As a new generation of seniors enters Medicare and millions of lower-income Americans gain Medicaid or private insurance for the first time in 2014, federal officials at the Office of the National Coordinator for Health IT (ONC) are trying to help align the patient engagement movement with consumer e-health.
“The full potential of consumer e-health is far from realized and may not even yet be fully understood,” Office of Consumer eHealth Director Lygeia Ricciardi and other ONC officials write in February’s Health Affairs. As patient e-health is in its nascent stage, Ricciardi and colleagues say that the current trajectories of both health IT and mobile technologies “have created ideal conditions” for the growth of patient health information technologies.
Mobile health apps have proliferated, online patient portals are growing more common and the ONC is incentivizing personal health information tools in meaningful use Stage 2 requirements. At the same time, they write, one “major obstacle to greater use of health information in electronic form appears to be lack of access, not lack of interest.”
In a 2011 Deloitte survey of U.S. adults, 65 percent of respondents considered online access to their health important, but only 17 percent had access. About 85 percent of respondents wanted the ability to email or call their providers, but only 10 percent were able to do so.
Among certain demographics, though, consumer e-health has grown organically, Ricciardi and colleagues write. Patients with chronic conditions are increasingly using mobile health tools, such as diabetes and medication management apps, and many also use online patient forums and chat rooms. Medicare beneficiaries are turning to mobile and online apps, such as the Blue Button, too, with 17 percent of American seniors using personal health records, the highest proportion of any age group, according to Ricciardi and colleagues.
The idea, Ricciardi and ONC colleagues argue, is that wired patients tend to be more engaged with their healthcare and can in turn be smarter consumers, finding the best quality and most cost-effective services.
A study of patients with chronic conditions by the American Association of Retired Persons (AARP) found that “activated” patients who felt comfortable self-managing their care decisions were about three times less likely to suffer negative health consequences from poor communication among providers, compared with less engaged patients. The more activated patients were also twice as likely to avoid a hospital readmission and were half as likely to experience a medical error.
The recent burgeoning of e-health and mobile health follows the past decade’s growth in Internet use and the e-consumerization of retail, travel, banking and other industries. Technology is “rapidly democratizing information,” Ricciardi and colleagues say, and as the ONC tries to help expand access to personal health technologies, it is also promoting the idea of of evolving provider-patient expectations, toward “a less hierarchical, more collaborative partnership.”
One way ONC is spreading that idea is through meaningful use incentives. Stage 2, starting in October for hospitals and next January for eligible physicians, requires providers to have secure email available to patients, as well as offer ways to view, download or share the information.
Patients “need to feel comfortable requesting electronic access to their health records, asking providers questions, sharing their own health knowledge and weighing in on treatment options,” Ricciardi and colleagues write. “A cultural shift — among patients and providers — is necessary to support these kinds of behavior.”