Consumer engagement: 'more rhetoric than reality'

Policymakers must address technological and policy shortcomings that limit interoperability and its function
By Jessica Davis
10:57 AM
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Health IT is moving toward a consumer engagement focus to fuel population health. But despite a growing patient demand for electronic access to personal health records, technical and political barriers often limit the amount, value and accessibility of data, a recent EDM Forum report finds.

Consumer engagement has no agreed-upon definition. But at its core lies consideration of consumer preferences and needs with regard to healthcare decisions at all levels.

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HITECH and ACA have helped increase consumer engagement, but the term still remains "more rhetoric than reality," the report argues.

"We're trying to create a partnership where we keep asking patients to be more engaged and empowered, but if we don't welcome them into that role, that won't work," according to one interviewee in the report.

Consumer engagement struggles with certain barriers that impede enhanced health information access: patient factors, such as low health and IT literacy; technology factors, such as limited interoperability, and political factors such as non-incentive payment systems.

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The majority of those interviewed agree there's merit to focusing on supply issues, but the challenge lies in putting a plan into motion.

"There is no one place you can go to download your longitudinal health record," one interviewee says.

"It's a great start and it's important and it whets the consumers' appetite for what is available, but the frustration is that people are expecting one thing when they click the button and it may or may not be what they want to see," this person adds.

To bridge this gap, health institutions must resolve existing HIE technology barriers and develop better consumer-focused applications. Provider incentives can demonstrate the benefit of consumer engagements to healthcare institutions, as well, the report states.

Developers must also build a stronger case to convince policymakers that consumer engagement improves care and health outcomes, while lowering costs.

Key stakeholders have created initiatives to encourage members to respond to consumer interest in patient engagement. However, most of these efforts are in early stages, the report finds.

A recent National eHealth Collaborative survey found its members view consumer engagement in health IT of great importance, but few had defined strategies in place to integrate the concept into daily operations.

The report asserts the study respondents are "looking forward to potential Stage 3 (meaningful use) requirements that would support an increase in two-way communication, allowing consumers more ability to correct and add personal health information to their EHRs."

However, proposed Stage 3 requirements are controversial, the report argues, "leaving the final status of future meaningful use requirements uncertain."

Furthermore, technological challenges exist in the interoperability realm, as there's no standardized format across the systems, so access is impeded between systems. The current federal "Blue Button" initiative seeks to encourage providers to make consumer access easier, but the barriers remain.

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To make consumer engagement more of a priority, policymakers must address technological failings that limit interoperability and its function, the report states.

There are critical gaps between the current infrastructure and its ability to support interoperability and data exchange; an issue that won't be alleviated without a "broad-based, voluntary multi-stakeholder buy-in" to establish a comprehensive plan, the report finds.

The ONC Interoperability Roadmap has this goal in mind, but the report states it "remains to be seen how initial goals will be translated into action in a multi-stakeholder environment."