Can someone do my Week 5 discussion IN MHA 616 Health Care Management Information Systems

CHAPTER 10Engaging Patients and Consumers in Managing Their Health

LEARNING OBJECTIVES

To describe how various digital health tools may be used to promote and enhance patient engagement in managing their health and care.

To discuss how a patient engagement framework can be useful to health care organizations/providers in considering strategies and tools for engaging patients more fully in managing their heath.

To discuss the purpose and use of patient engagement tools, including patient portals, personal health records, remote patient monitoring, health apps/wearables, the Internet and social media, and telehealth.

To identify the challenges associated with incorporating patient-generated health data effectively into the care process.

To explore new entrants in the patient engagement space and direct-to-consumer health care.

It has been over two decades since the Institute of Medicine (IOM) called for reforms to achieve a “patient-centered” health care system. The report envisioned a system that provides care that is “respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” (IOM, 2001). Out of this recognition, in part, the concept of patient engagement emerged. Studies have shown that patients who are actively engaged in their health and care are more likely to have better outcomes at a reduced cost. Engaging patients and their families/caregivers in managing their health and health care has become the cornerstone of a patient-centered health care system and vital to achieving the Triple Aim. It has also become an important strategy for health care organizations and providers in managing population health more effectively under value-based payment.

From their experience of care perspective, patients are expecting the same level of ease and accessibility in health care as they do in other areas of their lives, whether it is making airline reservations, ridesharing using an app, or e-commerce (getting recommendations, shopping easily, and having things delivered to home (Fields & Gandi, 2019)), the rapid and expansive shift to offer care remotely and safely during the COVID pandemic, many patients and consumers had the opportunity to experience the convenience of telehealth. With the genie out of the bottle, offering appropriate services via telehealth and embracing other digital tools to engage patients are likely to be an integral part of health care delivery in the years to come.

Patient engagement is a widely used term, but is often a poorly understood concept in health care. It is often used synonymously with patient activation and patient- and family-centered care. In this chapter we define each of these terms and their relation to patient engagement. Health care organizations and providers offer digital health and digital tools as a means to improve patient engagement and transform health care delivery. We focus attention on specific digital tools designed to foster patient engagement by enabling patients to access their own health information, communicate with providers, seek and obtain health services, and manage their own health.

The chapter also introduces the Patient Engagement Framework developed by the National eHealth Collaborative and Healthcare Information and Management Systems Society (HIMSS). The framework illustrates the various degrees and levels of patient engagement and provides examples of how digital tools may be used to engage patients in managing their health and care. We describe the adoption, use, and application of patient engagement tools, including patient portals, personal health records, remote/home monitoring, health apps and wearables, and social media, along with advances in telehealth, and discuss strategies for incorporating them into the care delivery process. The chapter concludes with a description of how companies such as Apple, Amazon, and Google are seizing the opportunity to implement products and services that promote and support consumer engagement in health.

DIGITAL HEALTH AND THE EMPOWERED CONSUMER

DEFINITION OF DIGITAL HEALTH

The concept of “digital health” has become a buzzword in contemporary literature, often without a uniform definition or understanding of it. According to HIMSS, digital health “connects and empowers people and populations to manage health and wellness augmented by accessible and supportive provider teams working with flexible, integrated, interoperable, and digitally enabled care environments that strategically leverage digital tools, technologies and services to transform care delivery” (Snowdon, 2020). Valued at $96.5 billion in 2020, the digital health market is expected to grow at a compound annual growth rate of 15.1% from 2021 to 2028 (Grand View Research, 2021). Other terms often used to describe digital health include “mHealth” (mobile health), “eHealth” (technology and digital applications to assist patients in their health), “ePatient,” virtual care, and telehealth. Digital health is introduced here in the context of patient engagement, and the vital role health care providers and organizations have in partnership with patients in realizing its potential.

Under the broad umbrella of digital health, there is a vast array of patient and consumer digital tools, everything from patient portals to health apps, to sensor-based tracking systems, health-related social media and online social networks, telehealth systems, and wearable devices. Use of health apps/wearables and patient remote monitoring technologies generates patient health data that may be relevant to managing care and chronic conditions. Incorporating patient-generated health data (PGHD) in clinical care can empower patients more fully in clinical decision making (Lavallee et al., 2020). Thus, health care executives should have a fundamental understanding of the common digital tools and platforms for engaging patients in managing their health and care, and how these tools may be incorporated into the care delivery process and overall health IT strategies and solutions to achieve organizational goals related to patient access, quality, and cost. Before describing the various digital tools, we begin with a general overview of patient engagement.

PATIENT ENGAGEMENT OVERVIEW

TERMS, DEFINITIONS, AND ATTRIBUTES

Patient engagement is a frequently used term to describe the concept and importance of actively involving patients (and their families) in decisions regarding their health, wellness, and care. Studies show that patients and their families who actively engage with their health care providers and care teams have better outcomes, often choose less costly care, and express greater satisfaction with their health care experiences (IOM, 2012). When Don Berwick, MD, MPP, former Centers for Medicare & Medicaid Services (CMS) administrator and president emeritus of the Institute of Healthcare Improvement (IHI) states, “the most direct route to the Triple Aim is through implementation of patient and family-centered care in its fullest form” (Berwick, 2012), he acknowledges the importance of patient engagement.

