Patient engagement does not mean patient empowerment

David Lee Scher

The term "patient engagement" is everywhere now. It's part of the vernacular in advocacy circles, government, health technology companies and payers. It used to signal a new healthcare ecosystem in which the patient is more of a spotlighted consumer  -  where reimbursement hinges on patient satisfaction, where the shortage of physicians dictates new care paradigms and where the cost of healthcare must decrease as well as be redirected to wellness and home care from the more expensive treatments of preventable chronic diseases and institutional care.

The Center for Advancing Health defines patient engagement as "actions individuals must take to obtain the greatest benefit from the healthcare services available to them."  It is defined by an active role that patients play in their own care.

According to the National eHealth Collaborative, the Five Phases of the Patient Engagement Framework are:

1. Inform me;
2. Engage me;
3. Empower me;
4. Partner with me; and 
5. Support my e-community

Each of these phases has a process corresponding to a stage of Meaningful Use. They are also provider-facing, in much the same way the patient-centered medical home is. I agree fully with the framework of 'inform me' preceding 'empower me.' But the accompanying narrative ("A healthcare provider in this phase demonstrates basic levels of patient engagement with an emphasis on the use of simple tools that make healthcare more convenient and accessible. This also includes providing patients with standard forms, both printable and electronic, and information about advance directives, privacy and specific conditions") implies that patients will become informed if they can use simple technology tools. 

I would say that the technology is a tool, not a solution, to informing patients. The technology itself must be put into a framework that involves human interactions, and 'empower me' refers to "advanced patient engagement activities through substantive use of health IT."  If the MU directive only requires 5 percent of patients to have patient portals, how substantive is it?  Do patients need to wait for this third phase to be empowered? Should Stage 3 of Meaningful Use be a surrogate for true patient engagement?

Physicians and other providers need more than this framework to begin to engage patients. There needs to be a change in the mentality and culture of healthcare on the part of all stakeholders to empower patients before they become engaged. When my practice hired a nurse practitioner 13 years ago, referring physicians were livid that patients were seen (for routine follow-up, not consultations) by a non-physician. That culture has since changed dramatically, but took many years to do so.  

Empowerment or enabling will come simply with the realization of how much one can do with lifestyle changes to improve health and maintain wellness. This need not take years and should be independent of MU schedules and technology. Patient engagement is more conceptually restrictive and technology-oriented than patient empowerment.  

I submit that patient empowerment can come to those even unwilling or unable to use digital technologies. Without empowerment there can be no engagement. Engagement cannot be passively bestowed upon a patient because technology is available. 

Patient empowerment should start in schools. Children are always seeking to become enabled in all aspects of life, and I believe that teaching them how much they can do to keep themselves well will, if done appropriately, yield huge benefits.  

I applaud the efforts of the e-Health Collaborative. But we need not wait for MU to mature nor depend upon technology to have patients obtain the respect or responsibilities from others to become empowered. That only takes knowledge and a change of culture.

Critics of engagement and empowerment will say that there are many patients and consumers who do not desire to participate in their care. I realize this and that topic is for another discussion. The above implies to those who wish to.

David Lee Scher is a former cardiac electrophysiologist and is an independent consultant and owner/director at DLS Healthcare Consulting, LLC, (www.digitalhealthconsultants.com) concentrating in advising digital health companies and their partnering institutions, providers and businesses. A pioneer adopter of remote cardiac monitoring, he lectures worldwide promoting the benefits of digital health technologies. Twitter: @dlschermd, He also blogs at http://davidleescher.com. He was cited as one of the 10 cardiologists to follow on Twitter and one of the top ten blogs on healthcare technology.