Increasing Patient Engagement Through Online Health Records and Apps

AS THE DEFINITION and metrics of “meaningful use” pertaining to electronic health records (EHRs) progress, physician and patient engagement is progressing as well. Providers are in a unique position since EHRs can provide talking points and encouragement to help patients get involved with using technology to enhance their own care. This includes making and canceling appointments online, opting in on automated reminder calls and texts for appointments and medications, and utilizing newer patient engagement technologies such as medical apps and personal health records (PHRs) — all of which provide them with data and the ability to work with their doctors to meaningfully use it. “Meaningful use initially was [created] to incentivize and provide quality checks on the [providers’] installation and initial use of EHRs,” says John Sharp, senior manager of Consumer Health IT with the Personal Connected Health Alliance at Healthcare Information and Management Systems Society (HIMSS). “As it has evolved, there has been more emphasis on patient engagement.” And, while interest in these technologies is higher for some patients than others, the sometimes steep patient learning curve can be lessened through staff and provider interaction and teaching tools in providers’ offices.

Technology Continuum

Software designers offer a wealth of options for a wide range of interests and access to health and wellness information. Even the simplest technologies such as a text message reminder can be effective. For instance, researchers at HealthCrowd working with patients in New York’s Health first Medicaid Managed Care program found that 32 percent of beneficiaries who were sent text messages as part of a two-and-a-half-month pilot program took at least one suggested action when contacted about prenatal care, wellness visits for children and/or vaccinations. The study authors predict that had the pilot program lasted a year, they ultimately would have had an 86 percent response rate.¹

Easy-to-access and -use healthcare apps linked to smartphones and tablets are another option that continues to gain popularity. Many apps allow patients to feed real-time data about their conditions into their PHRs, which feed that information into their providers’ EHRs. From tracking stress levels, blood pressure readings and glucose monitoring, providers can be alerted in the event of an out-of-range report, and patients can send secure messages to providers with specific questions regarding their care. These apps can promote greater adherence to recommended care plans, as well as greater understanding of how patients’ actions concerning topics such as nutrition, exercise and pharmaceutical interventions can affect their health.

Physicians, 80 percent of whom use smartphone technology, have information like never before at their fingertips. This includes clinical reference apps that provide access to pertinent medical studies, public health apps that deliver alerts and diagnostic tools, biosurveillance data provided by the Centers for Disease Control and Prevention that tracks real-time population health, and diagnostic apps that, through algorithms, offer assistance with treatment decisions.

When coupled with apps requiring patient participation such as passively wearing a monitor or actively providing input, providers and patients capture even more data to help with treatment plans. Telehealth and disease management apps help patients and providers actively manage chronic conditions,² fitness and nutrition apps provide data about how wellness choices impact health, stress management apps check in with users throughout the day to assess stress levels and provide relaxation techniques, and sleep tracker apps log patients’ restfulness and sleep patterns and provide referrals.

Hospitals are also taking advantage of new technology. A 2016 HIMSS survey found 52 percent of hospitals are using three or more connected health technologies, and 69 percent of respondents who use a mobile-optimized patient portal say the technology extensively supports their hospital’s secure data exchange strategy.³

Meeting Patients Where They Are

Becoming comfortable using new technology is challenging enough for many physicians, but now they are challenged with engaging patients as well. This requires putting in place the right mix of support, environment and reminders for patients to register for health records or apps and, once registered, to actively use them.

What motivates each individual differs. As would be expected, age may correlate with interest, but this is not always the case. Sometimes, a more urgent health need will spur individuals to engage. For example, the Harris Poll found millennials are much more likely to actively use medical apps, as are those with chronic conditions that require monitoring.⁴ They also found 60 percent of those polled who had been diagnosed with hypertension were very interested in monitoring their blood pressure through a smartphone app, and 63 percent of those diagnosed with heart disease were interested in checking their heartbeat for irregularities on a mobile device.

