Patient engagement is easy, right? Just create a portal and tell patients it’s there.

Of course, no one who puts a little thought into this idea believes it can be so simple. Healthcare isn’t “Field of Dreams,” after all. We can build it, but they still might not come.

But we still need to try and understand why. A 2014 Health Affairs study found that the increased use of EHR technology has not created a parallel increase in electronic communication among patients and clinicians. In short, if patient portal use is an accurate indicator, how do we get patients engaged and hold their attention?

One key issue might be that we’re not in agreement on what patient engagement is and what it is not. “Although highly supported by technology and its significant innovative leadership contributions, patient engagement is not an IT, HIT, regulatory or vendor-driven initiative, but rather it is a patient-facing, patient-driven strategy,” wrote Richard Upton, president of UPTONGROUP, in the KevinMD blog.

Patient engagement, says Tom Giulianni, MD, is not the same as a patient-centric model, which would certainly employ a patient portal to enable certain tasks, but it will also do a lot more. “There are lots of other little things a practice can do to provide a positive experience that makes them want to come back and helps them feel more engaged in their own wellness and can even improve outcomes,” Giulianni wrote recently in The Health Care Blog. “This consumer-like experience is really what patients want, not just a portal.”

Think for a moment about your relationship as a consumer with other businesses. You get order confirmations and delivery emails when you buy something from Amazon and other online retailers. Special offers and requests for feedback on your customer experience appear in your inbox. Online sites regularly upgrade functionality and user options to your benefit.

Chances are, the relationship you have with your physician resembles none of these.

This enhanced idea of patient engagement often includes the concept of patient as consumer for very logical reasons. In America today, we are all consumers to a greater or lesser extent. We expect commercial enterprises to earn our business and make us feel valued. Technology simply strengthens this expectation.

But healthcare and medicine are not the same thing as selling books online. The patient-as-consumer idea also divides providers, as the following examples demonstrate.

In a recent article, Shirie Leng, MD, writes that patients are not customers, offering these points:

  • Patients are not relaxed, having a good time and simply comparing available options.
  • Patients often have not chosen to buy a healthcare service and are not paying for it.
  • Patients are not buying a product from which they can demand a positive outcome.
  • The patient is not always right.
  • Patient satisfaction does not always correlate with the quality of the product.

Contrast that stance with the position of David Lee Scher, MD, who argues that, especially with the advance of healthcare IT, patient engagement means consumer engagement for five reasons:

  • Patients have choices.
  • Patient satisfaction counts.
  • All stakeholders in healthcare are looking for market share.
  • Mobile health technology success hinges on social engagement.
  • Most mobile health technologies are patient-facing.

They’re both right. I mean, look at each set of bullet points and imagine a scenario in which it is true. Some patients have choices, and some do not. Some have mobile health technologies, as Scher mentions, and some do not.

“Sometimes we view ourselves as patients, including when we await surgery for an acute, inflamed appendix,” wrote Robert Pearl, MD, in an article that appeared recently in Forbes magazine. That article effectively captures the conflicting personas we’ve all embodied at various stages in the healthcare experience. “And at other times, such as when we compare the costs and benefits of different health insurance plans, we’re clearly consumers. But most of the time, we are both.”

So, is it possible to come up with a universal definition and a set of recommendations for patient engagement? No, not really. The definition will depend on the provider, the facility and the patient/client base seeking treatment/services.

Still, most providers can up their game. Hospitals and physician practices need to explain how patients benefit from a patient portal, then make it easy to enroll in and use it. Clinicians can promote portal usage to each patient on every visit. Administrators should establish policies that define message response times, test result release times and internal processes for routing messages and responses.

Because patient portals aren’t currently wowing anybody, healthcare IT has to up its game, too. For starters, polling data shows patients want the ability to schedule appointments, pay bills and view records online. Make that the functional starting point. In a broader sense, healthcare IT vendors also have to make EHRs and portals more straightforward and easy to use.

Think of the patient portal as a tool, because that’s all it is, in a broader patient engagement strategy. Yes, the tool has to be functional, but it also has to be used correctly.

As Shahid Shah explains in a recent article, in some ways EHRs have to resemble customer relationship management (CRM) tools (think Salesforce) and “… support outreach, communication, patient engagement, and similar features we're more accustomed to seeing from marketing automation systems than transactional systems."

The comparison seems apt, especially because CRMs and other marketing and sales-enabling tools don’t close deals, they just make it easier to organize and find information, much like an EHR.

In the end, the implementation of EHRs, changes in payment models, the emergence of new concepts like medical homes and accountable care organizations—all are efforts to move toward healthcare based on quality instead of services and fees. If quality is the goal, then patients are going to evaluate that quality, and in the new paradigm, you want that evaluation to be positive.

Can we engage people through the patient portal in a way that appeals to them as both consumers and patients? The lack of strategy for appealing to both personas could prove the difference between the success and failure of portals and other patient-facing technologies.

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