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Online Patient Engagement

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  • 1. Online Patient Engagement<br />Dr. David Paschane<br />Civil Servants take serious the promises of consumer empowerment in healthcare, especially the online engagement that enables patient-control. Contemporary online patient engagement (OPE) is critical to establishing productive relationships with health providers, sustaining integrated knowledge about health and treatment, and contributing effectively to the interactive management of health outcomes. <br />As active contributors to public policies and bureaucratic decision-making, Civil Servants are keenly aware of the necessity and advantages of improving the depth and breadth of communications between individual beneficiaries and organizational services. Personal health communications, education, and management are now fundamentally changed with the recent intensification in OPE capabilities. The numerous exposures customers have to what is possible through online engagements is now a driving force in the selection of services – especially in the new paradigm of Healthcare 2.0. <br />The rapid advancement in digital communications has impacted nearly every component of healthcare management, and the drive to better care online has crated the Healthcare 2.0 market. Patients now seek to know an incredible array of information details that can affect their health—insurance benefits, treatment options, self-care capabilities, psychological roles, market offerings, provider’s background, drug formularies, referral parameters, care-seeking options, alternative services, and much more. Healthcare 2.0 is further enhanced by the integration of traditional healthcare and OPE to mitigate costs and risks. The OPE can be tailored to anticipate and address patients’ likely needs, characterized by their health, lifestyle, knowledge, and experience with disease chronicity and severity. The better fit enables opportunities to connect the right services to the right patients at the right time. Civil Servants with healthcare agencies are driving expectations for OPE through Federal explorations into Healthcare 2.0 integration with wireless monitoring devices, natural language customer systems, online interactive therapies, and real-time reporting on access conditions. <br />Increasingly, healthcare providers are demanding empowerment of patients’ roles in managing chronic and behavior-based conditions, adapting to home-based and spouse-based services, and controlling healthcare processes through OPE and its integration with technological advancements.<br />The design principles in OPE are guided by many specific goals, which these are more common examples:<br />Translates patient to provider language/understanding<br />Integrates physical and psychological elements<br />Provides patient ownership/gate-keeping of information<br />Reinforces patient’s role in clinical/non-clinical settings<br />Provides comprehensive/convenient assessments <br />Increases time for individualized attentive care<br />Focuses treatment through communication accuracy<br />Reduces costs through early and integrated care<br />Responds to care-seeking behavior in a timely matter<br />Engages patients in managing disease processes<br />Provides early identification of patients’ complications<br />Minimizes likelihood of errors and noncompliance<br />The growing Federal attention on OPE is driven by the significant research on how patients can and are willing to manage their healthcare processes, and find it necessary to survive the disorientation of most healthcare experiences. A lack of reinforced patient-integration can lead to unsuccessful restoration efforts by medical services, including unwanted consequences, such as diminishing a patient’s role in healthcare processes. <br />Patient-integration is the ability of a patient to evaluate, decide, and act according to personal preferences. Its scope includes all the functions that are relevant to healthcare management, and that can be affected by the patient. These include control over (1) visible and understandable information, (2) flexible and efficacious service processes, and (3) effective and authoritative decision-making. While all of these functions can be addressed in part through organizational initiatives, the most sustainable and effective form is excellence in OPE. OPE that has demonstrated content agility matched with psychological facilitation. <br />Ultimately, the patient psychology improved through OPE includes:<br />Sense of control and self-care<br />Motivation and self-determination<br />Expectations and compliance<br />These improvements reinforce patient control and can:<br />Enhance the immune system and physical responses<br />Reduce negative stress responses and reactance<br />Improve patient participation and effectiveness<br />The research behind patient-integration and the inspiration for Federal officers at agencies such as the Departments of Veterans Affairs and Health and Human Services to pursue OPE is grounded in a long history of innovative communications in clinical operations. In a ground breaking study by Greenfield and his colleagues demonstrated that both patients and the government programs benefited significantly from designs that reinforce patient-integration. The study was a 20-minute pre-visit coaching program, and it demonstrated sustained and significant benefits in patient engagement and physical health, without additional clinical time. The concluded was that without such “coaching,” patients “may not acquire the knowledge, skill, and more importantly the confidence and sense of control they need in the management of chronic disease” (p. 456). Similar studies have identified that other innovative approaches to patient-integration are useful in enhancing patient’s resiliency, managing pain treatment, reducing blood pressure, and limiting demand for surgery. The key factors in successful patient-integration seem to be information clarity and convenient delivery - elements that are all the more capable through advancements in OPE. <br />A breadth of research illustrates that patient-agency is a primary driver of demand and outcomes in healthcare. It is the patient who presents the illness, requests assistance, weighs the risks and benefits, consents to care, and continues the process through changing health status, treatment, and health-related behaviors. <br />OPE also fits the bottom line goals of an organization because it plays a role in several healthcare management functions: <br />Economizes decision-making<br />Reinforces self-management of consumption<br />Increases spending sensitivity, e.g., health savings accounts<br />Increases information verification, e.g., individual health records <br />Improves patient-provider communications<br />Establishes