This document summarizes information on patient engagement and telemedicine. It defines patient engagement as involving patients in decisions about their health and using interventions to promote healthy behaviors. When there are multiple treatment options, shared decision making uses decision aids to help patients choose based on their values. Research shows patient engagement can lower costs by reducing hospital admissions. Telemedicine uses technology to deliver healthcare remotely and can increase access, especially for rural patients, while improving outcomes and reducing costs. The document recommends establishing a task force to advance telemedicine in Maryland.

1. Lisa Tayman MS, RN, CEN, CCRN
Salisbury University
NURS 525

2. Federal Policy Brief
TITLE
Patient Engagement. People actively involved
in their health and health care tend to have
better outcomes—and, some evidence
suggests, lower costs

3. Patient Engagement
 calls for reforms to achieve a patient-centered health
care system, wherein individual patient
preferences, needs, and values are respected and
patients guide all clinical decisions
 combines patient activation (a patient’s
knowledge, skills, ability, and willingness to manage
his or her own health care) with interventions
designed to promote positive patient behavior, such as
obtaining preventive care.

4. Patient Engagement
 Shared Decision Making=
When there are multiple, reasonable
treatment options, each with their own risks
and benefits, the correct path to follow
should be guided by a patient’s unique
needs and circumstances

5. Shared Decision Making
 Decision aids such as:
booklets, videos, websites, and interactive
media are used
 All of these helpful aids will give patients
information on the risks and benefits of
various treatment options and help them
make the choice that most reflects their
personal values.

6. Research on Patient Engagement
 Patients who received enhanced decision-making
support had overall lower medical costs and fewer
hospital admissions than for those who received only
the usual support
 People with the least skills and confidence to actively
engage in their own health care (patient activation)
incur costs between 8-21% higher than patients with
higher activation levels

7. Patient Engagement
 May be affected by such factors as: cultural
differences, gender, age, and education
 For patients to engage effectively, they must have a
certain degree of health literacy
 One strategy to incorporate into practice is the “teach-
back” method

8. Teach-Back Method
 The provider will ask the patient to explain
back to them what they have learned, such
as: their own understanding of their
condition, the options available to
them, and their intentions to act on the
information

9. Future Research
 More studies need to be conducted to
determine the best practices for engaging
patients, as well as determining the extent
of the relationship of patient engagement to
health care cost savings

10. Patient Engagement
 Efforts are under way to hold health care organizations
accountable for engaging patients.
 The National Committee for Quality Assurance
surveys patients and ask about whether clinicians
engage them in shared decision making or provide
support for them to manage their conditions to
determine if this quality measure is being met.

11. State Policy Brief
Shared decision making and being engaged in
their care, increased compliance for such
issues as:
 blood sugar testing for gestational diabetes
 CPAP use

12. Telemedicine
 Definition:
The use of interactive audio, video, or other
telecommunications or electronic
technology by a licensed health care
provider to deliver health care services at a
site other than the site the patient is located.

13. “Telemedicine Recommendations”
 This report addressed that effective use
of telemedicine can increase access to
health care, reduce health
disparities, and create efficiencies in
health care delivery

14. Telemedicine Benefits
 Has the potential to increase access and
reduce the cost of care.
 Both consumers and providers can
benefit from telemedicine

15. Telemedicine
 Consumers can experience increased access to
providers, quicker and more convenient
treatment, better continuity of care, and a reduction in
lost work time and travel costs
 Providers can experience instant access to other
providers, a reduction of medical errors, and increased
efficiency with reduced travel and research times

16. Research shows:
Telemedicine
 improves time-to-diagnosis
 facilitates access to care for patients in
remote regions
 increases patient satisfaction

17. Telemedicine
 Telemedicine offers an alternative to the traditional
method of care delivery (face to face)
 Health care organizations faced with provider
shortages, access disparities and budget challenges, are
adopting telemedicine in order to connect
geographically-remote patients with specialists, to
allow scarce specialists to be available across
networks, and to provide remote monitoring of
patients

