessly transmit what’s happening in your body to another device like your smartphone or computer, and help clinicians detect disease and conditions at an early stage.

Telemedicine, much discussed, has become more widely adopted among health institutions and will continue to expand in 2016.  Telemedicine services can address the needs of hard-to-reach patients who require assistance with rehabilitation, including physical and occupational therapy following orthopedic and cardiac surgery, and stroke.  Telemedicine also has the potential to provide much needed mental health consultation services, and diagnostic and treatment advice from experts at major medical centers to small rural hospitals over video connections.  This is already saving lives and improving quality of care.

Robots in health care extend clinical capabilities and leverage best of care options by performing complex tasks using integrated datasets and intricate instruments that they are able to manage much more effectively than humans. Robots, in 2016, will be used across the continuum of care, in the OR and the ER, and for home-bound patients as well as for teaching, Robotic “Flight Simulator” Surgery has become a new way to train surgical students to perform complex operations without practicing on live patients, which improves their training and reduces medical errors.

Big Data
In 2016, large data sets that reveal patterns, trends, and associations, especially relating to human physiology and interactions between cells, proteins and other elements in the body, will be common in the medical setting.     This means that clinicians will have the ability to look for trends and associations to deliver best practices based on predictive analytics. Use of Big Data is going to be increasingly important in personalized/precision medicine (genetics and genomics), as more and more patients have their genome analyzed for the purpose of finding a specific customized treatment solution for a complex medical issues. As more connected devices come online and new data sources such as those from wearables and social media  gain acceptance, the promise of big data analytics in medicine is enormous.

Key Challenges 2016:
Over $28 billion dollars have been spent in the U.S, to date, on implementing health information technology, particularly Electronic Health Record Systems (EHR).  However, these systems are not yet interoperable, meaning that information does not flow seamlessly between disparate health records. This prevents hospitals and medical groups within states and across geographic boundaries from exchanging patient data when an individual has an emergency situation that requires attention outside of his or her familiar medical home. This complicates treatment and thwarts healthcare’s most basic objectives, full information at the point of care. This is a challenge we should attempt to resolve in 2016.

Healthcare Consumerism
Patients are consumers of healthcare, and accordingly, they expect to be treated as customers. Until recently, consumerism in the U.S. healthcare industry was a non-issue. Several issues are converging to change that dynamic.  Higher deductibles and copayments, greater transparency into provider performance and cost of care, better health literacy supported by an influx of health information in every media from print, video and online, all contribute to patients becoming healthcare consumers who expect support and service.

According to a McKinsey survey of more than 11,000 people across the country about how they perceive their healthcare needs and wants, how they select providers, and how they make other healthcare decisions, consumers want the same qualities in healthcare companies that they value in non-healthcare settings. great customer service that includes delivering on expectations, making life easier and offering great value.

Consumers want healthcare delivered to them in a way that is a very different paradigm from the way healthcare works today.  The lack of affordable insurance on ACA exchanges, low price transparency around healthcare costs, and increasing financial burdens on consumers will drive the shift towards consumerism in 2016.

Cutting Edge Innovation
2016 will also see great advances in innovative technology and customized patient services, as well as in development of medications that provide better cures for many long-time incurable diseases.  Today, there is a wide gap between the availability of such drugs and the ability of the public to pay for these remedies that are so highly priced.  There are enormous hurdles to overcome in the implementation and acceptance of new technologies as old habits die hard.