John Sharp, MSSA, PMP, FHIMSS
Senior Manager
Health Information Systems
HIMSS
June 6, 2014
Value of Patient
Engagement
Technologies

• Patient Engagement is key to
Meaningful Use Stage 2
• Reaching the 5% participation
threshold is a challenge
• Integration of patient engagement into
a strategic initiative is the key
• There is growing evidence that patient
engagement impacts medical outcomes

• This is our goal, is it happening now?
Friend is being treated at two health systems,
both have the same EHR, PHR
• When he logged into the second PHR, it prompted him,
asking if he agreed to integrate his two medical records. He
agreed.
• The next time he saw his specialist at the first facility, she
noticed that his records from the other system had been
integrated into his record
• Lessons:
– Health information exchange works
– Should be driven by the patient’s consent
– Leads to a more engaged patient
– This is what Meaningful Use is about

Patient Engagement Defined
We define engagement as
“actions individuals must take to obtain the greatest
benefit from the healthcare services available to
them”
This definition focuses on behaviors of individuals
Relative to their healthcare
That are critical and proximal to health outcomes
Rather than the actions of professionals or policies
of institutions
Center for Advancing Health 2010

Meaningful Use Stage 2
• Provide patients the ability to view online, download and
transmit their health information within four business days of
the information being available to the EP (for EPs only) More
than 50% of all unique patients seen by the EP are provided
timely online access to their health information
• Provide patients the ability to view online, download and
transmit their health information within 36 hours after
discharge from the hospital (for Eligible Hospitals/CAHs only)
• Use secure electronic messaging to communicate with
patients on relevant health information (for EPs only) More
than 5% of all unique patients seen

Patient Activation is the First Step for
Patients and Providers
• Believing the patient role is important
• Having the confidence and knowledge
necessary to take action
• Actually taking action to maintain and
improve one’s health
• Staying the course even under stress
• More likely to have a breast cancer screen
or clinical indicators in the normal range
(A1c, HDL, and triglycerides)
• http://link.springer.com/article/10.1007/s11606-011-1931-2
Activate

Unique aspect of this standard
• Requires patient participation
• Incentivizes the provider or
hospital to engage and
motivate the patient to
participate in a portal and
secure messaging
• 87 percent – say they want to
control their health data.
(Accenture)

Blue Button as a Tool
• One solution for View, Download, Transmit
• Available for Medicare and VA patients now
• Cerner just announced its participation
• Additional Resources
– Blue Button Plus -Learn how to structure a
patient health record and how to transmit it to a
patient’s location of choosing.
– Blue Button Connector – select a source,
search to see if that source uses Blue Button,
ID yourself, download

Blue Button Plus

BlueButtonConnector

Tools - Direct Trust
A simple and standards-based way
for people to send and receive
authenticated and encrypted
health information over the Internet,

Why Patient Engagement
Blue Button Public Service Announcement

Patient Engagement Tools
• Patient Portal basics
– Appointments
– Prescriptions including refill
requests
– Results – lab, radiology, etc.
– Problem list
• Secure Messaging

Implementation of Patient Engagement
• Module from EMR vendor or add on?
• Must have the workflow in place to
manage these
– Triage workflow – similar to phone
calls – who does prescription refills,
appointment requests, when to
escalate to the provider?
• What about proxy access?
• Releasing labs – immediate or after
provider reviews?
• What are the exceptions to release of
data? Mental health, genetic testing, HIV,
cancer diagnosis, others?

Adoption Strategies
• Opt-in versus Opt-out?
Opt out gets you there faster
• Educate at the point of care
– Have patient/caregiver login day of or day
before discharge
– Education in waiting rooms
– Online how-to videos
• Educate patients about
appropriate use of
secure messaging
• Mobile

Viewing Patient Engagement as
a Checkbox
or
Adopt as a Strategic Initiative?

