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Engagement Is A Strategy, Not A Tool: Part 1

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“A journey of a thousand miles begins with a single step.” —Lao-tzu,

As a cornerstone of Meaningful Use Stage II and a key theme of HIMSS13, it might be easy to get the idea that patient engagement is all about Health IT, but it’s about a much broader spectrum of activities. We’re just at the beginning of discovering what works under what conditions.

A Question

I was asked this week by Lygeia Ricciardi, Director of Consumer eHealth at the ONC, “What more could ONC be doing to support patient engagement?”

(My first reaction: It’s great to be asked this question from an organization responsible for getting people engaged.)

My response went something like this: “In the context of Meaningful Use, it seems like patient engagement is all about sharing data. Engagement isn’t just about Blue Button+ and sharing data (although they are necessary foundations for innovation and enabling patient action). The key to engagement in early stages is to get people’s attention and to let them see what’s possible by using the tools available to improve their health. It’s a process and a strategy, not a data set.”

It was refreshing to hear that I was preaching to the choir.

ONC and the Consumer eHealth office understand there’s a need to get into that area between technology and human motivation, the area that makes technology a pathway to better outcomes.

According to Ricciardi, the “ONC’s overarching strategy for engaging consumers consists of three As: Access, Action and Attitudes:

  1. Giving consumers Access to info in a format they can use

  2. Supporting growth of an ecosystem of tools and apps that allow them to take Action with their health info

  3. Helping to evolve Attitudes about consumer engagement and health.”

While the big news and headlines among health IT people is around Access, the impact on public health, the national financial picture and the triple aim will come with second two — Actions and Attitudes.

But what can or should the ONC, a group dedicated to health IT in its very title, do for action and attitudes?

One of the challenges with Action, is making people’s health data usable. Like any tool, it doesn’t do much good if nobody knows how to use it. In Dave Chase’s words, people need to have motivation to use their data and it has to be “easy, consumable, shareable and relevant” before it can be valuable in improving outcomes. Understanding design exists at the intersection between people, their data and their ability to act. Along those lines, the ONC has issued design challenges for Patient Records. The results look clean, clear and a clear improvement from most products on the market.

For Attitudes, Ricciardi says “Under our Blue Button Pledge Program we are working with Eliza and Alex Drane on a survey to help figure out how to talk about access to data/engagement in health in a way that is genuinely compelling to the general public.”

Ricciardi hopes to uncover “how engaging with the health care system can be fun, playful, sexy, scary–compelling in some way that will draw people in.” The ONC will be releasing the results of a survey Eliza is fielding at HealthDataPalooza in June 2013.

As part of that initiative they’re also working with Kyra Bobinet in BJ Fogg’s lab to help apply the results of that research.

As I’ve written before, changing the health system for better communication requires the understanding of the available tools, abilities and motivations of all the stakeholders in the health care system, including physicians and patients, areas where Fogg is an expert, including how all this relates to online marketing. Each type of patient, physician and other stakeholder has inherent abilities and motivations. We tend to treat the tools or motivations distinctly, but a combined approach, as Fogg shows, will likely be the most successful.

HHS has also enlisted behavioral scientists like Dr. Audie Atienza to understand what motivates people toward better health, and several behavioral scientists had a hand in the NeHC’s Patient Engagement Framework.

Quick plug: if you’re interested in the crossroads of technology, engagement and motivation mark your calendar for Healthcare Unbound 2013, which will have a new focus on patient engagement strategies this year, July 11-12. ONC’s Lygeia Ricciardi will co-host a track with Patient Engagement Framework architect Leslie Kelly Hall.

There’s a long way to go on the behavioral medicine and patient engagement path. What hurdles might we encounter? What might a patient engagement strategy look like?

Read “Engagement is a Strategy, Not a Tool: Part 2, The Engagement Spectrum”

 

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Leonard Kish

Leonard is Principal and Co-Founder at VivaPhi, an agency that solves multi-disciplinary business problems involving data science, software, biomedical science, behavioral science, health care, product design, community development, marketing, consumer engagement and organizational design. He has been quoted in Forbes and other top-tier publications for thought leadership on patient and consumer engagement. In addition to his role at VivaPhi, he is Chair of the Marketing and Communications Group for the Collaborative Health Consortium.

  • Even though we’re a patient engagement tools vendor, I couldn’t agree more that successful patient engagement is a strategy (not a tool). On a more sobering note, my observation is that until one makes a fee-for-value commitment, they tend to think of patient portals/engagement as a box to check as though it was another CPT code. Once there is a FFV commitment, there is recognition that there is little hope of FFV success without a strong patient engagement strategy.

    Those providers who have had success with patient engagement often start with “tools” such as phone, text, gmail, excel, etc. In other words, not elegant tools but ones that are functional. At that point, using more sophisticated tools simply becomes a logical next step.

  • These discussion points are critically important and need to be elevated. Data exchanges are meaningless to patients without context. We need to
    identify ways to better connect with people about their health before we can
    expect them to be fully engaged in their healthcare. And that means reaching, educating, motivating them (us) to be more aware and activated about health and well-being.

    Patient engagement has to cover not just the problems that need to be resolved but also the opportunities to make better daily choices and improve their health behavior actions. They will not engage because they can more easily access doctor-generated
    data – they will engage because “we” can offer solutions and ideas that improve
    their health and well-being.

    It’s heartening that folks like Alex Drane, Kyra Bobinet and BJ Fogg are active in this space – they each have a holistic perspective on consumer engagement and can help drive smart strategies.

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  • Great points, Dave. Thanks! You’re right, it’s the value-based system (and more evidence that engagement works and allows for shared savings) that will tip to more sophisticated use of engagement.

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