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Beyond the Buzz: The Myths and Realities of Consumer and Patient Engagement

Posted on September 29, 2015 I Written By

The following is a guest blog post by Peter Edelstein, MD, is the Chief Medical Officer at Elsevier.
Peter Edelstein, MD
Today’s healthcare reform world is filled with buzzwords.  “Population Health Management.”  “Value-Based Care.”  “Patient Engagement.”  I am in no way suggesting that these topics do not play critical roles if we are to realize the enormous potential of healthcare reform.  However, if you ask ten people to define any one of these buzzwords, you’ll receive twelve different definitions.  And in a world of threatening reimbursement penalties and expanding healthcare legislation, the sooner that we come to some consensus on the basic meaning of these terms, the sooner we can understand the associated myths and realities.

Relative to the patient population (that is, the general population), the population of providers (doctors, nurses, and other clinicians) represents a fairly homogeneous and small group to target with initial reform efforts.  In addition, we are all painfully aware of the unacceptable number of preventable deaths and complications which occur at the hands of providers each and every day.  Thus reform legislation has first focused on reducing variability, elevating quality, and controlling the cost of care delivery through programs focused on providers (hospitals and healthcare systems, as well as the physicians, nurses, other clinicians who work in such institutions). 

Again, this makes sense as a starting point.  That said, to believe that we will achieve our ultimate goals of evolving into a system dominated by preventative care and outpatient and home health maintenance (leaving hospitals to serve only those whose chronic conditions can no longer be controlled in the outpatient setting) solely by changing how providers deliver care is a myth of epic proportions.  Far-and-away our greatest opportunity to shift our population’s health from reactive, acute, and expensive to proactive, preventative, and cost-efficient is by directly engaging and educating and empowering the general population of patients and future patients themselves. 

This perspective is based on two major realities.  First, studies (as well as our own experience) confirms that even individuals with chronic conditions spend on average only a handful of hours annually in front of a professional care provider.  (How many hours did you or your spouse spend under the direct care of a provider in the previous twelve months?  For the overwhelming majority of you, the answer is less than a couple.)  Second, patients who demonstrate interest in and ownership of their health have better clinical outcomes and reduced costs of care.  In a nutshell, people spend virtually all of their lives away from doctors, nurses, and hospitals, and as with virtually any complex processes, those who are more involved and knowledgeable have better outcomes.

Now we come up against another reality:  limited resources.  Hospitals and healthcare systems have limited staff and finances, and Patient Engagement often draws the short straw when competing with electronic health records, computerized order sets, and other provider-specific support solutions.  But, as I’ve suggested, de-prioritizing Patient Engagement as “less important” or “less impactful” is a myth which greatly limits our potential to increase the value (elevate quality/reduce costs) of healthcare delivery.  Thus, the most important first step for healthcare stakeholders to accept is the reality that assigning resources to Patient Engagement must be as great a priority (if not greater) as allocating staff and money to products and solutions which target only traditional providers.

Once healthcare leaders accept the critical importance of Patient Engagement, they again have to consider their limited resources.  It is another common and perilous myth when trying to allocate resources and develop and implement Patient Engagement strategies to consider all patients within a healthcare system’s catchment area as a homogeneous population.  The reality here is that not all individuals have the same potential for or barriers to becoming engaged patients.  And understanding with which patient subpopulations you can get “the most bang for your buck” is a necessity which is often overlooked. 

For example, any of us who have directly cared for a large cohort of patients knows that there are some individuals (comprising a patient subpopulation) who simply have no intention of ever lifting a finger to care for themselves.  I think about the roughly 50% of Americans with chronic conditions who fail to take their medications as prescribed.  Or the diabetics who simply cannot be troubled with checking their blood sugars.  Every provider can immediately call to mind dozens of patients who, understanding how to better their own health, simply refuse to do so.  The reality is that as in all areas of life, there are simply some people who just will not engage, be accountable, take ownership.  To waste valuable resources trying to engage this patient subpopulation is foolish, disillusioning for staff, and wasteful, and it is best to quickly identify these individuals and accept that all you can do is provide reactive care when they become ill.

A second and large patient subpopulation is well worth the resources and efforts to engage.  These are the folks with limited literacy and numeracy skills.  Multiple studies have demonstrated the inverse relationship between literacy and healthcare outcomes.  Thus, assigning resources to clearly engage and educate these individuals so that they have the knowledge and understanding necessary to engage is worthwhile.