patient ownership of information<br />Overcomes barriers due to disabilities or language <br />Accommodates differences in patients’ understanding <br />Enhances healthcare services and experiences<br />Improving OPE requires analytic monitoring of the utility, appeal, and patient benefit of web-enabled applications, and their impact on the patient and other resources. OPE metrics can help determine the likely functionality, content, and interactivity to increase customer satisfaction. Methodologies in improving OPE focus on the degree, depth, and impact of patient and provider involvement. This extends not only to individual usage, but also behavior change, personally-realized effect, community interaction, user perception, and peer influence. Ultimately, OPE reflects the quality of the content, aesthetics, functionality, serviceability, infrastructure, alignment to user needs, facilitation of communication and decision making, orientation, marketing, and promotion of the best alignment between the patient and provider services. <br />As OPE improves, transactions will become more efficient in terms of time and cost to the user; user knowledge, skills, and abilities will increase; and, operational costs from other resources (e.g., call centers, drop in clinics) should decrease, thereby allowing resources to be reallocated to better serving patient priorities. <br />The innovation that can be introduced through successful OPE is rapidly entering markets where Healthcare 2.0 is popular. Examples of these innovations include: <br />Online personal account of the status of all available benefits, and online applications for benefits that are submitted electronically. <br />Online tracking of integrated wireless patient self testing, self monitoring, and appointment and emergency notification devices.<br />Online and call-in tracking of medical services’ best times, given patient traffic flow in surrounding facilities. <br />Online physical care adherence training tailored to each treatment regiment.<br />Online, call-in natural language processing for ensuring consistent, authoritative information and coaching-like responses.<br />OPE solves long-standing problems in healthcare. It overcomes problems of enabling patient-centric quality, mobility, and access, while making health-seeking experiences and the patient role easier, continuous, and more agile.<br />OPE is a communications framework that can facilitate three major sets of improvements: <br />Easy and Effective Healthcare Communications – overcome patient-to-provider communication barriers. Natural language translation tools designed to fit the quality health dialogue needs of patients. Solutions to address cultural differences, comprehension of patient and medical messages, psychology of patient control, and diminished capabilities through illness or disability. <br />Continuous and Comprehensive Communications – overcome patient-to-provider monitoring limitations due to distance, mobility, and availability of testing. Wireless patient monitoring devices synchronized with provider access to patient released medical status. Solutions to address chronic and complicated illnesses and progress through treatment regimes. <br />Agile and Accessible Communications – overcome patient-to-provider access by monitoring use and availability of service points and ancillary conditions, such as wait times, hours of operations, and parking. Online, real-time analysis of supply and demand in markets, with easy-to-use searches engines and service agents. Solutions to address time efficiencies for both patients and providers, appropriate use of services, and planning of improvements in supply of services.<br />Citations:<br />Austin KL, Stapleton JV, Mather LE. 1980. Relationship between blood meperidine concentrations and analgesic response. Anesthesiology, 53, 460-466.<br />Chen FM, Rhodes LA, Green LA. 2001. Compelled to rescue: Family physicians’ experiences of their fathers’ health care. Journal of Family Practice, 50, 762-766.<br />Deyo RA, Cherkin DC, Weinstein J, Howe J, Ciol M, Mulley AG. 2000. Involving patients in clinical decisions: Impact of an interactive video program on use of back surgery. Medical Care, 38, 959-969.<br />Diesnstbier RA. 1989. Arousal and physiological toughness: Implications for mental and physical health. Psychological Review, 96, 84-100.<br />Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJ. 1988. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. Journal of General Internal Medicine, 3, 448-457.<br />Hall JA, Roter DL, Katz NR. 1988. Meta-analysis of correlates of provider behavior in medical encounters. Medical Care, 26, 657-675.<br />Herbert TB, Cohen S. 1993. Stress and immunity in humans: A meta-analytic review. Psychosomatic Medicine, 55, 364-379.<br />Hull CJ, Sibbald A. 1981. Control of postoperative pain by interactive demand analgesia. British Journal of Anaesthesia, 53, 385-391.<br />Larsen KM, Smith CK. 1981. Assessment of nonverbal communication in the physician-patient interview. Journal of Family Practice, 12, 481-488.<br />Lazure LL, Baun MM. 1995. Increasing patient control of family visiting in the coronary care unit. American Journal of Critical Care, 4, 157-164.<br />Paschane DM. A theoretical framework for the medical geography of health service politics. Seattle, WA: University of Washington, 2003<br />Rimer B, Levy MH, Keintz MA. 1987. Enhancing cancer pain control regimens through patient education. Patient Education and Counseling, 10, 267-277.<br />Sieber WJ, Rodin J, Larson L, Ortega S, Cummings N, Whiteside T, Herberman R. 1992. Modulation of human natural killer cell activity by exposure to uncontrollable stress. Brain, Behavior, and Immunity, 6, 141-156.<br />Wiedenfeld SA, O’Leary A, Bandura A, Brown S, Levine S, Raska K. 1990. Impact of perceived self-efficacy in coping with stressors on components of the immune system. Journal of Personality and Social Psychology, 59, 1082-1094. <br />Author:<br />Dr. David Paschane is a Healthcare Scientist and Consultant with 15 years of professional experience. He has published extensively on human-organizational interactions in healthcare, with emphases on health communications, behavioral health, health IT, and healthcare management. His scholarly and applied work has been with National Institutes of Health, U.S. Department of Veterans Affairs, and the Heath Research Services Administration. He was honored with the 1996 U.S. Department of Health and Human Services Award for Excellence. He has a doctorate from the University of Washington where he focused on human factor and system analyses in health politics, health systems, patient agency, business dynamics, and bureaucratic effects. He also had degrees in Behavioral-Organizational Research, Psychology, and Visual Arts. He served honorably as a combat medic and is a service-disabled veteran.<br />