Improving Patient Engagement with an EHR

One of the most prevalent concerns in implementing a new EHR is making sure it works for all of the stakeholders in the project. A lot has been said about selecting a system that works for doctors, administrators and staff at all levels. But as healthcare has long been resistant to making patients an equal partner, they are often left out of the process,which makes the changeover hard to explain to them. Imagine being a regular patient in a doctor’s office, and one day you are told “sorry for the troubles, but we are switching to a new computer system.” I’d want to know how this system is going to aid my care. While meaningful use stage 2 (as well as some of the proposed guidelines for stage 3) calls for greater patient engagement in healthcare, the things that are required seem to only scratch the surface of what can be done if we try to explore the possibilities of using technology to engage patients.

There are several different levels in which providers can take advantage of their EHR to make the patient realize new benefits to their care. The simplest level is to give the patient access to their notes and summaries of their visits. A recent study published in the Annals of Internal Medicine indicated that in a series of situations where patients were allowed access to read their physicians visit notes, not only did most of them take advantage of this option, but over 75% felt like it helped them feel in more control of their healthcare. Nearly everyone who took part in the experiment, both providers and patients, indicated a desire to continue these activities afterwards.

The National eHealth Collaborative, a group promoting further health information exchange, has identified 5 levels of patient engagement. These levels are, essentially: “Inform, Engage, Empower, Partner, Support.” Each of these levels offers a new opportunity for patients to improve the relationship the have with their provider and get the most out of new technological advancements. “Inform” is more or less the basic standard required right now, including providers making tools and forms available to patients. “Engage” takes it one step further, inviting patients to use electronic tools to keep track of their health status. This could be as little as using the computer to schedule appointments or to keep track of eating and exercise habits or pregnancy markers. These items could then be easily shared at the next visit.

It is when we reach “Empower” that we start covering what many see as unexplored territories. In this stage, the patient can start doing things like exchanging messages to the provider regarding health issues. Giving patients access to their health record can allow them to do things like ensure that what their doctor sees is what they see, as well as basic levels of patient generated data. One suggestion at this level might be allowing patients to fill out some of the pre-appointment issues, like past medical history and family history when they are at home, where there is less of a concern over ensuring accuracy within a limited timeframe. Further stages within this framework take these elements farther. “Partner” takes patient generated data further, encouraging reporting of all types of clinical lists, including medicines, allergies and advanced directives. Additionally, it adds a level of collaborative care allowing providers and patients to share records with other doctors. The final level “Support” involves an entire e-community including features like advanced telemedicine, a complete collaborative care record, and the possibility of a medical home.

While the future goals for meaningful use call for certain aspects of patient engagement, it is not quite clear yet how far we can go regarding improving patient engagement and access to healthcare. Much of it depends upon how much each specific patient desires to do in order to have greater control over his or her healthcare. The truth is that we really don’t know all the possibilities that might become open to doctors and their patients as technology evolves. But healthcare organization that offer their patients these options, or at least begin to explore the possibility, can engender a level of support from their patients beyond what exists today.

Further readings:

5 stages of patient engagement

Patient Engagement Framework

Study from Annals of Internal Medicine:

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