The third large patient subpopulation worth targeting is comprised of people whose upbringing or culture serves as a barrier to engagement.  Perhaps the largest of these cohorts is elderly Americans, many of whom were raised never to question a physician or ask for clarification.  Such patients are unable to engage because they refuse to address their lack of understanding of recommendations for their self care.  Another large faction are those who were raised in cultures (often outside of the United States) where, as with elderly Americans, the provider is God, never to be questioned.  Thus, these folks don’t really understand what they can do to improve their health, and they refuse to ask for further clarification.

The reality for these two large patient subpopulations is that the appropriate use of resources to understand and directly address the obstacles to true engagement and education can result in great successes.

In the end, our ability to achieve truly dramatic and impactful healthcare reform depends to a great extent on engaging and educating the patients of today and tomorrow.  Appreciating this reality, and understanding the realities related to identifying patient subpopulations which can truly be engaged and educated is the best approach to achieving successful reform.

About Peter Edelstein, MD
Peter Edelstein, MD, is the Chief Medical Officer at Elsevier. Edelstein is board certified by the American College of Surgeons and the American Society of Colon and Rectal Surgery. He has more than 35 years of experience practicing medicine and in healthcare administration. Edelstein was in private practice for several years before serving on the surgical faculty at Stanford University, where he focused on gastrointestinal, oncologic and trauma surgery. He then spent more than a decade as an executive in the Silicon Valley medical device industry. Edelstein’s most recent role was as Chief Medical Officer for the healthcare business at LexisNexis Risk Solutions, a Reed Elsevier company. He is also the author of the recently published book, ‘Own Your Cancer: A Take-Charge Guide for the Recently Diagnosed & Those Who Love Them’.

The Next Major Healthcare Product – Care Management System

Posted on May 1, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While meeting with a lot of people at HIMSS I started to think about what would be the next “must have” IT system that a healthcare organization would look at purchasing. When you look back at the history of IT purchases in healthcare, the Practice Management System (PMS or PM depending on your preference) was one of the first systems that most practices purchased. It was an easy buy for most people. They saw a lot of value to digitize the billing side of their practice. Adoption of practice management systems was widespread. Everyone was and is using one.

After the practice management system came the Electronic Health Record (EHR, but many could argue that EMR came before EHR, but that’s semantics in my books). Over the 10 years that I’ve been blogging about EHR software, we’ve seen the evolution of people asking if they should buy an EHR software to everyone realizing that they needed to go electronic but were trying to figure out which solution was best to $36 billion of government money which basically had the vast majority of doctors choose to hop on board EHR. While we don’t have 100% EHR adoption, we’re getting there. The market for EHR purchases is quite mature now.

With that as background, I’ve been thinking about what system or platform would be purchased next by a practice. I asked a number of people at HIMSS about this. Dr. Tom Giannulli from Kareo suggested that Care Plan Engagement could be an interesting next step. With the coming ACOs and value based reimbursement, you can see where Dr. Tom is coming from in his thinking. Plus, his term mixes the meaningful use term of patient engagement with the care plan approach that’s likely going to be required in future business models.

When I sat down with Carl Ferguson from CTG, he called the next product a Care Management System. When I heard it, I thought that this term could have staying power. The practice management system manages the practice (ie. billing). The electronic health record stores the records electronically. The Care Management System is going to be centered on the patient and the care that a patient receives.

What do you think of the term: Care Management System? There were probably a hundred products at HIMSS that have started to build a product like this. Although, I think a care management system would probably have to be a combination of a number of products out on the market today.

Regardless of what we call it, I think what will set apart the next big healthcare IT product offering is that it will be centered around the patient. A care management system by its very nature would have to be interoperable since the care is being given across multiple organizations. A care plan would make since because the patient’s at the center of the care management system and everyone could be involved in creating the care plan and ensuring that the care plan is being followed. At first take, I really like this terminology and I hope it gains some traction.

One challenge with the term Care Management System is that the abbreviation is CMS. That abbreviation is already quite popular with the government organization (CMS) and also the popular Content Management System (CMS). Although, if that’s the biggest problem with the term, then I feel pretty good about it. Although, this does make me wonder if we’ll go back to the age old integrated PM/EHR debate again when it comes to an integrated EHR/CMS. Will EHR vendors see this opportunity and offer a Care Management System module for their EHR? Some probably think they already are doing that.

13 Insights for Conquering Healthcare Challenges

Posted on April 30, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently asked to take part in a “From the Experts” series where they asked us to contribute an insight into how you conquer the healthcare challenges of the future. My response was, “The most valuable prep for #valuebasedcare is to create deep patient connections.” I think that’s still really good advice for healthcare organizations.

Check out the other 12 insights from a wide variety of experts in this embedded slideshare below:

What’s Your Value Based Care Strategy? What Role Does IT Play?

