Three Perspectives of Patient Engagement: A National Study Collaboration between HIMSS Analytics, WebMD, Medscape & M-Consulting LLC Authors: Pat Wise, HIMSS, Lorren Pettit, HIMSS, Christina Hoffman, Medscape Education/WebMD, Mazi Rasulnia, M Consulting Study was partially supported by Genentech
Learning Objectives List your 3-5 session learning objectives that have been approved by HIMSS. 1. Describe system/physician/patient views on patient engagement. 2. Identify barriers to patient engagement. 3. Discuss the differences in perceptions of patient engagement between the patient, provider and organizational perspective.
Study Design Target National Sample Survey HIMSS Chief Information Officers (CIOs) of hospitals 125 Attitudes, Practices, Beliefs on Patient Engagement (PE) Medscape Primary care physicians (PCPs) 359 Attitudes, Roles, Practices, and PE Expectations WebMD Patients having visited their doctor within the past 90 days 2,567 Expectations and values about engaging with their Health Care Provider (HCP) Source: All data collected between July-August, 2014
4 Summary of Findings Patient Engagement (PE) is generally viewed positively by all stakeholders but notable differences exist Definition Ownership Barriers Mis-alignment around what PE means Hi-Tech For CIOs, PE is about technology and driven by MU Hi-Touch For Providers and Patients, PE is about relationships Disagreement around who owns PE CIOs CIOs, since PE requires technology Providers Patients need to take more responsibility for their care/outcomes Patients Providers need to be willing to spend more time with them Different barriers for different audiences CIOs Attitudes and expectations of Providers and Patients Providers Time demands and training Patients Provider s time
HIMSS System Perspective
Conflict of Interest Lorren Pettit, MS, MBA Vice President, Market Research HIMSS Analytics Has no real or apparent conflicts of interest to report. HIMSS 2015
CIO/CMIO s view of the impact Meaningful Use patient engagement activities could have on their organization A win for patients Improve data sharing Improve patient education efforts Increase patient satisfaction Improve patient safety Improve data recording Improve the quality of care delivered Increase treatment/clinical efficiencies Reduce the incidence of preventable health concerns Improve Evidence Based Medicine protocols Improve operational efficiencies Increase nursing staff satisfaction Improve financial results Increase physician satisfaction 5.62 5.54 5.21 5.05 5.03 4.89 4.72 4.60 4.50 4.01 3.88 3.70 3.24 1.00 2.00 3.00 4.00 5.00 6.00 7.00 strongly disagree strongly agree
CIO/CMIO s view of the impact Meaningful Use patient engagement activities could have on their organization but a potentially harder sell to clinicians Improve data sharing Improve patient education efforts Increase patient satisfaction Improve patient safety Improve data recording Improve the quality of care delivered Increase treatment/clinical efficiencies Reduce the incidence of preventable health concerns Improve Evidence Based Medicine protocols Improve operational efficiencies Increase nursing staff satisfaction Improve financial results Increase physician satisfaction 5.62 5.54 5.21 5.05 5.03 4.89 4.72 4.60 4.50 4.01 3.88 3.70 3.24 1.00 2.00 3.00 4.00 5.00 6.00 7.00 strongly disagree strongly agree
The HIMSS Health IT Value Suite www.himss.org/resourcelibrary/valuesuite.aspx#/steps-app
CIO/CMIO s view of the impact Meaningful Use patient engagement activities could have on their organization Those indicating a 6 or 7 on a 7 point scale Measure with least agreement Measure with most agreement Overall Category Mean S Satisfaction Physician satisfaction (6.4%) Patient satisfaction (48.0%) 4.11 T Treatment/Clinical Clinical Efficiency (37.6%) Patient Safety (43.2%) 4.89 E Electronic Information/Data EBM Protocols (30.4%) Data Sharing (63.2%) 5.05 P Prevention/Patient Education Preventable Concerns (24.0%) Patient Education (61.6%) 5.07 S Savings Financial results (12.0%) Operational efficiency (20.8%) 3.85
Challenges to overcome in a Patient/Consumer Engagement effort Patient Engagement is not so much an access issue, ATTITUDE - Shifting attitudes and expectations regarding clinician's roles ATTITUDE - Shifting attitudes and expectations regarding consumer and patient roles ACTION - Developing tools and services that help consumers and patients take action using their health information ACTION - Developing tools and services that help clinicians take action using their patient's health information ACCESS - Giving consumers and patients electronic access to their health information 5.89 5.77 5.22 4.89 4.46 1.00 2.00 3.00 4.00 5.00 6.00 7.00 not at all challenging very challenging
Challenges to overcome in a Patient/Consumer Engagement effort indeed hospital s are embracing patient portals, 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% Percent of U.S. Hospital with Patient Portal HIMSS Analytics Database 0.0% 38.0% 45.0% 50.7% 54.8% 62.0% 2010 2011 2012 2013 2014 year