But, interest doesn’t always translate to action as found in a California Health Care Foundation survey that showed that, although 80 percent of Americans who have online access to their health information use it, only 20 percent of all U.S. adults currently have access to their medical records online.⁵

EHR Barriers

How can providers interest patients in managing their health electronically? And, what is the right mix of face-to-face versus digital communication? The answer depends on the patient. For those with multiple chronic conditions, there is a lot of interest and benefit to continuous monitoring. For healthier people who see their doctors infrequently, says Sharp, there may be fewer reasons for accessing online records and more utility in wellness apps. For example, a fitness tracker may be of more value to patients in an employee wellness program. Of course, for apparently healthy people, a challenge for the physician is what to do with all the data.

While it is easy to blame lack of interest in apps and technology on age and a “non-techy” mind-set, infrastructure can be a barrier. Many people lack Internet access, and many don’t have a smartphone or tablet. Infrastructure challenges at the provider level can include technologies that don’t readily talk to each other. This is a problem for patients who may have multiple providers and multiple portals with which they must connect, and for providers who may have systems that don’t talk to patients’ other providers. While the goal eventually is a common language where portals can more readily communicate, that is not yet in place.

Rural areas with limited or no broadband are a hindrance (though many communities have or are applying for grants to remedy that). Broadband requirements are crucial for telehealth, especially with a shortage of physicians in many isolated communities.

Language and literacy are also barriers, though pilot programs are underway to look at various ways to address this. One pilot is examining the effectiveness of a texting program targeted toward Hispanics who are diabetics that offers suggestions for eating right and monitoring blood glucose. And, some senior centers are testing the ability to educate their residents about computers, while at the same time instructing them on how to access their PHRs.

Strategies for Engagement

With so many opportunities and benefits, two strategies stand out as most successful for encouraging patients to access their health information online: repetition and patience. “A full-out recruitment marketing strategy is needed,” says Sharp.

Much like any marketing strategy where multiple touch points are key, multiple messaging may be required to help patients realize access is not only available, but useful. Posters and informational videos in waiting rooms can alert patients to the opportunity, as can communication with reception staff, medical technicians and even billing departments at check-out. For instance, researchers in Virginia found patient engagement in technology increased 139 percent when patients were invited to log into their portal during their office visit versus sending a direct mail invitation to do so.⁶ Sharp also suggests physicians use the word “portal” as a verb. Providers can say to patients at the end of a visit: “If you think of any questions, portal me.” “That’s most effective,” he says. “It is saying to patients: ‘I use this all the time, and so should you.’”

Taking extra time to invite patients to register while at the office by having a dedicated staff person available to walk them through the process can make huge strides in getting patients to take the first step. This can reinforce patient understanding of what types of information they’ll find in their PHRs and how access can be beneficial. Once registered, patients will need help to understand where various pieces of information are found, including test results and health education materials. They also need to learn how to create appointments, request prescriptions and send secure messages to their providers.

Once patients are comfortable online, providers can invite them to view their own and their family’s health history in their PHR where they can fill in any lacking pertinent details. They can also show them where lifestyle information is found and how to either manually or automatically download information found in monitoring apps.

Developing an officewide strategy for patient engagement should include all staff, particularly those who have frontline patient interaction who can encourage registration and use of online records and apps. Staff should revisit talking points and other strategies at regular intervals to discuss what is working for patients and what can be improved.

Offices concerned with the logistics of a big rollout can start small with a focused group of providers and patients to better understand how their patients will use the apps and to get feedback. Or, they can begin with a few accessible features within the PHR that can be slowly expanded on so it is not overwhelming for patients and staff.

The End Result

The trend toward digital health is working, however slowly. According to an Office of the National Coordinator for Health Information Technology Data Brief, in 2014, nearly half of patients were offered online access to their PHRs with about one in 10 accessing their records six or more times during the year. Seven out of 10 patients who accessed their health information online also used it to monitor their health, and 12 percent transmitted their data to a third party such as a medical app or a PHR.⁷

It’s not a matter of if, but when, the digital health bandwagon will pick up speed. And when it does, improved access to health information will translate to improved communication and, hopefully, better health for everyone.