Nancy Fabozzi's Blog

Access, Action, and Attitudes: ONC Accelerates Efforts to Engage Consumers and Patients with Health IT

14 Sep 2012 | by Nancy Fabozzi
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The Seventh Annual National Health IT Week, sponsored by the Health Information Management Systems Society (HIMSS), the Institute for e-Health Policy, and the College of Healthcare Information Management Executives (CHIME), took place during the week of September 10, 2012. National Health IT Week features a variety of live and online events hosted by numerous partners and sponsors including nonprofit associations, academia, industry, and government agencies, all designed to raise awareness of the importance of health information technology to enabling health system transformation. As part of their participation in this event, the U.S. Department of Health and Human Services (HHS) in conjunction with the Office of the National Coordinator for Health Information Technology (ONC), held its second annual consumer health IT summit in Washington on September 10. The Summit brought together a variety of constituents across public and private sectors focused on efforts that encourage the use of health IT among consumers and patients. A video from the conference posted on YouTube presents a conversation between Dr. Farzad Mostashari, National Coordinator for Health IT, ONC, and Lygeia Ricciardi, Acting Director, Office of Consumer eHealth, Office of the National Coordinator for Health Information Technology, HHS in which they discuss ONC’s comprehensive strategy for driving consumer engagement.  In the video, Dr. Mostashari and Ms. Ricciardi outline three core elements seen as essential to moving the needle forward: 1) Access, which means getting information into the hands of patients and caregivers; 2) Action, which pertains to engaging consumers to use information to improve health; and 3) Attitudes, which is about how increased access and action enable new attitudes about the traditional roles of patients and providers. Key announcements from the Summit that further depict ONC’s efforts on this three-point strategy for consumer engagement include:

  • Push to Leverage Blue Button-Type Functionality: “Blue Button” refers to a VA-led initiative launched in 2010 that allows veterans to download their personal medical information by clicking a blue button on a secure website. The Blue Button approach is a simple and straightforward way for patients to gain access their health data. The program is very popular and more than half a million veterans have already downloaded their records. ONC is strongly encouraging technology vendors and providers to extend this concept to the broader patient population. Dr. Mostashari emphasized that these stakeholders must focus on the “view, download, and transmit process” via blue-button type technology as a key way to drive consumer engagement. ONC has also established a Twitter hashtag of #VDTnow to encourage people to post about their efforts in this area.

  • Stage 2 Meaningful Use Raises the Bar on Patient Access: The recently released rules for Stage 2 calls for hospitals and physicians to confirm that 5 percent of patients access their medical information online. ONC designed this requirement to help motivate patients and providers to get more involved in their own care. The 5 percent requirement in the final rules is a compromise from the proposed rules which called for confirming that 10 percent of patients access information online—a requirement that was widely contested by providers. ONC believes that the lesser requirement should, nonetheless, still be quite helpful in encouraging their goals for patient engagement via health IT.

  • Two New Workgroups Formed to Assist Policy-Making: ONC announced plans to add two new workgroups to its advisory Health IT Policy and Standards committees that will focus exclusively on patient engagement. Members of the public will be able to nominate committee members to serve on those committees

  • Results of PHR Video Challenge: This past July, ONC launched a video challenge to promote PHR use. The "What's in Your Health Record??" invited people to create a brief video depicting ways in which they are getting access to their personal health information. The contested was intended to inform the public of their legal right to access their health records and to illustrate the importance of how being informed and involved leads to better care.  Six awards totaling to $7,700 were presented at the Summit.

Patient-Centric Care Means Patients Need to Be in the Information Loop

We hear a lot about how health IT can enable “patient-centric” health care. The patient-centric concept can mean a variety of things. From a provider’s perspective, it has mostly pertained to using technology that integrates disparate sources of information so that there is a “single source of truth” offering a complete, comprehensive view of a patient’s history and status. Access to this information is also important for patients and their family members. Thus, a truly patient-centric health care system must include patients in the information loop, and that means using information technology. Acknowledgement of the need to engage consumers and patients with health IT is not new but efforts are accelerating and taking on more urgency. As with provider health IT, ONC, providers, and technology vendors are emphasizing potential improvements in the quality of care and as well as patients’ rights to their own data as the reasons for their interest. However, another very important driver of this movement to consider is the shift to accountable care and bundled payments. In a health care system where reimbursement will increasingly be based on the concept of value (defined as the overall quality of care in terms of process and outcomes that is derived from total resources expended), the issue of patient compliance takes on a particularly critical role. Problems around patient compliance have long been seen as a critical factor influencing outcomes. The physician and care team can do everything right but if the patient is non-compliant with treatment protocols, outcomes are often negatively impacted. This is one of the core dilemmas in health care and it grows in importance with value-based reimbursement. Thus, in an era of reform and transformation, there is no getting around the fact that people must take on more responsibility for their own health care. Patients need to be accountable too. For payers and providers, this comes down to changing human behavior, a difficult-- but not impossible—challenge. That means efforts will accelerate to help develop informed and engaged consumers of health services. Those efforts will include shared decision-making, actively tracking and monitoring compliance with treatment protocols, and having ready access to their personal health data and various educational tools. A variety of approaches and technology tools are needed to enable patient engagement including PHRs, patient portals, mobile apps, telehealth solutions, and remote patient monitoring. Not all patients will be able to participate equally in health IT—and many never will do so, realistically. However, as more innovative and user-friendly technology tools like Blue Button features become more widespread, cultural attitudes about health IT will inevitably change among larger numbers of patients as they have among health care providers. The VA experience is proof of this concept. Using health IT tools will become more comfortable and natural for people and will ultimately pervade every aspect of their health care experience, from the initial point of engagement with payers and providers on through active treatment, post-treatment, and ongoing monitoring and maintenance.

Pay Attention to the Voice of the Patient

The need to engage patients and consumers is greater now than ever as witnessed by accelerated activity among numerous public and private entities. Patient behavioral change is a key component of health system transformation and the “voice of the patient” must be a key focus for all market participants. A comprehensive, concerted effort among all stakeholders is necessary to ensure success.