Posted on February 23, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I pretty regularly take a look at various healthcare IT whitepapers to glean insights into what’s happening in the industry and what advice vendors are offering healthcare organizations. I’ve been keeping a special eye on the changing reimbursement model and move to value based care and so I was interested in this whitepaper titled “How to Win with Value-based Care: Developing Your Practice’s EHR Strategy.”

The whitepaper starts with a dive into some of the changing care and reimbursement models that are emerging in healthcare. Then they offer this 4 step “Winning Strategy” for being ready for these changes:
Step 1: Assess your current situation
Step 2: Develop a customized VBC Plan that’s right for your practice
Step 3: Determine IT solution needs
Step 4: Implementation

In many ways, this 4 step plan could be applied to any project. Of course, the whitepaper dives into a lot more detail for each step. Although, I was struck by step 3. It takes for granted that value based reimbursement will require an IT solution. This whitepaper comes from a healthcare IT company with some value based IT product offerings so you have to question whether IT will be at the core of a practice’s value based care strategy or not.

As I think about the future of coordinated care and value based reimbursement, I think it’s more than fair to say that technology will be at the center of these initiatives. Value based care requires data to prove the quality of the care you’re providing. Certainly you could try and collect some of this data on paper, but does anyone think this is reasonable?

Try identifying all overweight patients in your patient population using paper chats. I can see in my mind’s eye an army of medical records professionals sifting through stacks of paper charts. It’s not a pretty solution and it’s fraught with error. That’s one query on an EHR system.

One of the biggest elements of value based reimbursement will be communication with patients. Can we build that real time communication on the back of snail mail? It sounds almost silly talking about it. Of course we’re going to use mobile devices, secure messages, and even secure video communication. We still have A LOT of work to do in this regard, but it’s the future.

Of course technology is going to be at the core of value based reimbursement. It’s the only way to accomplish what we’re striving to accomplish. The next question is: will the EHR make this possible or are we going to need something new and more advanced?

What Is the Future for Rural Physicians? Is There One?

Posted on January 28, 2015 I Written By

Value based payments.  Value based care.  Meaningful  use.  Is there a place for an independent doctor in a suburban location?  This article says that these and all the technology to go with them along with physician acceptance is “Inevitable”.

I have four physicians.  I don’t see a place for them long term.  My first is my Internist.  A few years ago he was given a cell phone as a gift.  It does all he will ever want.  If it rings, he answers it.  If he has to make a call, he dials the number.  He has no computers in his office.  All his files are paper.  As a Doctor he is recognized as one of the best in the state. EHR is not in his future.  Phones, fax, copier suit him just fine.  The article that raised these questions for me was a report from Deloitte.  You might end up with some of the same questions after reading it. 

My second physician has been using EHR for as long as I have known him.  He has 2 offices and four other doctors working for him.  He needs the technology.  He hates it, upgrades only when he has to and would never do it again.  He is also recognizes as one of the best in the state.  His daughter is now in her residency and will join him next year.  My gut feel is that in 3-4 years he turns the business over to her, let’s her worry about it and sails off into the sunset.

My radiation oncologist was great.  He treated me 8 years ago.  My last visit with him was 4 years ago.  The company he worked for terminated him for not generating enough revenue.  His waiting room was always filled but with little to no wait.  His staff was great and could have easily made more money by moving to a large city.  They, like he, enjoyed the suburban life.  All were dumbfounded when he was terminated.  They also learned that for this big city practice, profit was the only incentive.  He’s in FL now, out in the sticks and owns his own practice.

Doctor #4 is a general surgeon.  He is probably the only one that could/would survive in the “inevitable market”.  His office is at the medical arts building at the local hospital.  There are 3 other surgeons in his practice.  He has a fairly up to date computer system,  though not in his location and not compatible with the hospitals new system.  I know that his definition of value based anything and mine differ.  On my last visit he kept me waiting for 45 minutes because lunch went longer than scheduled.  He’s all business.

For 3 of these 4 I see the choice of conforming and or selling out.  They are all rated in the top 25 physicians in the state.  They are not going to increase their patient base to increase revenue.

I am sure that Doctor #4 will succeed. He is all and only business.  He holds the purse strings for his practice and has absolutely no problem in spending whatever it takes for technology to increase profit.  As long as he doesn’t have to use it.

The area that I live in is not unique The hospital‘s area of reach is a bit under 60,000.  As part of that is a resort area, add another 10K for the summer months.  Is there a future for physicians like this?  If so, what will they need to do to stay viable?  Hire a business manager?  More nurse Practitioners?  Sell, retire or join together a form their own physician groups?  Any thoughts?