Prior to the establishment of electronic health records there was often poor communication between practitioners and their patients. Initiating conversations with patients was the responsibility of the provider who was often already stretched thin. These types of conversations were not always received well, especially when they involved the patient taking some degree of responsibility for their own care, since patients were not necessarily engaged by their practitioner.
This was an era when patients looked to providers to evaluate and diagnoses them then provide them with instructions to follow. Patients often interacted with their providers only when there was something wrong with their health, so suggestions for preventive care such as screenings often were not followed. With the comprehensive electronic records that are now accessible to the patient and their providers, all health information is found in one place. This makes it is easier for all parties to grasp the patient’s health status and needs in order to work together to address these as appropriate.
Patient Engagement and Patient Portals
Several Meaningful Use Stage 2 objective involves patient engagement. Patient engagement is a crucial part of the national plan aimed at improving health and quality of care with lowered expenses. This goal focuses on patient empowerment providing for confident joint decision making with health care providers. The strategies used through patient portals to meet Meaningful Use Stage 2 objectives include regular information provision, medical feedback, individualized education opportunities and access to secure communication channels between patients and their providers. HIPAA policies include the goal of addressing patient engagement from the point of implementation using incentives for all Meaningful Use stages.
The main method of patient engagement encouraged by OMC is the use of patient portals. Patient portals provide 24 hour, secure, online access to individual health care information to patients and specified family members. OMC believes that effective use of patient portals increases engagement, improves care coordination and increases positive patient outcomes including patient satisfaction.
An important component of patient portals is the clinical summary. Clinical summaries for each healthcare visit provides basic clinical information related to the reason for the visit and how this reason was addressed, a list of any medication changes and prescriptions provided, reminders of all upcoming appointments and medical instructions given to the patient. Changes from Meaningful Use Stage 1 to Stage 2 include how quickly clinical summaries are accessible to patients. MU Stage 1 required the summary to be accessible within three days. This requirements is shortened to one day for MU Stage 2 requirements. (In order to meet this objective, providers must demonstrate that clinical summaries can be accessed within one day for at least 50% of patients seen.)
Clinical summaries increase patient involvement in care, compliance with medical instructions and patient responsibility for follow-up care. Providers can use clinical summaries to ensure care coordination meets patients’ needs. The quick turnaround required by MU Stage 2 also enhances patient engagement. The summary also provides necessary information for patient communication with their healthcare providers which is most likely to occur shortly after an appointment.
Patient portals can be used to provide educational resources specific to each patient. This encourages patient to learn more about their conditions and self-care strategies at their own pace. It also prevents patient from experiencing shame or humiliation from feeling like a physician is lecturing to them about what they must do. Many patients may not understand what their providers are telling them but will not admit this because they don’t want to appear stupid. They act as if they comprehend everything said, ask no questions, agree to comply and then fail to do so such that their health worsens by the time the next visit occurs. Both Provider and patient become frustrated, the provider due to failure to understand why the patient is not complying with important medical instructions and the patient for failure to understand why their provider can’t explain their health care status in simple terms.
The portal is under the patients control and patients don’t feel judged or shamed by the computer. Patients often view learning new information and progressing to the next lesson as similar to a video game where the patient learns certain information, demonstrates their knowledge, then moves to the next level. Simple vocabulary files can be included so that when patients don’t know the meaning of a term, they can easily look it up to better understand the material provided. The control factor is also an important feature since it alters the sense of responsibility so that it is now longer viewed as 100 percent provider based, instead seen as shared by provider and patient. General health maintenance and quality of life information can also be made accessible through the patient portal. Information about nutrition, exercise, coping with difficulties and developing social networks are a few of the topics that some providers include under the general resource tab.
With the advent of patient focused care, the goals of health care professionals have changed. Providers are now working toward making patients partners in their care and having them become part of coordinating their health care services. Practitioners believe this focus will help improve medical, psychological and quality of life outcomes. To help meet these goals, providers need strategies and systems in place to engage patients and make it worth their while to become involved in their healthcare. In addition to putting up instructions and signs in waiting rooms and addressing the use of patient portals during visits, the use of media, TV, and print options are useful strategies that can be utilized. Encouraging patients to use patient portals from their mobile devices is also important in creating a comprehensive communication platform. (Make sure patient portals include all necessary security measures to meet HIPAA guidelines before featuring this option.)
Once patients have positive experiences with patient portals they will become more likely to use them in the future until these portals become one of the sites they check regularly. For rural patients, low income patients, or those managing chronic health problems who traditionally are more difficult to engage and who display more non-compliance, extra effort needs to be used to get them to register and use a patient portal. However, the effort is well worth it. Using a patient portal helps empower such patients and increases their self-care behaviors since their perceived self-efficacy increase as does their sense of control. Meaningful Use Stage 2 objectives challenge eligible professionals and hospitals to make patient engagement an important part of their regular care provision. However, it is up to providers to not just encourage patient registration, but to ensure that patients actually use the portals since patient activity is a main measure for successful completion of Meaningful Use Stage 2 criteria.