Clarifying Patient Engagement

This entry is part 1 of 2 in the series HIT and Patient Engagement: The Cart Before the Horse

“Patient engagement is the blockbuster drug of the century” 1

…or so asserts Health Information Technology (HIT) futurist Leonard Kish. But like many transformational themes in healthcare, we do not have a commonly agreed upon definition of what exactly “patient engagement” is. Last year, the National eHealth Collaborative conducted a survey of stakeholders on various aspects of patient engagement. They found that three quarters of those surveyed believe patient engagement is a crucial factor in transforming health care transformation – but their opinions on just what patient engagement means varied greatly. Responses ranged from Patient uses educational material and online resources to learn about better health or their own health conditions to Patient emails doctor or nurse with questions to Patient makes medical appointments online. 2

Despite no clear definition, these interpretations highlight two important points. First, patient engagement strategies often involve HIT. Second, what drives patient engagement closely mirrors a crucial goal at the heart of our disparate national healthcare agenda: Donald Berwick’s Triple Aim: (1) to improve healthcare quality, (2) to increase healthcare access and (3) to reduce healthcare cost. 3

Regardless of how we define patient engagement, people from a wide variety of ideologies and political views agree on two key challenges when measuring its practical meaning and effect.

First, defining patient engagement in terms of its underlying HIT raises a question: are we doing this in the wrong order? While HIT can support the Triple Aim, we must understand the patient engagement problem before suggesting any solutions, HIT-based or not. The relationship between patients and their healthcare team is bewilderingly complex. If we proceed without a fundamental understanding, we will have trouble connecting the dots of cause and effect, leaving us prone to magical thinking about HIT “solutions” that may have adverse effects.

Second, some early patient engagement data suggests that technology – driven patient engagement can have unintended consequences, a feature we have come to expect with technology. A study published in the AMA Medical News earlier this year found that in the hospital setting, engaged patients had longer hospital stays and higher costs than patients who delegated decision making to their providers. 4

In addition, engaging patients through HIT efforts such as a patient portal can be challenging. At the 2013 HIMSS conference, Eric Manley, product manager of global business solutions at the Mayo clinic, reported that after three years, fewer than five percent of the nearly a quarter-million patients who signed up for online access through the patient portal had actually used it. To avoid these consequences, the first step is ensuring we have a full and deep understanding of the root cause of the problem.

  1.  Kish, Leonard, ‘The Blockbuster Drug of the Century: An Engaged Patient,’ HL7 Health Standards blog, August 28, 2012, retrieved on June 25, 2013 from:
  2.  2012 National eHealth Collaboration (NeHC) Stakeholder Survey Results, National eHealth Collaborative, retrieved on June 25, 2013 from:
  3.  Berwick DM, Nolan TW, Whittington J., The triple aim: care, health, and cost, Health Aff (Millwood). 2008 May-Jun;27(3):759-69. doi: 10.1377/hlthaff.27.3.759
  4.  Cook, Bob, ‘Study gauges effect of patient engagement on health costs’, American Medical News blog, June 11, 2013, retrieved on June 25, 2013 from:
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Posted on October 5th, 2013 in Innovating Health Care IT
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