Patient Engagement: Do We Deliberately Disengage Patients?

The reporter on ESPN stated that cyclists in a forty-kilometer race could shave seventy-nine seconds off their time by shaving all of their hair. The reporter failed to mention how much time could be shaved by pedaling faster. Sometimes the easiest answer is overlooked, perhaps because it is too easy to be believed.

Patient engagement. Hospital disengagement. I get the image of what happens when trying to push two oppositely charged magnets together. They repel one another.

Patient Engagement is a phrase bandied about as much as the phrase population health management. The phrases have two things in common; patient engagement is a tenant of an effective population health management program, and both phrases are equally amorphous.

One definition of patient engagement used the words empathy, trust, respect, and empowered. Amorphous with a capital A.

The good news is that if someone—a patient or customer—has never been engaged then they do not have to worry about being disengaged. Or do they? Mr. Webster defines disengage ‘to release from attachment, to flee, break off contact as with the enemy’. The thesaurus offered, “pull the plug” and “weasel out”.

I think patient engagement falls into two buckets. Bucket One, the one getting all of the attention, is clinical engagement. This bucket predominantly deals with interactions that occur at the health system or at the primary care provider.

Bucket Two, the empty one, is accessibility. It deals with the interactions between patients and prospective patients, and their health care provider. It is mostly transactional. And it is almost always a one-way interaction; from the health system to the individual. At the health system level there is almost no engagement because there is very little access.

Rule 1: Without access there is no engagement.

Rule 2: Engagement, like access, should be two-way

Health systems want access to their patients. Patients want access to their health system. If I cannot access my health system my health system and I are not engaged. If my health system cannot access me, my health system and I are not engaged.

Another term for engage is betroth. It means to contract, to tie oneself to, and to make a compact.

I am engaged with every company with whom I do business, everyone save my health system. We have an agreement, an understanding. Whether it is formal or informal does not matter. What matters is that when I want to interact with them I can. Day or night. And they can do the same with me. And at a time and on a device of my choosing.

I can call them after 6 P.M., and I can call them on weekends. More importantly to me, I can do everything I need to do with those companies without every speaking to someone. I can even do that with the healthcare apps on my phone.

Why does this matter? It matters because my healthcare apps have more data about the state of my health than my health system. The app does not care a thing about my data. The app does not know what to do with my data, it simply records it. If I gain fifteen pounds in two months, the app is not going to tell me that I am showing signs for Type 2 diabetes. Have another cheeseburger Paul.

That data only becomes information when it is accessible and actionable. It becomes actionable when my health system collects it and monitors it. It becomes information that benefits my health system and me only if my health system has access to my information.

My health system is U Penn, an outstanding institution in every way. My cardiologist is a water-walker extraordinaire. And once a year I learn that my heart is healthy; EKG, stress-echo, blood work. The other three hundred and sixty-four days I assume my heart is healthy, and my barometer for gauging the rest of my health probably comes down to something as simple as whether or not I had another heart attack. No heart attack today, I must be healthy.

I record my exercise each day on a fitness app. And my diet. And my data is locked away in some cumulus cloud doing nothing for anyone.

Good data; almost worthless information. That is because my apps do not engage me. But then again, neither does my health system. Engage is a verb, but only if one is engaging.

In three years more data will be collected about my health in a month than had been collected cumulatively prior to then. In three years millions of people will be collecting this data about themselves. Unfortunately it will not be available to any health systems unless the health system develops a plan to access it. And that is not a trivial exercise.

My loyalty as a patient will be to whatever institution is able to engage me each day about my health. Data about my health and wellness is being amassed everywhere; through apps and wearable devices and smart phones and watches.

If you want to engage me, if you want to retain me as your patient, do so more than once a year. If you want to really own population health management, design a way for your health system to capture daily health and wellness information about the people who make up the population you serve. People would prefer that someone who knows more about their health than they do is monitoring their data.

That is patient engagement. It is an interactive exchange of information; I tell you something, and you tell me something. And if we do it enough I will be healthy proactively, and I will remain your patient. This approach to patient engagement is more expensive and more engaging than having a recorded message telling callers to ‘call back during business hours’, but in the end everyone wins.

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