Challenges to overcome in a Patient/Consumer Engagement effort as it is a culture issue ATTITUDE - Shifting attitudes and expectations regarding clinician's roles ATTITUDE - Shifting attitudes and expectations regarding consumer and patient roles ACTION - Developing tools and services that help consumers and patients take action using their health information ACTION - Developing tools and services that help clinicians take action using their patient's health information ACCESS - Giving consumers and patients electronic access to their health information 5.89 5.77 5.22 4.89 4.46 1.00 2.00 3.00 4.00 5.00 6.00 7.00 not at all challenging very challenging
Who s Most Accountable for Patient Engagement efforts in your organization? CIO/CMIOs believe they drive their hospital s Patient Engagement efforts Information Technology Nursing Marketing Quality Assurance Finance/Business Office Physician Affairs Other 46.4% 14.4% 13.6% 6.4% 1.6% 1.6% 16.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% Percent selecting response option
Challenges to overcome in a Patient/Consumer Engagement effort yet without a formal patient engagement strategic plan, the challenge of the ATTITUDINAL (culture) barrier is elevated. Percent indicating the Barrier to be very challenging BY the presence of a Patient Engagement Strategic Plan Barrier Yes (%) No (%) DELTA ATTITUDE - Shifting attitudes and expectations regarding clinician s roles 38.5 47.9 9.4 ATTITUDE - Shifting attitudes and expectations regarding consumer and patient roles 30.8 46.5 15.7 ACTION - Developing tools and services that help consumers and patients take action using their health information ACTION - Developing tools and services that help clinicians take action using their patient s health information 23.1 16.9-6.2 28.8 29.6 0.8 ACCESS - Giving consumers and patients electronic access to their health information 15.4 16.9 1.5
So What? What does the CIO perspective tells us about better ways to engage patients? PE conversations are driven by those with a technology focus PE efforts are less daunting when an organization has a PE plan in place. PE requires a cultural shift but are CIOs the right leaders to drive this effort?
Medscape Physician Perspective
Conflict of Interest Christina L. Hoffman, MS Executive Managing Director, Strategic Integration & Innovation Medscape Education/WebMD Has no real or apparent conflicts of interest to report. HIMSS 2015
Sample Characteristics (Physician, N=359) N Percent/Average Internal Medicine or Family Medicine 325 90.5 Male 223 62.1 Years in practice < 10 years 61 17.0 > 11 years 298 83.0 Practice type Group practice 152 42.3% Hospital based practice 76 21.1% Solo practice 63 17.5% VBP program (yes) 258 71.9 Patients seen per month -- 246 Have EMR (yes) 297 82.7
2 Physician Perceptions of Patient Engagement Physicians definitely see the upside of Patient Engagement For me, patient engagement is: Beneficial 84% Part of the job 79% Easy 76% Effective 69% Efficient 39% 0% 20% 40% 60% 80% 100% Source: Q10 Physicians Survey, N =359, percent of physicians who indicate item
Physician Perceptions of Patient Engagement Barriers but have very tangible concerns about PE. Rate the applicability of each statement as a potential barrier to regularly implementing patient engagement strategies in your practice COMP 42.3% 46.5% TIME 59.1% 61.8% 12.3% 17.0% 20.9% 21.4% 22.0% 30.4% 30.4% The decision to Lack of engage knowledge on patients in their how to own care is integrate beyond my patient control. engagement function into my day-to-day practice. Lack of provider training in patient engagement. Lack of defined roles and responsibilities for patient engagement within my practice. Do not employ staff skilled in patient engagement. Lack of Concern over incorporation ofpatients lack of patient competency in engagement managing their metrics in own health quality improvement measures and reports. Insufficient payment for carrying out patient engagement Organizational protocols that constrain Limited time Limited time within the after the visit to patient visit to follow-up with explain care patients options Source: Q13 Physician Survey, N=359, (agree and strongly agree)
Current Engagement Practices by Physicians How often do you use the following strategies to engage with the patients in your practice? Not My Job 8.4% 22.6% 23.4% 29.5% 30.6% Shared Decision Making Effort 34.0% 39.8% 44.3% I rely on other staff in my practice to engage and involve patients in their care. I coordinate patient care with other providers in or out of my practice. I take the time necessary to understand my patient needs, behaviors, and home environment when making treatment decisions. I assess my patient s literacy level and technology capabilities so I can adapt my communication with them. I gather input from my patient or their family in their treatment and care plan. I include patient concerns and preferences as a key part of the treatment decision making process. I provide treatment options to my patients. I provide my patients pros and cons of treatment options. Source: Q14 Physician Survey, N=359, (100% of the time)
