As more providers move to accountable care and population health reimbursement arrangements, many realize the importance of improving efforts to engage patients in their care.

While understanding that engagement efforts will be crucial to support changing reimbursement methodologies, these new efforts so far have been been perplexing to implement, says Nick van Terheyden, MD, chief medical officer at Dell Healthcare & Life Sciences.

Part of the reason is that information technology in use by providers has been built to automate routine transactions and present useful information and services, but doesn’t always meet that goal, he explains.

Physicians were compelled under the federal meaningful use program to implement electronic health records to store patient information, but EHRs in large part have not saved costs, Terheyden notes. Nor have EHRs become intuitive and provide to physicians services they and everyone else can get on their smartphones, van Terheyden believes.

Nick van Terheyden, MD
Nick van Terheyden, MD

Smartphones offer the potential to provide intelligence that gives insights without disruption to workflows, and that’s what EHRs need to do, he adds. One way to improve the workflow and intuitiveness of EHRs could be use of technology such as Amazon’s voice-command Echo Alexa smart home appliance that has Wi-Fi and streaming music, and can serve as a personal digital assistant.

Technology such as that provided by Echo Alexa delivers relevant insights at the right time to the right user, van Terheyden says, and EHRs need to do that—such as automatically informing a physician at the point of care that the patient has not had a tetanus shot in 10 years. This type of technology also can improve patient and physician engagement and foster better outcomes, according to van Terheyden.

Right now, engagement is intended to foster better outcomes, but in large measure isn’t yet doing so, he contends. “You go see the doctor who tells you what to do and you do it, but that’s not engagement. That’s simply consumption and I’m not sure if that is the best choice for me and my circumstances and preferences.”

In short, patients may be following directions, but not taking additional steps to achieve optimal outcomes. Physicians, Terheyden says, need a more interactive approach to patient engagement; they can advise the need to reduce calories and exercise more, but that generally does not equate with a reduction in weight. What’s required is a change not just in patient behavior, but physician behavior as well.

While patient engagement may not be optimal much of the time, there is a growing subset of patients who do research on their own. They are questioning what the physician advises and maybe even know more about a particular medical condition than the physician, van Terheyden says. “We doctors have to come to the realization that we’re not always the smartest person in the room anymore. Patients need to be their own primary care manager, and physicians have to accept it.”

With technology such as that employed by Echo Alexa, a physician could simply ask the EHR for the last time a patient had a CAT scan or another procedure. And if a red dot can appear on your phone indicating a message, the EHR could present a red dot indicating that a lab result is now available.

Historically, best practices discovered in medicine often take a decade or more to be substantially adopted. Now, van Terheyden says, the technology exists to apply best practices as soon as there is industry consensus. “Technology integrated into a workflow, is an imperative for physicians to cope in our data-exploding world.”

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