Nationally, patient engagement is being recognized as an increasingly important component of healthcare delivery. Fueling this trend are changing healthcare delivery paradigms, the proliferation of technology that helps patients connect with their healthcare providers and health information, meaningful-use (MU) objectives focused on engaging consumers, patients and their families in their healthcare, and a growing number of patients and their families who want to be electronically connected to their healthcare providers and information.

Most organizations, however, do not have a clear vision of patient engagement and have not established a solid tactical plan to support their patient engagement efforts, especially when it comes to the use of e-health tools. A recent study by the National eHealth Collaborative (NeHC) found 53 percent of healthcare organizations rank consumer engagement with health IT as “high” or “very high priority,” but only 8 percent consider their consumer engagement strategies with health IT to be clearly defined. Fifty-nine percent of those surveyed described their strategies as “evolving toward clarity.”1

For many meaningful-use eligible professionals (EPs) and eligible hospitals, the meaningful-use requirements are the foundation of their patient engagement endeavors. In Stage 1 of meaningful use, several objectives are focused on patient engagement, including:

  • Providing patients with an electronic copy of their health information, upon request;
  • Providing patients with an electronic copy of their discharge instructions, upon request;
  • Sending reminders to patients per patient preference for preventive/follow-up care; and
  • Providing clinical summaries for patients for each office visit.

The objectives are small but important steps in moving providers and patients toward electronic communication.

In Stage 2 of meaningful use, patient engagement becomes more prominent and explicit. One of the most widely discussed Stage 2 objectives is to provide more than 50 percent of patients with timely online access to their health information, and have more than 5 percent of patients view, download or transmit their health information to a third party. Additionally, EPs must provide patients with the ability to send a secure message through certified EHR technology to the care provider or team, and more than 5 percent of patients must send a message. Given the industry pushback on these measures in the proposed rule, CMS lowered thresholds in the final Stage 2 rule from 10 to 5 percent. However, CMS also noted they continue to believe EPs and hospitals are in a unique position to strongly influence the technologies patients use to improve their own care.2 Indeed, recent market research3 supports CMS’ position, finding that among personal health record (PHR) users, 35 percent said a physician recommended its use. Among those not currently using a PHR, many said they would use one if a member of their care team suggested it.

With this backdrop, healthcare organizations are pursuing a number of strategies to meet meaningful-use patient-engagement objectives. Electronic health records (EHRs) and portals are being enhanced, marketing and communication resources are being engaged to develop materials to better inform consumers and patients of e-health tools, and existing forms and policies are being refined. For example, one integrated delivery network (IDN) added a statement to printed discharge instructions and after-visit summaries on how patients can access their health information online.

Engaging front-line care and service providers can be another important strategy to drive patient engagement. A recent study found “staff attitude” was the main contributor to patients rating their healthcare experience positively. However, it also found that 55 percent of healthcare professionals prefer paper to electronic tools and communication.4 Given this information, healthcare organizations must educate employees on how they can – in a positive manner – help the organization increase electronic communications with and for patients. In-services and training for healthcare information management (HIM) and/or nursing staff on specific patient engagement workflows and policies should be provided as part of MU readiness efforts.

However, educating staff and even patients often only gets organizations part of the way there. For example, an IDN in the Midwest provided its nursing informatics and HIM staff education on the new MU requirements and trained them on the workflow for fulfilling and tracking requests for electronic copies of health information. But, as the HIM director noted, after six months of measuring MU performance, they had not received any requests from patients for their information in an electronic format. Simply put, most patients are not yet accustomed to having their health information – or healthcare providers – available to them through electronic means.

With a year or two of meaningful use under their belts, many EPs and hospitals are reviewing lessons learned. Many providers now realize training staff to respond to requests is not sufficient; rather, employees should have a more active role in promoting electronic interactions between patients, their medical information and caregivers. Otherwise, “everybody’s job becomes nobody’s job.”

Many healthcare leaders see enhancing staff engagement as a means to patient engagement as essential for sustaining meaningful use. For example, a nurse executive colleague said she foresees conducting in-services for floor nurses to increase awareness about the importance of talking with patients and their families about accessing health information online. This “in-the-moment interaction” is key. When present with the patient, staff can tailor the message based on what they know about the patient demographically and relate it to something specific and relevant. For example, a practice medical assistant can remind the patient that the results of today’s lab work will be available online, as well as past results. Thus, rather than suggesting the lab patient “call in a few days” or directing a patient to contact the HIM department, frontline staff can use the moment to mention the portal or PHR – and the patient avoids another dissatisfying handoff.

As we look toward Stage 2, eligible professionals and hospitals must be innovative in communicating with and engaging patients and staff to ensure more challenging e-health measures are achieved and sustained. Some ideas include:

  • Refine scheduling and registration processes so staff ask patients about their use of e-health tools and, if appropriate, provide information on how to access and use portals, personal health records (PHR), etc.;
  • Send appointment or inpatient visit follow-up emails alerting patients that information about their recent hospitalization or visit is now online, along with information on how to enroll and use the secure online tools;
  • Include coaching on how to access health information online in pre-operative and post-operative phone calls with patient and family members;
  • Offer closed-circuit television programming teaching patients how to access health information on the portal and PHR;
  • Send point-of-care alerts to physicians, nurses or clerical staff that the patient has created an account but has not viewed any health information;
  • Create avatars for use in waiting room kiosks and portal sites so patients have a personal yet virtual introduction to e-health tools;
  • Provide patients in waiting areas with iPads so they can establish their accounts while they wait, and have clerical staff or nursing students available to teach them how to view, download and transmit health information; and
  • Use patient entertainment systems to provide education and coaching during hospitalization.

Patient engagement is essential for meaningful use, and studies show it is becoming more definitively linked to consumer satisfaction. In response, healthcare organizations must define a clear vision of patient engagement and use a variety of tactics – from communications and marketing to upgrading and enhancing usability of PHRs and portals to training and engaging clerical, HIM staff and frontline caregivers as allies in promoting patient engagement. Tactics aside, the positive outcomes – i.e., increase in patient satisfaction, potentially improved treatment compliance and meaningful-use incentives – will far exceed organizations’ investments in making patient engagement a priority. HMT

About the Author

Laura Kreofsky is principal, Impact Advisors LLC. For more on Impact Advisors:


1. “Consumer Engagement with Health Information Technology Summary.” National eHealth Collaborative. Accessed Dec. 5, 2012.

2. Federal Register Volume 77, Issue 205. Oct. 23, 2012. Accessed Dec. 5, 2012.

3. Lynne A. Dunbrack. “Vendor Assessment: When Will PHR Platforms Gain Consumer Acceptance?” IDC Health Insights. March 2011. Accessed Dec. 5, 2012.

4. “Customer Experience in Healthcare: The Moment of Truth.” PWC Health Research Institute. July 2012. Accessed Dec. 5, 2012.

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