A year ago we wrote about advancements to date and potential future challenges to the continued growth of mobile health (mHealth) in the United States. As a tool to impact behavior change and to support positive health activities, mHealth had a good year in 2013. We will revisit the topic later this year. To start 2014, we are going to look at a related topic, patient engagement. We have touched on this topic in previous columns, but would like to focus solely on patient engagement at this time.
While it is tempting to define patient engagement as specific activities, we believe it is best to first think of it as a philosophy. We define patient engagement as an approach to healthcare in which patients are viewed as experts who have unique insights (and questions) regarding their own care. Given this definition, patient engagement activities give patients the opportunity to review information, ask questions, provide input and information, or take other actions that directly relate to the healthcare they receive. Hopefully, it is clear that patient engagement can take a decidedly different direction from healthcare delivery models of the past.
We like to think that community pharmacy has been at least partially influenced by a philosophy that includes patient engagement. Pharmacists collaborate with patients to identify patient-centered strategies to tailor medication regimens around the patient’s day. To provide a complete, overall picture of current treatments, pharmacists actively seek from patients their lists of OTCs, vitamins, and other nonprescription medications that are important. Pharmacists also engage patients in discussions about challenges and enablers to implementation and maintenance of healthy lifestyle behaviors.
These are clearly important activities to a patient’s medication-related health. A primary limitation of many current methods of patient engagement is that they are largely episodic, occurring when the patient and pharmacist (or other provider) happen to have an opportunity to focus their discussions on these topics. Additionally, these activities, for the most part, do not allow patients to serve as experts who understand their healthcare and who longitudinally contribute to their own care. Advanced patient engagement efforts occur at the time and place that the patient desires, and are not necessarily limited to healthcare facilities.
The National eHealth Collaborative created the Patient Engagement Framework (http://www.nationalehealth.org/patient-engagement-framework) to help healthcare organizations and providers develop a strategy to direct their patient engagement activities. The framework approaches patient engagement in a stepwise, simple-to-complex fashion of five levels. Lower-level activities focus on providing general information and patient-specific education to patients. As you move to higher levels in the framework, activities allow patients to submit and view quality reports of their experiences with the healthcare system; participate in virtual coaching; receive text messages specific to their situation; document symptoms and maintain a personal health record; generate and share data from home monitoring equipment; and ultimately contribute to a shared, electronic health record. We encourage readers to visit the Web address above, as this is not an exhaustive list of the activities and tools in the Patient Engagement Framework. Additionally, many readers can likely suggest other valuable ideas that would contribute to the framework, especially from a pharmacy perspective.
Patient Engagement Tool
One of the most highly publicized and wide-reaching patient engagement tools today is the Blue Button initiative. The Blue Button initiative (www.healthit.gov/bluebutton) was developed by the Department of Veterans Affairs (VA) as a tool for veterans to download their medical records in electronic format. The success of the initiative within the VA has led to wider availability of Blue Button functionality to other government and private-sector entities. The philosophy driving the initiative is that patients should have easy access to their medical information and that they should be able to review, share, and update the information based on their unique perspective as patients. Note that patients cannot directly update or edit their records; updating occurs in conjunction with the provider, insurer, or other entity maintaining the information.
Initial Blue Button activities allowed patients to download their data in a human-readable format that was not machine readable. This was an effective means to give patients access to their records. However, patients had to manually provide their records to other providers, and Blue Button did not allow sharing of data electronically with other applications. The Blue Button+ initiative addresses this limitation by establishing standards for the structure and transmission of patient data that has been downloaded through the Blue Button. The data can be pushed to compatible applications, and it can also be supplemented by patient-generated data, using appropriate tools. Ultimately, Blue Button and Blue Button+ advance patient engagement by allowing patients to access and manage their health information. This is consistent with the activities found in higher levels of the Patient Engagement Framework.
The information that patients access via Blue Button is dependent upon the source of the information. Insurers provide what is arguably the broadest picture of a patient’s healthcare by including information on care they have reimbursed. Hospitals and physician practices provide information for the care provided within their four walls. With several large pharmacy chains beginning to offer Blue Button functionality, patients have the ability to download prescription history information. Patients can use the information for their own purposes, or they can share it with others. As patient engagement efforts gain momentum and grow in importance to patients, we anticipate that Blue Button capability is something that patients will expect from their pharmacies, much like the ability to request refills through a variety of methods (phone, Internet, app). We encourage you to begin discussions with your pharmacy management system vendor to explore the incorporation of this patient engagement tool into your system. We believe it can open the door to greater engagement with your patients. We welcome your comments. CT
Brent I. Fox, Pharm.D., Ph.D., is an associate professor, and Bill G. Felkey, M.S., is professor emeritus, in the Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University. They can be reached at foxbren@ auburn.edu and firstname.lastname@example.org.