Physicians have long understood the value of engaging patients in their health, their care, and their recovery.
The technologies available for fostering this engagement, however, have traditionally been quite limited: think informational print-outs and a telephone call or two. The advent of the web-based patient portal boded well for increasing patient engagement. But even this tool now feels dated due to its passivity. A portal is inert until accessed; it requires patient engagement, but does not necessarily encourage it.
New tools that take advantage of simple but effective communication methods with daily check-ins and notifications are finally fulfilling some of the long-held hopes around greater patient engagement. This article discusses the five areas where greater patient engagement is proving to be a game-changer, and provides examples about the concrete and measurable strides being made in these areas today.
1. Patient Satisfaction
Many investigations of the factors influencing patient satisfaction conclude that it boils down to one simple wish: Patients want to feel like they matter to their physician and care team. A 2015 Johns Hopkins study analyzed the ways hospitals and physicians could reinforce that feeling, and found that providing a high level of attention and “commitment” had significant impact. Because physicians face countless demands on their attention, though, the only way to increase the attention given to their patients is to a) place fewer demands on their time or b) to provide tools that help extend contact with patients—without adding another item to the physician’s to-do list. Automated messaging technology such as daily notifications (a text or email triggering the patient to “check-in online”) tailored to the patient’s condition or status (recovery after surgery or successful management of a chronic illness) is an example of this second approach.
Daily notifications that include important health information can be sent automatically from the physician’s address to the patient. This form of communication means that patients receive information in a digestible, appropriately timed manner—rather than as an (often unread) stack of instructions or in a rush as the patient is discharged. The regularity of these messages gives patients the sense of a true, ongoing partnership. Information also flows the other way: in responses to automated questions or messages, patients give their providers a glimpse into the barriers they face, or into other unexpected factors shaping their illness or recovery. This information helps physicians better understand their patients and meet each individual’s specific needs, which further increases trust and a sense of partnership. For instance, physicians at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles found that patients’ satisfaction was significantly increased with the use of automated messaging technology (compared to those who didn’t receive that communication). Researchers noticed a significant increase in Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery survey scores—the “HCAHPS for ASCs”—as well.1
2. Treatment Effectiveness
Noting that approximately 50% of patients do not take their medications as prescribed, a Mayo Clinic Proceedings article observed that “The more empowered patients feel, the more likely they are to be motivated to manage their disease and adhere to their medications.”2 Messaging technology can deliver information about how medications should be taken or when they reach milestone during the post-operative phase, but it can also be used in real-time as a reminder to take medications.
Patient adherence to pre-operative preparation guidelines, medicine and treatment protocols, and post-operative instructions can make an enormous difference to their health outcomes. This direct impact makes patient compliance the area where patient engagement may be discerned most easily. For instance, a study done by the MD Anderson Cancer Center in collaboration with HealthLoop found that only 21% of patients who had received printed materials correctly identified what ionizing radiation was, while 66% of patients who used the digital patient engagement platform did.
3. Reduction of Readmissions
The Centers for Medicare and Medicaid Services (CMS) estimates that the health care system spends over $26 billion per year on avoidable readmissions for seniors, as nearly one in five Medicare patients discharged from a hospital are readmitted within 30 days.3 The penalties introduced by the Hospital Readmission Reduction Program (HRRP) have helped prompt a modest decrease in these rates of readmission, but there is still ample room for improvement.
Patient engagement, particularly when it is actively supported by physicians and hospitals, can prevent those readmissions that are potentially avoidable. One reason for this is that engaged patients can flag problems they’re experiencing before those problems become complications requiring readmission to the hospital. A study done by Anthem in collaboration with HealthLoop found that automated messaging technology led to a 45.4% reduction in 90-day hospital readmissions, a 54.4% reduction in 90-day surgical complications, and an average savings of $656 per case. Another study done at University of California at San Francisco found that HealthLoop’s technology reduced 30-day readmissions from 4.3% to 1.2%, a relative reduction of 70% that was statistically significant.
Many readmissions happen in that vulnerable period between when patients get discharged and when they manage to get a follow-up visit with their physician, so contact with the patient during this time of heightened risk is crucial for tackling readmissions. Automated, regular communication can uncover problems that can often be addressed in a less acute setting.
Hospitals and physicians can also use this information to inform quality improvement efforts. Because CMS analyzes avoidable readmissions on an annual basis, hospitals cannot rely on CMS for timely insights into the cause of readmissions. Post-discharge communication between patients and physicians can fill in many of those blanks.
Readmissions are both a quality concern and a financial consideration for hospitals. It is likely that these two aspects will meet in the near future as patients consider readmission rates when they decide where to have a procedure done or which physician they select. Already, ProPublica has built a Surgeon Scorecard that includes readmissions among its benchmarks for physicians and hospitals. This area promises to have a greater impact on consumer choice as other, similar resources emerge.
4. Patient Safety
Most patient safety initiatives focus on what happens inside the hospital. Automated messaging technology, detailed and right-timed advice, and a communication channel that isn’t subject to “phone tag” help hospitals keep the focus on patients even after they leave the premises.
Such technology has saved lives, specifically by reinforcing the symptoms of possible complications such as deep vein thrombosis (DVT), which can lead to a potentially fatal pulmonary embolism. Referring to information that came to him after his surgery via messaging technology, one patient was able to distinguish the pain of a DVT from the natural pain of the recovery process, prompting him to make a life-saving call and visit to his doctor.4 The likelihood of patient safety “catches” like this one increases when patients are prompted to report any episode-specific signs and symptoms that could lead to a complication. Patient compliance with these symptom checkers is far higher when combined with empathetic and useful self-care guidance that makes the patient feel like it’s actually their doctor or care manager reaching out to them.
The fundamental fact is that patient engagement is a patient safety issue. When the lines of communication are more efficient for care teams to share information back and forth with their patients, it lowers the threshold for patient questions (that they otherwise may not “bother” physicians with) and helps to flag complications before they become life threatening.
5. Physician burnout
The pressure to see more patients while also meeting greater demands for documentation has led to widespread physician burnout. Because time is such a stress point for physicians, anything that can help them provide better care without adding to their workload can help ameliorate burnout. Too many technologies, though, have promised to improve physicians’ lives but have instead ended up adding to their stress.
Automated engagement with patients outside of the care setting is so effective because it extends the physician-patient relationship without adding to the physician’s workload. As a replacement for lengthy bouts of voicemails and follow-up calls, it can save an enormous amount of time. The information shared via email also enables a more tailored use of face-to-face appointments. Email-based technology provides the attention patients want, on their own terms. It may even mean that patients can cut down on certain follow-up visits, saving themselves transportation headaches and the interruption to their own schedules. Crucially, though, all of these time savings come at the same time that patients are being engaged more actively: their greater satisfaction and well-being feeds back into their provider’s satisfaction—another protective factor against burnout.
Patient engagement
Patient engagement leads to greater satisfaction for the patients themselves and the physicians who treat them; it can improve the quality and safety of care; and it has a considerable financial dimension as well. Automated technologies have a track record of engaging patients these goals while pleasing patients and reducing the burden on physicians.
1 https://www.ncbi.nlm.nih.gov/pubmed/29399589.
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/.
3 https://www.cnn.com/2016/02/10/health/automated-empathy-emails-doctors-patients/index.html.
4 https://www.healthloop.com/wp-content/uploads/2018/02/HealthLoop-Health-First-Case-Study.pdf.