Three Perspectives of Patient Engagement: A National Study Collaboration between HIMSS Analytics, WebMD, Medscape & M-Consulting LLC Authors: Pat Wise, HIMSS, Lorren Pettit, HIMSS, Christina Hoffman, Medscape Education/WebMD, Mazi Rasulnia, M Consulting Study was partially supported by Genentech

Learning Objectives List your 3-5 session learning objectives that have been approved by HIMSS.

1. Describe system/physician/patient views on patient engagement.

2. Identify barriers to patient engagement. 3. Discuss the differences in perceptions of patient

engagement between the patient, provider and organizational perspective.

Source: All data collected between July-August, 2014

3

HIMSS

Medscape

WebMD

Target

Chief Information Officers (CIOs) of hospitals

Primary care physicians (PCPs)

Patients having visited their doctor within the past 90 days

National Sample

125

359

2,567

Survey

Attitudes, Practices, Beliefs on Patient Engagement (PE)

Attitudes, Roles, Practices, and PE Expectations

Expectations and values about engaging with their Health Care Provider (HCP)

Study Design

• Different barriers for different audiences CIOs – Attitudes and

expectations of Providers and Patients

Providers – Time demands and

training Patients – Provider’s time

• Disagreement around who “owns” PE CIOs – CIOs, since PE

requires technology Providers – Patients need to take

more responsibility for their care/outcomes

Patients – Providers need to be

willing to spend more time with them

4

• Mis-alignment around what PE means Hi-Tech – For CIOs, PE is about

technology and driven by MU

Hi-Touch – For Providers and

Patients, PE is about relationships

Patient Engagement (PE) is generally viewed positively by all stakeholders… but notable differences exist

Summary of Findings

Definition Ownership Barriers

System Perspective

HIMSS

Conflict of Interest Lorren Pettit, MS, MBA Vice President, Market Research HIMSS Analytics Has no real or apparent conflicts of interest to report.

© HIMSS 2015

A win for patients…

CIO/CMIO’s view of the impact Meaningful Use patient engagement activities could have on their organization

3.24 3.70

3.88 4.01

4.50 4.60 4.72

4.89 5.03 5.05 5.21

5.54 5.62

1.00 2.00 3.00 4.00 5.00 6.00 7.00

Increase physician satisfactionImprove financial results

Increase nursing staff satisfactionImprove operational efficiencies

Improve Evidence Based Medicine protocolsReduce the incidence of preventable health concerns

Increase treatment/clinical efficienciesImprove the quality of care delivered

Improve data recordingImprove patient safety

Increase patient satisfactionImprove patient education efforts

Improve data sharing

strongly disagree strongly agree

…but a potentially harder “sell” to clinicians

CIO/CMIO’s view of the impact Meaningful Use patient engagement activities could have on their organization

3.24 3.70

3.88 4.01

4.50 4.60 4.72

4.89 5.03 5.05 5.21

5.54 5.62

1.00 2.00 3.00 4.00 5.00 6.00 7.00

Increase physician satisfactionImprove financial results

Increase nursing staff satisfactionImprove operational efficiencies

Improve Evidence Based Medicine protocolsReduce the incidence of preventable health concerns

Increase treatment/clinical efficienciesImprove the quality of care delivered

Improve data recordingImprove patient safety

Increase patient satisfactionImprove patient education efforts

Improve data sharing

strongly disagree strongly agree

www.himss.org/ResourceLibrary/ValueSuite.aspx#/steps-app

The HIMSS Health IT Value Suite

CIO/CMIO’s view of the impact Meaningful Use patient engagement activities could have on their organization

Measure with least agreement

Measure with most agreement

Overall Category Mean

Satisfaction Physician satisfaction (6.4%)

Patient satisfaction (48.0%) 4.11

Treatment/Clinical Clinical Efficiency (37.6%)

Patient Safety (43.2%) 4.89

Electronic Information/Data

EBM Protocols (30.4%)

Data Sharing (63.2%) 5.05

Prevention/Patient Education

Preventable Concerns (24.0%)

Patient Education (61.6%) 5.07

Savings Financial results (12.0%)

Operational efficiency (20.8%)

3.85

S

T

E

P

S

Those indicating a 6 or 7 on a 7 point scale

Patient Engagement is not so much an “access” issue,…

Challenges to overcome in a Patient/Consumer Engagement effort

4.46

4.89

5.22

5.77

5.89

1.00 2.00 3.00 4.00 5.00 6.00 7.00

ACCESS - Giving consumers and patients electronicaccess to their health information

ACTION - Developing tools and services that helpclinicians take action using their patient's health

information

ACTION - Developing tools and services that helpconsumers and patients take action using their health

information

ATTITUDE - Shifting attitudes and expectationsregarding consumer and patient roles

ATTITUDE - Shifting attitudes and expectationsregarding clinician's roles

not at all challenging very challenging

… indeed hospital’s are embracing patient portals,…

Challenges to overcome in a Patient/Consumer Engagement effort

38.0% 45.0%

50.7% 54.8% 62.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2010 2011 2012 2013 2014year

