"You're really going to get the value if you're in a risk environment," Montgomery says. He suggests that online communication could be a convenient alternative to office visits for chronic disease care or routine follow-ups.
Indeed, Tim Smokoff, chief executive officer of Numera Inc., a Seattle company that specializes in patient engagement through telehealth and online social connections, recommends that providers focus on aging in place – keeping older people in their own homes rather than in long-term care facilities, usually with the aid of monitoring technology – as well as management of chronic conditions and post-acute care. "They are going to get more than 5 percent if they invest in those areas," Smokoff says.
"In this demographic, we don't talk as much about patient engagement as we do care-team engagement," Smokoff says. Care teams might include physicians, nurses and other case managers, pharmacists, physical therapists, family members and patients themselves. "It's really about keeping people healthy and in their homes and out of the hospital," he says.
Christian envisions portals and PHRs as focal points for wellness and care coordination. "The patient portals are going to be platforms for collaboration and communication" among providers and between providers and their patients, he says.
"The patient portals can be windows for additional information that could be germane [to patient care]," Christian continues. "You can make it as powerful as Facebook is." Christian mentioned PatientsLikeMe, a networking site for patients to share advice with others who have similar health issues.
"You are trying to give people experiences," Christian said. "These portals can be a good source of good, quantified information."
They can be, but Christian believes the technology has to be simple to use. St. Francis has multiple EHR vendors and could present some patients with as many as five different portals across various departments, centers of excellence and an assisted-living facility.
"How many portals does a patient need?'" Christian wonders. "For me, the vision is to create one, consolidated place where all this information can be."
The information also has to be relevant and easy to understand. Plain English – or Spanish, or Mandarin – matters because the average patient is likely to struggle with medical jargon. "As clinicians, we're trained to make everything sound erudite, and it's not necessary," says Dr. Joseph C. Kvedar, founder and director of the Center for Connected Health at Harvard University-affiliated Partners HealthCare in Boston, which encourages the adoption of technology to move care into people's everyday lives.
He recommends either retraining physicians to speak in lay language, have software translate what they say, or both. "Fundamentally, we have to be more understandable," Kvedar says. Patients certainly could be offended or falsely reassured as they start gaining access to their own medical records. "We are very candid in records and we're objective," Kvedar says. For example, a doctor might tell someone fighting cancer, "We think we got it all," Kvedar says, even though the record could still indicate the presence of a tumor.
"Fundamentally, we have to be more understandable," Kvedar says. "There's a lot of opportunity for us to clean up our game."
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