ONC puts forth patient engagement action plan

With the number of Medicare beneficiaries rapidly growing and more Americans qualifying for Medicaid and private insurance under healthcare reform, the Office of the National Coordinator for Health IT (ONC) is trying to align efforts in patient engagement with consumer e-health.

“The full potential of consumer e-health is far from realized and may not even yet be fully understood,” Office of Consumer eHealth Director Lygeia Ricciardi and other ONC officials wrote in February’s Health Affairs. Ricciardi and colleagues say the current trajectories of both health IT and mobile technologies “have created ideal conditions” for the growth of patient health IT.

Despite the rapidly growing number of mobile health apps, increasing use of patient portals and Meaningful Use incentives regarding personal health information tools, obstacles remain. One “major obstacle to greater use of health information in electronic form appears to be lack of access, not lack of interest,” the authors wrote.

In a 2011 Deloitte survey of U.S. adults, 65 percent of respondents considered online access to their health important, but only 17 percent actually had access. Approximately 85 percent of respondents wanted the ability to email or call their providers, but only 10 percent were able.

Among certain demographics, though, consumer e-health has grown organically, Ricciardi and colleagues wrote. Patients with chronic conditions are increasingly using mobile health tools like diabetes and medication management apps, and many also use online patient forums and chat rooms. Medicare beneficiaries are turning to mobile and online apps like the Blue Button, too, with 17 percent of American seniors using personal health records, the highest proportion of any age group, according to the Ricciardi and colleagues.

The idea, Ricciardi and ONC colleagues argued, is that wired patients tend to be more engaged with their healthcare and can in turn be smarter consumers, finding the best quality and most cost-effective services.

A study of patients with chronic conditions by the American Association of Retired Persons (AARP) found that “activated” patients comfortable self-managing their care decisions were about three times less likely to suffer negative health consequences from poor communication among providers, compared to less engaged patients. The more activated patients also were twice as likely to avoid a hospital readmission and were half as likely to experience a medical error.

The recent burgeoning of e-health and mobile health follows the past decade’s growth in internet use and the e-consumerization of retail, travel, banking and other industries. Technology is “rapidly democratizing information,” Ricciardi and colleagues said, and as the ONC tries to help expand access to personal health technologies, they’re also promoting the idea of evolving provider-patient expectations, toward “a less hierarchical, more collaborative partnership.” Several trends suggest a strong potential for growth in consumer e-health, according to the article, including the rapid democratization of information, health IT adoption is increasing and the rising consumer financial responsibility in healthcare.

ONC is using Meaningful Use incentives to encourage the spread of that collaboration. Stage 2, starting in October for hospitals and January 2014 for eligible physicians, requires providers to have secure email available to patients, as well as offer ways to view, download or share the information. They also must achieve a certain percentage of their patients actually doing so.

The agency has boiled its national action plan for patient engagement to increase access, enable action and shift attitude. Patients “need to feel comfortable requesting electronic access to their health records, asking providers questions, sharing their own health knowledge and weighing in on treatment options,” Ricciardi and colleagues write. “A cultural shift—among patients and providers—is necessary to support these kinds of behavior.”

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