The Two-Way Street of Patient Engagement in Health IT
By Jane Sarasohn-Kahn

In 2005, President George W. Bush channeled Harry Truman's "chicken in every pot" moment saying that "within 10 years, every American must have a personal electronic medical record." That vision is coming into view under President Obama. HHS has undertaken a major push to get U.S. citizens to understand the concept and value of electronic health records.

As that old "Field of Dreams" effect goes, "If you build it, they will come." But, will patients really want to engage with health IT?

Consumers Want Online Health Data Access

Consumer surveys conducted in the past 12 months show most U.S. adults are interested in various aspects of electronic health information. Three-quarters of people would use a secure online tool to make it easier to communicate with the doctor's office, according to an Intuit poll conducted in January 2011. Furthermore, one-half of those interested in online access to doctors would consider switching doctors to one whose office offered secure online access.

If people could securely connect with doctors, Intuit found, 51% would ask care-related questions. Thus, interest in online connections with doctors' offices goes well beyond appointment scheduling (the top-desired electronic function, with 81% saying they would use it), prescription requests (68%), obtaining lab results (62%), completing medical forms (59%), and reviewing and paying bills online (53%).

Another survey, conducted by Dell in February 2011, asked U.S. adults what capabilities and tools should be implemented to improve the patient experience. Three out of four people said they would like "EHRs to be shared between [their] physician, hospital" and other health care providers. Furthermore, seven in 10 people would like to be able to email with their doctor, and 61% want access to their personal health record through a Web portal or private website.

Concerns About Security, Privacy Persist

While findings about U.S. health consumers' interest in electronic health data are welcoming, concerns about data security and privacy could put the brakes on patient engagement in health IT.

The Dell survey found that two-thirds of respondents were concerned about health data security. Six in 10 respondents also were worried about hospitals and health care providers adhering to privacy laws such as HIPAA, and nearly 50% of people fretted about their health data being shared between hospitals.

The 2011 SailPoint Market Pulse Survey echoes consumers' worries about potential exposure of their personal health information as health care providers transition to EHRs. According to the survey, consumers' top concerns about moving their personal health data to EHRs are:

• Identity theft;
• Exposure of personal health data on the Internet;
• Employers finding out about a personal medical condition; and
• Personal health information being viewed by parties not directly involved in their care.

Consumers may be well-justified in these concerns. In a September 2011 report, titled "Old Data Learns New Tricks: Managing Patient Privacy and Security on a New Data-Sharing Playground," PricewaterhouseCoopers' Health Research Institute focused on a survey of health executives' approaches to protected health information. Only 58% of health insurers reported including appropriate EHR use as a component of employee privacy training. Of health organizations sharing data externally, only one-quarter have executed data sharing agreements with all of their business partners.

The emerging mobile health communications platform is adding complexity to securing protected health information. PwC found that more than one-half of health organizations have not yet addressed privacy and security challenges of mobile devices. Fewer than half have included the approved uses of social media and mobile devices into their organization's privacy training.

The conundrum is that privacy concerns might be keeping many health organizations from engaging with patients via digital communication platforms.

How To Bridge the Gap

What will bridge this gap to open up that two-way street between health care providers and patients through the shared use of patients' personal health information? Consumer demand seems to be shifting toward embracing EHRs and, ultimately, the PHR portals their providers will enable. Manhattan Research's 2011 Cybercitizen Health survey shows a substantial uptick in U.S. adults' interest in electronically accessing health information.

So when will consumers push that Blue Button to access their health data? As in the adoption of all new technologies, there will be a first generation that will demand immediate access to their EHR data. That health-engaged, pioneering group of health consumers and caregivers will already be informed about and motivated to use health IT.

HHS also hopes people will be inspired to engage in health IT once landing on the new HealthIT.gov website. According to Peter Garrett of the Office of the National Coordinator for Health IT, the website "lets personal stories fuel the national movement toward adoption of EHRs. It puts the 'I' in Health IT." If a consumer visits Healthit.gov, they will see a tab under the "Patients & Families" folder on "Protecting Your Privacy & Security." HHS wisely put this topic top and center on the consumer health IT landing page.

Not everyone is engaged in their health or health care. The 2011 Edelman Health Barometer, which measured digital engagement in health, found that globally, 21% of people are at one end of the spectrum, and are "actionists" who use the Internet for health information at least weekly. At the other end of the continuum are the 23% of people who are offliners and "never" use the Internet for health information. What about those in the middle who are neither uber-engaged nor "never" engaged?

In the two-way street that is patient engagement, it is health care providers who will play a key role in getting the mass-middle of people more involved in their health data. That may be a lot to ask of health care providers given their already-cramped workflow, but doctors and hospitals will be motivated by at least two market drivers: payment and consumer pressure. 

On the financial front, hospitals will have a hard dollar incentive to reduce readmissions for acute myocardial infarction, congestive heart failure and pneumonia under the federal health reform law. Patients who are more engaged have better health outcomes.

In an effort to encourage patients to better monitor their health conditions, health care providers should offer discharged patients access to personal health records, patient portals and remote monitoring tools to discharged patients.

Meanwhile, as the Intuit survey found, many patients want electronic access to their health care information and could leave their doctor's practice if it is not available.
 

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