Terms often used synonymously with patient engagement include patient activation and patient- and family-centered care. Patient activation refers to a patient's knowledge, skills, ability, and willingness to manage his or her own health and care (James, 2013). Activation is one aspect of an individual's capability to manage health and engage in care but does not address the individual's external context, such as the environment in which the patient lives; nor does it focus on behavior (Carman et al., 2013). Patient- and family-centered care is an approach to health care delivery that is grounded in mutually beneficial partnerships among health care providers, patients, and families. According to the Institute for Patient- and Family-Centered Care, “it redefines the relationships in health care by placing an emphasis on collaborating with people of all ages, at all levels of care, and in all health care settings. In patient- and family-centered care, patients and families define their ‘family’ and determine how they will participate in care and decision-making. A key goal is to promote the health and well-being of individuals and families and to allow them to maintain their control” (Institute for Patient- and Family-Centered Care, n.d.). For example, in patient- and family-centered care, the patient's needs and desired health outcomes are the driving force behind all care decisions and quality measurements. Patients and families are viewed as partners with health care providers, and providers may consider the patient's needs not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.

Patient engagement is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care or exercising regularly (James, 2013). It is also congruent with the values of patient- and family-centered care. Higgins and colleagues (2017) identified four attributes of patient engagement: personalization, access, commitment, and therapeutic alliance (Higgins, Larson, & Schnall, 2017).

Personalization: The need to tailor interventions or strategies to care according to the unique needs and circumstances of the individual patient. Appreciating the individual patient's health literacy, cultural background, attitudes toward health interventions, and availability of caregiver support system are all important factors that may inhibit engagement of the patient.

Access: Includes the ability of the patient to confidently access and understand important information about their care and health status. Included are factors such as functional literacy status, geographic location, or socioeconomic status.

Commitment: The cognitive and/or emotional factors that motivate the patient to use the resources available.

Therapeutic alliance: Sustains the patient's connection with the provider within the care delivery system, potentially creating an effective partnership in pursuit of the patient's health goals (Higgins et al., 2017, p. 32).

Understanding and appreciating these four attributes can be incredibly important in formulating and implementing a health care provider's strategy for fostering patient engagement in an impactful way. For example, simply providing individuals with access to a patient portal is of little value if the patient does not have access to technology, is unable or uncomfortable using it, or fears his or her privacy will be negatively impacted. In fact, studies have shown that differences in access, adoption, use, adherence, and effectiveness of digital health tools can contribute to health disparities (Nouri et al., 2020; Veinot, Mitchell, & Ancker, 2018).

The attributes of personalization and access are particularly relevant in the context of ensuring health equity and access to all patients (Higgins et al., 2017). Personalization requires that providers consider the individual needs and expectations of patients. Access requires that providers consider the patient's functional ability, health literacy, and health status. Vulnerable populations, such as the elderly, individuals with low-income levels, or those with limited English proficiency, for example, may require additional support and options (Carman et al., 2013).Not only do providers need to be aware of these barriers but developers of digital tools also need to consider factors such as access and usability among diverse groups of users.

Besides considering the patients’ “readiness” for engagement, providers and care team members also need to be onboard. If the provider worries that giving patients access to their notes in the electronic health record will make them more vulnerable to litigation or add to their workload through increased patient questions/concerns, they may be less likely to support the effort. Providers can also offer insight into the patients’ needs and limitations as well as workflow issues. In a recent study examining care team members perspectives on the use of an inpatient portal, participating providers offered suggestions for best meeting the needs of older patients, training patients on tablet and portal use, and allotting time to answer patient questions and requests (McAlearney, Hefner, et al., 2020). The researchers found that understanding the care team members’ experiences were critical to the successful integration of the portal into their workflow (McAlearney, Hefner, et al., 2020).

Given that digital patient engagement tools often require interaction, collaboration, and communication on both the patient and the provider (or care team)'s part, actively involving both in the design and implementation is important. Hospitals and health systems with more engaged leadership and more integrated IT systems are more likely to have advanced patient engagement functions (Holmgren, Phelan, Jha, & Adler-Milstein, 2021).

PATIENT ENGAGEMENT FRAMEWORK

Before delving into the various patient engagement digital tools, platforms, and technologies, we begin with a conceptual model or framework for patient engagement that illustrates the different levels of patient engagement and different types of digital tools/strategies that may be employed. The Patient Engagement Framework was initially developed by the National eHealth Collaborative, and later expanded upon by the Health Information Management Systems Society (HIMSS) (Walker, Sieck, Menser, Huerta, & McAlearney, 2017). More than 150 health care providers, health services researchers, and sociotechnical experts contributed to its development. The Patient Engagement Framework serves as guide to health care organizations as they develop and implement IT aimed in involving patients in their care process. The framework defines five successive levels of patient engagement: (1) inform me, (2) engage me, (3) empower me, (4) partner with me, and (5) support my e-community. (See Figure 10.1.) It was originally developed to correspond with CMS Meaningful Use criteria. Although the Meaningful Use program has ended and evolved into the Promoting Interoperability Program, the framework remains a useful tool for visualizing different types of digital tools that can be used to advance and support patient engagement.

Walker and colleagues (2017) used the Patient Engagement Framework to evaluate the state of US hospitals and their use of IT and digital tools to engage patients in 2017. They employed an ontology mapping approach where items from the American Hospital Association IT Supplement were mapped to defined levels and categories within the Patient Engagement Framework. Thirty-six functions were mapped to the each of the five levels in the Patient Engagement Framework. (See Table 10.1.) Although examining the methods used is beyond the scope of our discussion, the framework illustrates two important points.