We are currently challenged by a healthcare system problem. Too often patients only communicate with their provider to receive episodic care; we need to emphasize the importance of the provider-patient relationship in preventative care.

The election of President Obama in November 2008 marked the beginning of the health reform era in the United States. Since his election, several legislation, including the American Recovery and Reinvestment Act of 2009 (ARRA) and the Health Information Technology Economic and Clinical Health Act (HITECH Act), have been passed to address the inefficiencies and depreciating quality of health care delivery within our health care system. The underlying costs of the healthcare system are exploding. Our nation currently boasts a health care GDP of nearly 17%[i] and an uninsured population of over 50 million (which includes an estimated 10 million non-citizens).

Whether we argue that health expenditures or inefficient quality are responsible for increased healthcare spending and disparate health outcomes, our current performance on economic and health quality indicators show a need for reform. But can we achieve healthcare reform without including patients at the table?

Patients remain the most underutilized resource in our health care system. If we want to optimize prevention and wellness, we must improve patient involvement and understanding of their health care. Health reform and embracing new technologies won’t be successful if patients aren’t engaged.

Why patient engagement?

Patient engagement is the process of involving patients in the management of their health care in order to satisfy their healthcare needs.  Examples of patient engagement include documenting patient preferences, discussing healthy lifestyle behaviors, and the use of new technologies, like patient portals, to facilitate patient-provider communication.

It is important that we look to patients as partners in their health care management, and not placing prejudice on their ability to understand “just what the doctor ordered.”

One of the recommendations from the Using Open Innovation to Reinvent Primary Care project addresses the need to engage patients and hold them accountable for the management of their healthcare. Similarly, at Working Together Towards a Healthier Generation: The Implementation of Health Reform, the Metropolitan Washington Public Health Association’s 2011 Annual Meeting, Dr. Mohammad Akhter, Director of the District of Columbia’s Department of Public Health, spoke about the need for patients to understand what health care reform means to them.

This requires a cultural shift where the patient, in collaboration with the physician, takes the initiative in managing his/her care.

Just because health reform promises to place a health insurance card in the hand of every citizen and documented person does not guarantee that patients will use this coverage. Health insurance coverage without patient engagement will not lead to the outcomes we hope to see (i.e. better care coordination, controlled hemoglobin A1Cs, etc.) As the old adage goes, “you can bring a horse to water, but you can’t make him drink…”

Recognizing the importance of patient engagement in care delivery, there are a number of tools being introduced to help transform the way we deliver care. Recent discussions celebrate the use of mobile or software applications to facilitate ongoing communication between the patient and health care provider. Whether we rely on the use of mobile applications of electronic records, the use of technology provides an opportunity to merge the disparate words of health IT and patient engagement in care delivery.

What’s all this about health information technology?

E-health technologies, such as the electronic health record, can improve patient engagement. The electronic health record is a longitudinal archive of a patient’s medical history. It has the ability to offer providers immediate access to their patients’ medical records. Empirical data on the clinical effectiveness of the electronic health record suggests that this technology can help improve care coordination between providers caring for the same patient and ensure that providers educate their patients with up-to-date, relevant information on managing their care (see reference links below).

E-health technologies, if implemented, can transform the way health care is currently delivered by vastly improving health providers’ ability to involve patients in the care management process.

Reference Articles

1. Gustafson DH, Hawkins R, Boberg E, Pingree S, Serlin RE, Graziano F, Chan CL (1999) Impact of a patient-centered, computer-based health information/support system. Am J Prev Med 16(1):1-9.

2. Poon EG, Keohane CA, Yoon CS, et al. (2010) Effect of Bar-Code Technology on the Safety of Medication Administration New England Journal of Medicine 362:1698-1707.

3. Resnick HE, Alwan M (2010) Use of health information technology in home health and hospice agencies: United States, 2007 Journal of the American Medical Informatics Association 17(4):389-395.

4. Zaia AH, Grant RW, Esteya G, Lestera WT, Andrews CT, Yeea R, Mortd E, Chueha HC. 2008. The Practice of Informatics Application of Information Technology Lessons from Implementing a Combined Workflow–Informatics System for Diabetes Management. JAMIA. 15:524-533.

5. Kwok R, Dinh M, Dinh D, Chu M (2009) Improving adherence to asthma clinical guidelines and discharge documentation from emergency departments: implementation of a dynamic and integrated electronic decision support system. Emerg Med Australas. 21(1):31-7.

[i] “Two Myths about the American health care system.” Montreal Economic Institute. June 2005. Retrieved 2011-04-15.

I always inform new patients about the personal philosophy that guides my practice as a family nurse practitioner in primary care and determines how I approach patients, families, and health.  Revealing this early helps patients decide whether I might be the right health professional to manage their unique health care needs.  When I firmly state, “I am not responsible for your health, you are!” many will stare open-mouthed and ask, “But you are the medical person so how can I be the one responsible?”   I reply, “I am not with you 24/7 so how can I be responsible for the behaviors and practices that contribute to your overall health and well-being?”  This I-You exchange can be confusing.  Patients are often under the misconception that the health care professional has control when in reality they are in control, especially if they are living in the community and make their own decisions about other aspects of their lives.  I go on to stress that I am a partner, and my responsibility is to help them acquire the knowledge, skills, and confidence they need to manage their health to the best of their ability.

In Using Open Innovation to Reinvent Primary Care, the fifth recommendation from the Hope Street Group addresses empowering the consumer to take personal responsibility for improving their health.  Several strategies suggested to achieve this are more global than interactions in individual provider-patient relationships.  One reason I left critical care nursing and became an advanced practice nurse in primary care was to work with patients who had the capacity, ability, and power to be active participants in the decision-making process concerning individual and family health and the care received.

Many chronic health conditions affecting Americans are related to lifestyle behaviors and choices.  Empowering patients to take personal responsibility begins with the provider relinquishing their perceived control and giving the patient that authority.