18. Telemedicine
 It is recommended that payments accurately
reflect the cost of delivery for providers and
the effectiveness of the treatments must be
proven to payers and patients.
 Payment must be sufficient to cover actual
costs, but should not favor telemedicine
over face-to-face services

19. Telemedicine legislation
 According to the Department of Health and
Mental Hygiene, telemedicine should be
used to address access to care issues related
to specialists being located a long distance
from patients and not as a replacement for
in-person care

20. TELEMEDICINE
Current fiscal and policy notes:
 SB 494 regarding developing strategies and
recommendations for advancing telemedicine
technologies
 SB 496 regarding the reimbursement of telemedicine
services by Medicaid
 SB 776 regarding establishing a Task Force on the use
of telehealth to improve Maryland health care

21. Policy recommendations
 To establish a Task Force on the use of telehealth
to improve Maryland health care
 This task force must assess factors related to
telehealth and identify opportunities to use
teleheath, as well as collaborate with
organizations such as the Rural Maryland
Council, and make recommendations regarding
the use of telehealth in the State

22. Patient Engagement & Telemedicine
 Patient engagement combines patient
activation with interventions designed to
promote positive patient behavior
 Interventions such as telemedicine improves
time-to-diagnosis, facilitates access to care
for patients in remote regions, and increases
patient satisfaction

23. References
 Capistrant, G. (2013). Letter to Maryland House of Delegates. Retrieved from:
http://www.americantelemed.org/docs/default-source/policy/ata-comments-
on-maryland's-hb-931-and-934.pdf
 Commission on Maryland Cybersecurity Innovation and Excellence-Duties.
Maryland General Assembly 2013 Session, SB 494. Retrieved from:
http://mgaleg.maryland.gov/webmga/frmMain.aspx?id=sb0494&stab=01&pid=
billpage&tab=subject3&ys=2013RS and
http://mgaleg.maryland.gov/2013RS/fnotes/bil_0004/sb0494.pdf
 Health Policy Brief: Patient Engagement. (Feb. 14, 2013). Health Affairs, 1-5.
Retrieved from:
http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_86.pdf
 Homko, C.J., Santamore, W.P., Whiteman, V., Bower, M., Berger, P., Geifman-
Holtzman, O., and Bove, A.A. (2007). Use of an Internet-Based Telemedicine
System to Manage Underserved Women with Gestational Diabetes Mellitus.
Diabetes Technology & Therapeutics, 9(3), 297-306. doi: 10.1089/dia.2006.0034

24. References
 Maryland Medical Assistance Program – Telemedicine. Maryland General Assembly 2013
Session, SB496. Retrieved from:
http://mgaleg.maryland.gov/2013RS/fnotes/bil_0004/sb0494.pdf and
http://mgaleg.maryland.gov/2013RS/fnotes/bil_0006/sb0496.pdf
 Stepnowsky, Jr., C.J., Palau, J.J., Marler, M.R., and Gifford, A.L. (2007). Pilot Randomized
Trial of the Effect of Wireless Telemonitoring on Compliance and Treatment Efficacy in
Obstructive Sleep Apnea. Journal of Medical Internet Research, 9(2), e14. doi:
10.2196/jmir.9.2.e14
 Task Force on the use of telehealth to imfprove Maryland health care. Maryland General
Assembly 2013 Session, SB 776. Retrieved from:
http://mgaleg.maryland.gov/webmga/frmMain.aspx?id=sb0776&stab=01&pid=billpage&
tab=subject3&ys=2013RS and
http://mgaleg.maryland.gov/2013RS/fnotes/bil_0006/sb0776.pdf
 Telemedicine Recommendations. Maryland Quality and Cost Council, December 2011.
Retrieved from:
http://mhcc.dhmh.maryland.gov/hit/Telemedicine/Documents/sp.mhcc.maryland.gov/
telemed/md_telemedicine_report.pdf