Engaging Patients & Families Over the Internet: Meaningful Use under the HITECH Act of 2009

One day in early 2001, while working as a physical therapist in an outpatient clinic, I asked a colleague why we were spending so much of our time writing in patients’ charts and using faded crooked photocopies to educate them. Shouldn’t the clinic have us use computers or the internet to better accomplish these tasks? He responded by turning pale, giving a quick shrug, and dashing to his next patient.

Today, in conversations with clinicians in all walks of healthcare life, I get the same reaction to that question. It seems even today the HITECH Act of 2009 is still causing the "deer in the headlights" reaction in the healthcare market. The purpose of this article is to clarify and suggest functional steps regarding a single piece of the HITECH Act: engaging patients and families in health care.

Many articles have been written about the HITECH Act and electronic medical records. Meaningful use as a term and theory has been dissected in a hundred different ways, my favorite being this.

But collecting data into an EMR is only a fraction of the clinician-patient interaction cosmos, communication has a much larger role. Where is communication mentioned as part of meaningful use under the HITECH Act? In the “Meaningful Use” Matrix 1(page 3) as the second priority: “Engage patients and families” with the following clinical goals: 1) “Provide patients and families with access to data, knowledge, and tools to make informed decisions and to manage their health;” 2) “Provide access to patient-specific educational resources;” and 3) “Provide clinical summaries for patients for each encounter”. When Stage 1 Criteria for Meaningful Use was released 2 the language of the Act only emphasized providing access to data. I don’t know about you, but for me, reading my blood test results, while important, is far from engaging.

So why engage patients and families in health care? Research shows that patients who are engaged in their treatment have better outcomes 3,4,5,6, and are less likely to litigate if something goes wrong 7,8,9. Another significant reason for patient engagement, which is less often thought and written about , is the reduction in the cost of healthcare.

The price of medical procedures and pharmaceuticals is usually cited when discussing cost. However, time as a factor seldom makes it as a major component in the equation (time of providers as well as patients). Examine any interaction between a clinician and patient and you'll find that communication and treatment always take place. Communication may include data collection, specific education, and general discussion, while treatment can include decision making and performance of a procedure. How can patient engagement reduce cost? Shortening the time of clinical procedures is not always possible, but reducing the time spent on repetitive general communication by educating patients online pre and post encounter is not only possible but also quite effective if the right tools and enabling technologies are leveraged.

Using paperwork and verbal communication to educate patients is the standard today. But it is time consuming, lacks consistency, and patient comprehension is difficult to assess. EMR documentation is subjective at best, and it does not align with the pattern of Internet use by patients 10. Simply put, engaging patients with printed materials is ineffective when compared to newer alternatives 11.

Lets review again the goals of the HITECH Act for engaging patients and their families:
1. Goal: Provide patients and families with access to data, knowledge, and tools to make informed decisions and to manage their health. Result: Risk management pre and post encounter
2. Goal: Provide access to patient-specific educational resources. Result: Educating patients pre and post encounter
3. Goal: Provide clinical summaries for patients for each encounter. Result: Transparency, risk management, and patient education post encounter

In order to comply with the above goals clinicians must adopt the Internet as a primary communication/education pathway. Shifting from print materials and verbal education to practice specific online patient education is difficult in today's technology landscape. There are very few solutions that offer clinicians the ability to create and deliver practice specific online patient education. Even fewer are available with the capability of communicating/integrating with an EMR, thereby failing to achieve the goals set by the original Meaningful Use Matrix.

Any effective solution for meaningful patient engagement must allow at a minimum for the following:

1. Creation, customization, and syndication - of patient education materials by clinicians via a web friendly platform

2. Seamless integration - into websites and EMR

3. Minimal learning curve - for clinicians and patients to maximize adaptation and benefits

Initiating compliance with HITECH's patient engagement should be simple, as clinicians are currently only required to provide access to data. This will allow for a gradual ramp up of technology as it pertains to this aspect of HITECH. However, when shopping for and implementing EMR systems clinicians must take into consideration the future technical needs of patient engagement. Actively making this a requirement as part of the EMR purchase process will ensure longevity of the significant financial investment involved.
As a clinician and technology fan I am excited about the HITECH Act. The benefits to everyone involved far outweigh the confusion and discomfort the healthcare industry is experiencing now. We shop, bank, learn, date, and socialize online. It is time we added “get our healthcare online” to the list.

About the author
Eran Kabakov, PT, is the CEO of Info-Surge.com, a company offering innovative online patient education solutions. For more information about Eran visit: http://www.info-surge.com/about/team-members or http://www.linkedin.com/in/kabakov

1. http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_872719_0...
2. http://www.hipaasurvivalguide.com/part-495/ehr-incentives-495-006.php
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1337906/pdf/cmaj00069-0061.pdf
4. http://www.ncbi.nlm.nih.gov/pubmed/18254037
5. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TBC-4XVHS6D-4...
6. http://journals.lww.com/eurojgh/Abstract/publishahead/Structured_patient...
7. http://www.nature.com/oby/journal/v17/n5/abs/oby2008567a.html
8. http://www.ingentaconnect.com/content/sesc/tas/2005/00000071/00000005/ar...
9. http://www.ncbi.nlm.nih.gov/pubmed/8490411?itool=EntrezSystem2.PEntrez.P...
10. http://www.manhattanresearch.com/newsroom/Press_Releases/11212005.aspx
11. http://www.soard.org/article/S1550-7289(09)00269-X/abstract