Percent of U.S. Hospital with Patient Portal – HIMSS Analytics Database

…as it is a “culture” issue

Challenges to overcome in a Patient/Consumer Engagement effort

4.46

4.89

5.22

5.77

5.89

1.00 2.00 3.00 4.00 5.00 6.00 7.00

ACCESS - Giving consumers and patients electronicaccess to their health information

ACTION - Developing tools and services that helpclinicians take action using their patient's health

information

ACTION - Developing tools and services that helpconsumers and patients take action using their health

information

ATTITUDE - Shifting attitudes and expectationsregarding consumer and patient roles

ATTITUDE - Shifting attitudes and expectationsregarding clinician's roles

not at all challenging very challenging

CIO/CMIOs believe they drive their hospital’s Patient Engagement efforts…

Who’s Most Accountable for Patient Engagement efforts in your organization?

16.0%

1.6%

1.6%

6.4%

13.6%

14.4%

46.4%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

Other

Physician Affairs

Finance/Business Office

Quality Assurance

Marketing

Nursing

Information Technology

Percent selecting response option

Percent indicating the Barrier to be “very challenging” BY the presence of a Patient Engagement Strategic Plan

Barrier Yes (%) No (%) DELTA

ATTITUDE - Shifting attitudes and expectations regarding clinician’s roles 38.5 47.9 9.4

ATTITUDE - Shifting attitudes and expectations regarding consumer and patient roles 30.8 46.5 15.7

ACTION - Developing tools and services that help consumers and patients take action using their health information

23.1 16.9 -6.2

ACTION - Developing tools and services that help clinicians take action using their patient’s health information

28.8 29.6 0.8

ACCESS - Giving consumers and patients electronic access to their health information 15.4 16.9 1.5

… yet without a formal patient engagement strategic plan, the challenge of the ATTITUDINAL (culture) barrier is elevated.

Challenges to overcome in a Patient/Consumer Engagement effort

So What? What does the CIO perspective tells us about better ways to engage patients?

• PE conversations are driven by those with a technology

focus

• PE efforts are less daunting when an organization has a PE plan in place.

• PE requires a “cultural shift”… but are CIOs the right leaders to drive this effort?

Physician Perspective

Medscape

Conflict of Interest Christina L. Hoffman, MS Executive Managing Director, Strategic Integration & Innovation Medscape Education/WebMD Has no real or apparent conflicts of interest to report.

© HIMSS 2015

Sample Characteristics (Physician, N=359)

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N Percent/Average Internal Medicine or Family Medicine 325 90.5

Male 223 62.1

Years in practice < 10 years 61 17.0

> 11 years 298 83.0

Practice type Group practice 152 42.3%

Hospital based practice 76 21.1%

Solo practice 63 17.5%

VBP program (yes) 258 71.9

Patients seen per month -- 246

Have EMR (yes) 297 82.7

2

Source: Q10 Physicians Survey, N =359, percent of physicians who indicate item

Physician Perceptions of Patient Engagement

“For me, patient engagement is:”

39%

69%

76%

79%

84%

0% 20% 40% 60% 80% 100%

Efficient

Effective

Easy

Part of the job

Beneficial

Physicians definitely see the upside of Patient Engagement…

21

Source: Q13 Physician Survey, N=359, (agree and strongly agree)

12.3% 17.0% 20.9% 21.4% 22.0% 30.4% 30.4%

42.3% 46.5%

59.1% 61.8%

The decision toengage

patients in theirown care isbeyond my

control.

Lack ofknowledge on

how tointegratepatient

engagementfunction into

my day-to-daypractice.

Lack ofprovider

training inpatient

engagement.

Lack of definedroles and

responsibilitiesfor patient

engagementwithin mypractice.

Do not employstaff skilled in

patientengagement.

Lack ofincorporation of

patientengagement

metrics inquality

improvementmeasures and

reports.

Concern overpatients lack ofcompetency inmanaging their

own health

Insufficientpayment forcarrying out

patientengagement

Organizationalprotocols that

constrain

Limited timewithin the

patient visit toexplain care

options

Limited timeafter the visit tofollow-up with

patients

TIME COMP

Physician Perceptions of Patient Engagement Barriers …but have very tangible concerns about PE.

“Rate the applicability of each statement as a potential barrier to regularly implementing patient engagement strategies in your practice”

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Source: Q14 Physician Survey, N=359, (100% of the time)

8.4%

22.6% 23.4% 29.5% 30.6% 34.0% 39.8% 44.3%

I rely on other staffin my practice to

engage andinvolve patients in

their care.

I coordinate patientcare with other

providers in or outof my practice.

I take the timenecessary to

understand mypatient needs,behaviors, and

home environmentwhen making

treatmentdecisions.

I assess my patient’s literacy

level and technology

capabilities so I can adapt my

communication with them.

I gather input frommy patient or their

family in theirtreatment and care

plan.

I include patientconcerns and

preferences as akey part of the

treatment decisionmaking process.

