Jan Oldenburg, senior manager in Ernst and Young’s healthcare practice, had come to the annual meeting of the Health Information and Management Systems Society in Orlando, Fla., to deliver a lecture on “What Do Consumers Really Want from Personal Health IT?”
What she hadn’t anticipated was a proposal from the Office of the National Coordinator (ONC) that would dilute the MU stage 2 mandate that 5% of patients view, download or transmit their records digitally; and 5% email or secure-message their provider. As revised, the proposed rule would require that just one patient do the above.
“Guess what?” Oldenburg said. “One patient isn’t enough. One patient doesn’t require you to make it an organizational priority to engage patients. One patient isn’t sufficient to demonstrate that you are doing the organizational and cultural change necessary to embrace this.”
Quoting former ONC director Farzad Mostashari, MD, she shared the news that two thirds of organizations that have successfully passed MU 2 have circumvented the view/download/transmit requirement by invoking the exception granted to organizations that claim not one patient has asked for digital access to their records.
“I don’t believe that,” she said. “I don’t believe that is what our patients are telling us.” She and several others are spearheading an effort to lead a national patient call-in to healthcare providers asking for digital access to their records. “Some of you, at some point, will hate me for this.”
If Oldenburg seems impatient, it’s because she has spent the past 20 years thinking about what consumers want from personal health IT going back to a senior leadership position in the mid-‘90s in Kaiser Permanente’s web and mobile practice division. While she acknowledges that strides are being made by some organizations, progress toward digitally engaging patients has been woefully slow.
“The high cost of disengaged consumers affects everybody,” she noted. The annual cost of lifestyle diseases in the U.S. is $153 billion annually; medical costs related to obesity are $190 billion annually; and only 50% of US adults get the recommended amount of exercise, she said.
Multiple consumer trends are driving demand for a more digital patient experience. “Your patients are expecting consumer quality experiences in healthcare that reflect the kind of things that they can do digitally and the kind of services they get online and offline from other services,” she said.
For instance, Mint.com gives consumers access to a consolidated view of their financial information, no matter how many financial institutions it lives in. “Are we doing that in healthcare?” she asked. “Are consumers expecting it? Absolutely.”
Amazon and other retailers provide personalized service, in the form of recommendations based on your personal history with the company. “They are expecting personalization, the way the get it in a retail shop,” she said.
Companies like Samsung and Apple are entering consumer-generated healthcare and collecting and consolidating data, further raising the expectations of your patients. “That’s where the expectations are changing,” she said. “Not because of the things your competitor down the street is doing.”
Google, for instance, is testing a program to connect seekers of health information with a relevant telehealth encounter: For people searching on, for instance, knee pain, an avatar pops up and asks if the seeker would like to speak to a physician about that.
“That’s exactly the kind of services that are more convenient, more digital and address people where they live, that we are starting to see permeate people’s expectations of what they should get in healthcare,” she added.
Impact all three dimensions
Healthcare consumerism and patient engagement can impact all three dimensions of the Triple Aim, Oldenburg says. Beyond improving the actual experience of care, it can improve the health of populations and reduce per capita cost.
Disengaged patients are more than twice as likely to experience a medical error; poor communications with physicians is more rare with an engaged than non-engaged consumer; and patients who have good communications with their physician are less likely to sue them. “Those are the kinds of things that affect the bottom line, especially if your organizations are struggling with moving toward value-based care,” she said.
When Boston, Mass.-based Beth Israel Deaconess first introduced the concept of the OpenNotes project,