What does 'patient engagement' really mean?

The technology is just the plumbing
By Michelle Ronan Noteboom
10:25 AM
Doc and patient with records

I'm not a fan of "patient engagement."

To be clear: I fully support engaging patients in their own health to achieve better outcomes. I am just not a big fan of that ill-named term.

Patient engagement is used to describe everything from patient portals to social media strategies, from tracking vitals with wearables to patients actively participating in their own health and wellness. Everyone seems to be talking about patient engagement, even though we can't agree on what it is.

[See also: Power to the people! Engaging patients]

Whatever patient engagement is, it was a very hot topic at the recent HIMSS conference. Exhibitors were promoting patient engagement tools and educational sessions offered suggestions for engaging patients.

HIMSS published a leadership survey during the event, revealing that 72 percent of the respondents identified consumer and patient considerations, such as engagement, satisfaction and quality of care, as the business issue most impacting their organizations over the next two years.

The leaders also identified the IT strategies most commonly used to actively engage patients in their own care. Eighty-seven percent of respondents said their organizations offer a portal that enables patients to access their medical records, schedule appointments, and pay bills, while 82 percent said they engage patients through their organization's website.

I realize that IT departments can do only so much to encourage patient engagement, but I wonder how many leaders view portals and websites not only as a "strategy" for engaging patients, but as the actual solution.

I am a fan of patient portals and provider websites. But just because an organization has the technology to support the viewing/downloading/transmitting of a chart note doesn't mean the patient is participating in his own health and wellness.

My view is that patient portals are the plumbing in the patient engagement process. Clinical data is the water that flows through the plumbing. If I am thirsty, the presence of plumbing is not enough to quench my thirst – I still need a continuous flow of water. It's also helpful to have a good plumber around to provide professional guidance, when needed.

One reason stakeholders can't agree on a simple concise definition for patient engagement is that there are many degrees of engagement.

A couple of years ago, the authors of a Health Affairs brief offered a definition that I particularly like. Patient engagement was defined as a concept that combines a patient's knowledge, skills, ability and willingness to manage his own health and care with interventions designed to increase activation and promote positive patient behavior.

[See also: For portals, speak patients' language]

In other words, the patient is willing and able to participate in his care, and, someone (the provider) is providing "interventions" to promote that participation.

We need patients to participate in their own health and wellness because it typically drives better outcomes and lowers costs. Making plumbing available to patients is a good first step, but true participation requires more human interaction and the intervention of physicians and/or staff.

Of course many patients are not very interested in taking an active role in their health and wellness. Arguably these are the patients require the most provider intervention to offer education and encouragement.  

Being engaged suggests involvement in some sort of activity. Patient engagement would thus require activity on the part of the patient. If a provider offers a patient portal or similar technology and patients are not actively involved in their use, can we really call this patient engagement?

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