Training and resources needs seen as most valuable by Physicians Soft Skills Rate the value of access to training and resources in the following topics to you and your practice: Communication 56.0% 57.8% 63.9% 64.3% 64.9% 64.9% 70.7% 72.4% 72.9% 73.2% Applying change management principles to my practice Strategies for partnering with community providers and networks to maximize adherence to treatment or improved outcomes Assessing patient literacy and comprehension status Cultural competence Managing patient expectations Patient engagement: preparing patients for behavior modification Patient factors influencing patient engagement and adherence Strategies for communicating with caregivers and family Strategies for communicating with nonadherent patients Effective communication and listening skills Source: Q23 Physician Survey, N=359, (those indicating a 4 or 5 on a 5-point scale scale)
So What? What does the provider perspective tells us about better ways to engage patients? Accept that time is finite can t make more but can make better use of it Use time before and after the clinical encounter to prepare for and pull through patient engagement Redesign the entire clinical flow Accept and embrace a Value-based approach to managing patients Provide training on best-practice approach to transitioning from volume to value Transition help Capitalize on the Chronic Care Management code reimbursing providers OUTSIDE of the clinical encounter Training HCP on soft skills (e.g. communication, etc.)
WebMD Patient Perspective
Conflict of Interest Mazi Rasulnia, PhD, MPH, MBA Consultant to Medscape and Genentech Co-Founder of a patient engagement company PACK Health Acknowledgement: This study was supported by Genentech, Inc. HIMSS 2015
Patient Characteristics: Study vs. WebMD User Profiles Study Patients Profile (n=2,567) WebMD User Profile Marital Status % % Married 59% 42% Education % % Graduated college (4 yr degree) 18% 31% Ethnicity % % Black/African American 6% White/Caucasian 82% Other 122% Gender % % Female 76% 65% Male 24% 35% Age % % 18-24 1% 16% 25-34 3% 25% 35-44 7% 18% 45-54 18% 16% 55-64 33% 16% 65+ 38% 9% WebMD Data Source: comscore Multiplatform November 2014; comscore Plan Metrix November 2014 Note: Study population inclusion was to have seen your doctor in the past 90 days
Patient Perceptions of Patient Engagement: Patient-Provider Alignment There is more alignment between providers and patient on how to approach patient engagement than with organizations that house the providers or make decisions about patient engagement strategies for the organization. Patients view PE in terms of relationship (high-touch) Providers believe that PE is part of their job and responsibility and beneficial to their patients. Providers have a harder time seeing it as an easy task or efficient in their current models for patient care. Patients depend on providers as the primary source for engaging them (they want more time)
Patient Perceptions of Patient Engagement: Patient Expectations of Healthcare Providers My healthcare provider
Patient Perceptions of Patient Engagement: Patient Expectations of Providers during an office visit 90% 90% 89% 77% 87% 79% 78% 69% 69% 68% 53% 63% 56% 53% 21% 21% 21% 24% 24% 23% 25% I have confidence in my primary healthcare provider's knowledge I have confidence in my primary healthcare provider's skill I trust my primary healthcare provider Strongly Agree I feel like I can tell my primary healthcare provider personal things I am involved in my healthcare decision making as much as I want to be Somewhat Agree I do not wait more than 30 minutes to see my primary healthcare provider once I'm in their office I can easily discuss personal matters with my healthcare provider Q11. Please indicate how strongly you agree or disagree with the following statements. Base: Total Respondents (n=2,567)
So What? What does the patient perspective tells us about better ways to engage patients? Engagement should start or initiate from a trusted source Engagement should not adversely impact the experience of the patient (e.g. the clinicians interacting with EMR or technology rather than patient) Metrics of engagement should consider what matters to patients (e.g. time and empathy measures)
3 Summary of Findings Patient Engagement (PE) is generally viewed positively by all stakeholders but notable differences exist Definition Ownership Barriers Mis-alignment around what PE means Hi-Tech For CIOs, PE is about technology and driven by MU Hi-Touch For Providers and Patients, PE is about relationships Disagreement around who owns PE CIOs CIOs, since PE requires technology Providers Patients need to take more responsibility for their care/outcomes Patients Providers need to be willing to spend more time with them Different barriers for different audiences CIOs Attitudes and expectations of Providers and Patients Providers Time demands and training Patients Provider s time
Questions?