Digital health care gives patients a new opportunity to engage with their care providers on an unprecedented scale. With the electronic exchange of health information, consumers can access their medical records electronically, share them with providers, and make informed decisions. These advances in health IT make possible better consumer engagement, as well as more efficient and effective care. On October 17, 2012, Lygeia Ricciardi, acting director of the Office of Consumer eHealth at the Office of the National Coordinator (ONC) for Health IT, laid out the agency’s plan to increase patient engagement through health IT during a virtual briefing1 from the Health Information and Management Systems Society. Ricciardi presented “eConnecting With Consumers: Provider/Patient Engagement Through Health IT” as part of the briefing. Under HIPAA, she says, everyone has the right to access his or her medical records, but traditional paper access can be slow, cumbersome, and expensive. With a digital platform, access is quick and convenient, and it allows consumers to interact with their health data in new ways. The ONC sees the expansion of health IT as the perfect opportunity to engage consumers in health promotion. According to statistics presented during the event, consumer engagement reduces hospital readmissions, medical errors, and the health consequences of poor communication. The OpenNotes program,² sponsored by the Robert Wood Johnson Foundation, allowed patients to look at their records and physicians’ notes online. The result was positive: 60% of patients improved their medication adherence, and 99% wanted to continue beyond the study. Physicians were initially reluctant, but 100% chose to continue, in the end. These findings led the ONC to conclude that consumer engagement equals better care. From that premise, the ONC presented its Three As (access, action, and attitudes), a plan addressing consumer engagement using technology. The plan expands electronic health records (EHRs) through meaningful-use incentives, enables consumers to interact with their health data electronically, and promotes awareness of these new tools for consumers. Access According to Ricciardi, 90% of patients want access to their information electronically, and two out of three people consider switching to a physician who offers access to medical records online. People want access to their patient records, and widespread EHR adoption will make electronic access possible. Consumer engagement has been incorporated into meaningful-use requirements by establishing the necessary infrastructure for online data exchange, Ricciardi notes. Between 2008 and 2011, meaningful-use–driven adoption of EHRs by office-based physicians doubled. Stage 1 of meaningful use requires electronic access to health information, clinical visit summaries, and tailored educational resources. Under stage 2, the ONC is pushing for more data flexibility, so that patients will be able to view, download, and share their medical information (in addition to plugging it into third-party apps), with the goal of giving consumers ownership of their data. In addition, stage 2 calls for secure messaging channels between patients and providers. The ONC wants to expand its Blue Button program to include the general health-care consumer. Currently, more than a million veterans use Blue Button to access their medical data with one click. Information is downloaded into a text file that contains medication lists, conditions, and basic demographic information. With help from the Presidential Innovation Fellows program, Ricciardi says, the ONC hopes to expand those numbers by millions. The ONC is also mobilizing the community through Blue Button pledges, a loose coalition of organizations that have pledged participation in the program. There are two types of pledges: data holders (hospitals, providers, and payors holding patient data) and others that are not data holders (consumer organizations, employers, and technology developers). The program was launched in 2011, with 30 organizations on board initially, but that number has ballooned to over 400, ensuring compatibility across data holders and the development of new apps and tools by others. Action and Attitude The ONC will encourage the development of tools and apps to help patients make choices about their health outside the physician’s office, and it will run a series of challenges to encourage the development of apps for the medical data on Blue Button. These can include comparisons with national datasets and medical-product comparisons. For instance, the ONC has proposed a system (inspired by food labels) where practices can be compared on their privacy policies at a glance. Patients can see how their medical information will be stored and shared by practices. A radiology-specific app might cause a reminder for a woman’s annual mammogram to pop up on her smartphone, for example. The Healthy Apps Challenge supports development of third-party apps that can use data for modeling healthy behaviors. These apps cover a broad spectrum of apps in categories such as fitness/exercise and nutrition. Apps are judged on the degree to which they are usable, evidence based, innovative, and fun. For the health-care system to become more effective and efficient, patients will need to take responsibility for their care; to that end, the ONC is running an online awareness campaign to inform consumers about these new technologies through animated videos posted on its consumer website (healthit.gov). The goal of these videos is to motivate others and inspire them to use technology to improve their health. Digital health care offers the potential for a new level of intimacy between providers and patients, Ricciardi believes. Health IT will continue to play a bigger role in the future as ongoing payment reform emphasizes efficiency and more effective care. While digital health care will be challenging for providers, patients, and hospitals, opportunities will also abound.
Health IT for Patient–Provider Connection