I provide treatmentoptions to my

patients.

I provide mypatients pros andcons of treatment

options.

Current Engagement Practices by Physicians “How often do you use the following strategies to engage with the patients in your practice?”

Shared Decision Making Effort Not My Job

Training and resources needs seen as most valuable by Physicians—”Soft Skills”

23

Source: Q23 Physician Survey, N=359, (those indicating a 4 or 5 on a 5-point scale scale)

56.0% 57.8% 63.9% 64.3% 64.9% 64.9% 70.7% 72.4% 72.9% 73.2%

Applyingchange

managementprinciples tomy practice

Strategies forpartnering with

communityproviders andnetworks tomaximize

adherence totreatment or

improvedoutcomes

Assessingpatient literacy

andcomprehension

status

Culturalcompetence

Managingpatient

expectations

Patientengagement:

preparingpatients forbehavior

modification

Patient factorsinfluencing

patientengagement

and adherence

Strategies forcommunicatingwith caregivers

and family

Strategies forcommunicating

with non-adherentpatients

Effectivecommunicationand listening

skills

“Rate the value of access to training and resources in the following topics to you and your practice: ” “Communication”

So What? What does the provider perspective tells us about better ways to engage patients?

• Accept that time is finite…can’t make more but can make

better use of it • Use time before and after the clinical encounter to prepare for and

pull through patient engagement • Redesign the entire clinical flow

• Accept and embrace a Value-based approach to managing patients

• Provide training on best-practice approach to transitioning from volume to value

• Transition help– Capitalize on the Chronic Care Management code reimbursing providers OUTSIDE of the clinical encounter

• Training HCP on “soft skills” (e.g. communication, etc.)

Patient Perspective

WebMD

Conflict of Interest Mazi Rasulnia, PhD, MPH, MBA Consultant to Medscape and Genentech Co-Founder of a patient engagement company PACK Health Acknowledgement: This study was supported by Genentech, Inc.

© HIMSS 2015

Patient Characteristics: Study vs. WebMD User Profiles

27

Study Patients Profile

(n=2,567) WebMD User Profile Marital Status % % Married 59% 42% Education % % Graduated college (4 yr degree) 18% 31% Ethnicity % % Black/African American 6% White/Caucasian 82% Other 122% Gender % % Female 76% 65% Male 24% 35% Age % % 18-24 1% 16% 25-34 3% 25% 35-44 7% 18% 45-54 18% 16% 55-64 33% 16% 65+ 38% 9% WebMD Data Source: comScore Multiplatform November 2014; comScore Plan Metrix November 2014 Note: Study population inclusion was to have seen your doctor in the past 90 days

There is more alignment between providers and patient on how to approach patient engagement than with organizations that house the providers or make decisions about patient engagement strategies for the organization. • Patients view PE in terms of relationship (high-touch) • Providers believe that PE is part of their job and responsibility and beneficial

to their patients. • Providers have a harder time seeing it as an easy task or efficient in their

current models for patient care. • Patients depend on providers as the primary source for engaging them (they

want more time)

Patient Perceptions of Patient Engagement: Patient-Provider Alignment

My healthcare provider…

29

Patient Perceptions of Patient Engagement: Patient Expectations of Healthcare Providers

21% 21% 21% 24% 24% 23% 25%

69% 69% 68% 53% 63% 56% 53%

90% 90% 89% 77%

87% 79% 78%

I haveconfidence inmy primaryhealthcareprovider'sknowledge

I haveconfidence inmy primaryhealthcare

provider's skill

I trust myprimary

healthcareprovider

I feel like I cantell my primary

healthcareprovider

personal things

I am involved inmy healthcare

decisionmaking as

much as I wantto be

I do not waitmore than 30

minutes to seemy primaryhealthcare

provider onceI'm in their

office

I can easilydiscusspersonal

matters withmy healthcare

provider

Strongly Agree Somewhat Agree

Q11. Please indicate how strongly you agree or disagree with the following statements. Base: Total Respondents (n=2,567)

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Patient Perceptions of Patient Engagement: Patient Expectations of Providers during an office visit

So What? What does the patient perspective tells us about better ways to engage patients?

• Engagement should start or initiate from a trusted source

• Engagement should not adversely impact the experience of the

patient (e.g. the clinicians interacting with EMR or technology rather than patient)

• Metrics of engagement should consider what matters to patients (e.g. time and empathy measures)

• Different barriers for different audiences CIOs – Attitudes and

expectations of Providers and Patients

Providers – Time demands and

training Patients – Provider’s time

• Disagreement around who “owns” PE CIOs – CIOs, since PE

requires technology Providers – Patients need to take

more responsibility for their care/outcomes

Patients – Providers need to be

willing to spend more time with them

3

• Mis-alignment around what PE means Hi-Tech – For CIOs, PE is about

technology and driven by MU

Hi-Touch – For Providers and

Patients, PE is about relationships

Patient Engagement (PE) is generally viewed positively by all stakeholders… but notable differences exist

Summary of Findings

Definition Ownership Barriers

Questions?