Context Matters: Patient Engagement


Patient Engagement has been lighting up my twitter feed like a Christmas tree with aspirations of Rockefeller Center. As a social worker by professional training and an HIT consultant in this era of rapidly growing and changing technology, this excites me. As a Fitbit-wearing mom of two, sister to someone living with stage IV cancer, and daughter to an aging mom, it also excites me, but in different ways. The very definition of this “Patient Engagement” buzzword varies depending on context and who is doing the talking.

The reality is that our healthcare systems are entering an era where health policy is encouraging/mandating certain degrees and types of engagement between patients and providers. In the case of Meaningful Use, it’s receiving the ever elusive patient-generated secure message; in the case of Patient Centered Medical Homes and Accountable Care Organizations, it includes getting and using information from patient surveys, or being available to answer phone calls after business hours. These policy mandates are steps on a journey, and healthcare organizations range from taking their first few steps to being well down this road.

When talking with physicians, there is a whole different conversation happening. Engaging with patients is more about time and follow through. “How can I engage with patients when I see 60 patients a day? How can I get my diabetic population to do a better job of monitoring their blood sugar?” Physicians sometimes get a bad rap in the twitterverse, and there is a perception that they do not want to engage. The truth is, physicians got into this business because they want to help people. Their experiences and the culture of medicine have shaped their behaviors. No, most doctors do not want another mandate that drives new workflows, requires another application, or creates additional clicks, especially if it is an empty, time-consuming policy that provides no real value (think MU2 patient lists & patient reminders). For providers, if Patient Engagement could mean less patients per day, but for those that they do see, the software fades into the background and the patient rises to the forefront, they’d be all in.

Probably no one gets more excited or energetic about the conversation of Patient Engagement than the patient advocates themselves. This is truly an exciting time where the industry is being compelled to ask, “How do we engage?” There are patients lining up, clamoring at the door to say, “We have ideas. We have lived this. We have been sick and hurting within your walls, and we know what can help”. Patient advocates are a fantastic resource for both the experiences they have lived and the knowledge from the vibrant support communities that they are a part of.

What does Patient Engagement look like? There is no simple answer. It is contextual. It is ever evolving. My favorite story of real Patient Engagement is one of a woman with COPD and a compromised immune system. It is important that she get to the doctor regularly, but at the same time she is rightfully afraid of being in the clinic surrounded by sick people. She also sleeps most of the day and wakes up in the evening when her husband comes in from work. Her doctor’s office has worked with her to develop this plan: when she needs to be seen, they schedule her for the last appointment of the day, and then call her when their last patient has gone home. Her husband takes her to the office where they go straight to an exam room that has been wiped down. They have no internet, no wearables (unless you count the oxygen tank), no fancy smart phones – but she is engaged. Her husband is part of her care team. It is beautifully simple and elegant.

We need to address both our human systems as well as our software systems to increase Patient Engagement in a meaningful way. We need to be mindful of the context for all stakeholders and that different approaches may be needed for different settings.

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