Awareness of “Patient Engagement” has grown over the past 5 years and will certainly accelerate now that it is included as part of the Stage 2 “meaningful use” proposed rules. The notion of consumer engagement initially grew from the advertising industry as a by-product of the increasingly interactive internet phenomena of consumers posting comments on corporate blogs. Razorfish, a consumer marketing firm, in 2011 argued that “Engagement isn’t just about a channel. It is about the consumer’s relationship with a brand, his or her ability to choose how and when to engage, and the value each channel represents.” In the health care context, there are many channels- from the nurse at the doctor’s office to the patient portal online. Patient engagement, to be successful, has to begin and end with the patient, on their terms, with their values and priorities first and foremost.

Increasingly consumers have immediate access to the views of their peers on many different subjects, not least of which is health care. A 2011 Pew Internet study on “peer to peer Healthcare” shows that “one in five internet users have gone online to find others who might have health concerns similar to theirs.”  According to Susannah Fox, associate director at the Pew Internet & American Life project, more than 80% of internet users have looked online for health information. 10% of adult cell phone users have signed up for a health application,, although many may have only used it once. Johns Hopkins University currently has 49 official studies underway as part of its Global mHealth Initiative to determine which mobile health applications actually work.

Innovation often occurs at the intersection of different industries and disciplines. The MIT Media Lab is a famed example of an interdisciplinary hotspot, where structured serendipity, contempt for silos, playful invention, and a group of “open minded and dangerously creative people” produce breakthroughs. Within healthcare the promise of engaging patients, especially those with chronic conditions, has the potential of dramatically improving their health outcomes and decreasing costs of complications. This is where the intersection of marketing and health informatics can have a breakthrough impact.

Integrated Marketing arose as a solution to the fragmentation of marketing communications. I like the definition from the Centre for Integrated Marketing below:

Integrated Marketing is an holistic discipline using the fractal concept of wholeness, where the whole is present in each part, as in DNA, to develop congruent, sustainable and high-value brand experience for all stakeholders.

In the case of Integrated Marketing, the starting point is core identity, and this is then articulated as strategy through the business model, products, brand, vision, cultural values and business evaluation (amongst others). It is also communicated in creative ways through marcoms and service/touch points.

When applied to Patient Engagement, the core “”DNA” is the patient’s own need to act, in collaboration with others, towards a better outcome. This need is especially accessible to integrated care delivery systems with shared risk for patient outcomes, such as Accountable Care Organizations and managed care systems.

In the April/June 2012 issue of the Journal of Ambulatory Care Management Angela Coulter, of the Department of Public Health at Oxford University,  outlines the evidence supporting Patient Engagement.  She outlines three areas where the evidence is strongest that patient engagement has beneficial effects: (1) improving health literacy, (2) shared decision making, and (3) care process improvement.

The Board of the American Medical Informatics Association published a white paper in 2009 that defined the core content for a medical subspecialty in clinical informatics in 4 areas: clinical informatics, clinical decision making and process improvement, health information systems, and leadership/change management.

This core content is, of course, centered on the clinical context and care delivery organization medical and IT infrastructure. These are necessary areas for effective use of clinical informatics within and across the healthcare delivery system. To me, what to me seems missing in this content is a patient-centric orientation. This is not a criticism, but an observation that because the focus of the clinical informaticist is predominantly on improving care within the care delivery organization, through better work flow and improved clinical decision support for the medical, nursing, and allied health professionals.  The “engaged patient” can be part of this vision, and in the better health organization patient engagement is incorporated into clinical guidelines and care protocols.

The Electronic Health Record (EHR) is a key element of patient engagement. Patients need broader access to their record- far beyond the current proposed rule to provide access within 4 days. Patient engagement does not begin or end with the EHR. When it comes to actually connecting with patients outside the care environment (where patients live and interact most of their lives) it takes a different mindset and an expanded set of tools that are connected to the Patient’s life in a more holistic way that goes beyond “health care”. This is precisely the problem-space addressed by integrated marketing. The opportunities for collaboration between marketing  and clinical informatics professionals has never been greater.

Future posts will explore innovations in social media, mobile applications, and health services organizations to create an engagement model supporting patients actively involved in their own journeys towards better health outcomes.

Dr. Mostahari joined former Democratic Senator Tom Daschle and former Republican Senator Bob Bennett to discuss the promise of Health Information Technology today.  My favorite quote was from Sen. Bennett: “Everybody is in favor of Health IT”.

Tom Daschle said “This is the most transformational time in our history, with regards to Health.”

This was my first time seeing Farzad Mostahari, MD, the new National Coordinator for Health Information Technology, in action.  His bow tie certainly was an indication that he is not David Blumenthal, at least in the gravitas department. His message, though, was just as clear and welcome as that of his predecessor. He even invoked Clayton Christiansen’s concept of disruptive innovation as he buoyantly described the efforts of Open Source volunteers in support of the Direct Project, calling it a “Do-ocracy”.  It’s about those willing to do the work, not just talk about it, that has resulted in the creation and implementation of a new standard for exchanging clinical data within one year . That’s leadership I can support.

At a press conference in Washington DC today, top executives from five prominent health systems announced a consortium to securely share electronic patient information with each other. The members of this consortium include the Mayo Clinic, Geisinger, Kaiser Permanente, Intermountain Healthcare, and Group Health Cooperative.  It is notable that these organizations do not compete with each other in their primary geographic areas. Each has significant credibility in their own areas, and can legitimately aspire to national and even international visibility. In the ongoing restructuring of healthcare delivery models, such organizations are evolving into post-enterprise players, with infrastructure and organizational capabilities that transcend traditional company boundaries.

This announcement was more significant as a statement of organizational commitment to a new vision of healthcare than as any kind of new technical breakthrough accessible only to large IDNs.  Standards-based electronic patient information exchange technical capabilities are becoming commonplace as a result of federal certification requirements for Electronic Health Records technology. Accelerated by the ARRA stimulus funding, hospitals and providers who establish meaningful use of this technology are eligible for incentive payments through Medicare and Medicaid. What is remarkable about this Care Connectivity Consortium is that these institutions are smart enough to leverage their technology investments to enhance their brands as patient-centered visionary organizations. In the press conference each institution conceded that the number of patients who actually cross their organizational boundaries is rather small. As Marshall McLuhan once pointed out, the medium is the message, and the visual impact of these five health systems literally aligned at the same table spoke volumes about the real message, which is that these five organization are at the head table of using IT to advance patient benefits, and to advance their brands.

 For more information see http://www.visualwebcaster.com/CareConnectivityConsortium

and http://www.prnewswire.com/news-releases/five-leading-health-systems-create-new-care-connectivity-consortium-119301529.html