Meaningful Use Stage 1
• Many hospitals and providers were eager to
receive incentives
• Hurry to meet the minimum requirements
• Stage 2 – more emphasis on having an
impact on quality of care
• Should not be another check

Patient Engagement fit with Strategy
New Payment Models
•Patient Centered Medical Home
•Accountable Care Organizations
•To achieve these successfully,
patient engagement essential

Strategic Alignment
•Moving from
•Implementation of the EMR
•to
•Optimization
•Then to
•Transformation of care

Patient Engagement and
Outcomes/Value

Six Examples of Value (1)
Patient Education + Telemedicine = lower
blood pressure
Combination of patient education and remote
patient monitoring
• Reduce the average systolic blood
pressures for 34 patients by 20 points in
week
• continuing to a 30-point drop in week five

Six Examples of Value (2)
How Outcomes are achieved through patient
portals: a realist review
• 15 of the 18 Randomized Clinical Trials
demonstrated significant positive effects on
these outcomes
• No studies found serious adverse
consequences of patient portal
implementations
JAMIA 2014

Six Examples of Value (3)
Controlling asthma through apps
Pilot study from Geisinger Clinic
•50 percent reduction in the number of
people with uncontrolled asthma
among users of the device and app.
•App enables providers to check in
more often with their patients and may
help avoid asthma-related emergency
department visits or hospitalizations.

Six Examples of Value (4)
Mayo Clinic has started testing
a mobile Cardiac Rehab app
•Led to a 40 percent reduction in
admissions
•only 20 percent of participants
were admitted to the ER within 90
days
•In the control group, 60 percent
of participants were readmitted in
the same timeframe

Six Examples of Value (5)
Inviting Patients to Read Their Doctors' Notes:
A Quasi-experimental Study and a Look Ahead
• 11,797 of 13,564 Patients accessed visit notes
frequently
• a large majority reported clinically relevant benefits
and minimal concerns
• virtually all patients wanted the practice to continue
• With doctors experiencing no more than a modest
effect on their work lives, open notes seem worthy of
widespread adoption.
• Annals of Internal Medicine 2012

Six Examples of Value (6)
• Blue Button VA Users reported that:
– For 73% helps them understand their health history
better because it is all in one place
– For 72% helps them monitor their laboratory results
better
– 68% reporting that it makes it easier for them to
give others important information about their health.
– Use of the Blue Button for care coordination was
most likely in patients with diabetes or lung disease,
individuals who rated their computer ability higher,
and those who had a system for organizing their
health information.
– High rates of satisfaction
– Future work on the demonstrable impact of the Blue
Button on health behavior and outcomes

More Examples

And a Few More…
Engaging patients in medication reconciliation via a patient
portal following hospital discharge – JAMIA 2014
Out of 60 patients
– 108 discrepancies were seen
– 23 potential adverse drug events
Randomized controlled study of web-based
patient education in first time colonoscopy patients
18% less sedation medication
14% decrease in procedure time
11% more knowledgeable

Challenges of Measuring Value
Mayo Clinic – difficult to measure
changes in healthcare utilization
• Conclusions: No significant change in face-to-
face visit frequency was observed following
implementation of portal messaging.
• Secure messaging and e-visits through a patient
portal may not result in a change of adult primary
care face-to-face visits.
• Functionality of patient portal may change –
enhancements, upgrades
• Improved workflow may improve utilization

Healthcare’s new entrants: Who will be the
industry’s Amazon.com?
PwC : http://www.pwc.com/us/en/health-industries/healthcare-
new-entrants/index.jhtml

• Patient Engagement is key to
Meaningful Use Stage 2
• Reaching the 5% participation
threshold
is a challenge
• Integration of patient engagement into
a strategic initiative is the key
• There is growing evidence that patient
engagement impacts medical outcomes

• HIMSS Patient Engagement Resource Library
http://www.himss.org/library/patient-engagement-
toolkit
• HIMSS Connected Patient Community
http://www.himss.org/connectedpatient
• Blog post on Five Models of Patient
Engagement Demonstrate Value
http://blog.himss.org/2014/04/11/five-models-of-
patient-engagement-demonstrate-value/
• HIMSS Value Suite
http://www.himss.org/ValueSuite

Questions?
Contact
jsharp@himss.org
@johnsharp
LinkedIn.com/in/JohnSharp