Some healthcare initiatives underway these days are easier to explain in succinct terms than others. Take ICD-10 and meaningful use, for example. One can be summed up as an updated coding system; the other is an effort to encourage healthcare providers to switch from paper to electronic health records.

Now take a term like "patient engagement." Yes, it's safe to call it an effort to get patients to take more responsibility for their health information. But when you try to think in more specific terms it becomes clear that those specifics vary significantly from provider to provider.

On an operational level, what this means is that providers who want to improve their "patient engagement" need to determine both what that looks like presently within their own practices, and what steps they need to take to move forward.

According to David Levin, MD, chief medical information officer at the Cleveland Clinic, a few years ago the organization's leadership took a comprehensive look at how patients engaged the its services, focusing primarily on the impacts the overall patient experience had on care outcomes.

"The result," he said, "was a series of initiatives that helped define what we wanted to do (with patient experience), as well as how to measure the impact of the changes."

Together with Lori Posk, MD, Cleveland Clinic's medical director for its MyChart personal health record, Levin recently pointed to five key changes in how patients interact with the organization, changes which, he said, have led to dramatic improvements in the patients' experience.

• Open access scheduling. According to Levin, one of the earliest and biggest changes came when the decision was made to make it easier for patients to get in and see their doctors. Now, at all of Cleveland Clinic's family health centers, patients can log on through the patient portal, view their provider's entire schedule and make their own appointments.
• Patient education. A key part of ensuring both patient satisfaction and ongoing engagement, Levin said, is "being sure that patients understand what's going on with them, as well as what's supposed to happen next." To that end, Cleveland Clinic creates appropriate patient educational materials, which can also be accessed online, that runs the gamut from follow-up information following individual visits to continuing care information for chronic conditions.
• Open medical records policy. According to Posk, Cleveland Clinic has had an open records policy for years, but now everything is getting put online in personal health records. Moreover, since October of 2012 the organization has been rolling out increasing access to electronic patient information, beginning first with lab results,. From January to September of this year, Posk noted, 3.5 million lab results and images had been made available to patients electronically. Soon, she said, patients will also be able to review their physicians' notes online after a visit, in addition to being able to schedule follow-up appointments.
• Two--way messaging via patient portal. The telephone has long been the indispensable tool for communications between doctors and patients, but now communication has been significantly expanded, as well as made considerably more convenient, with email and other electronic formats made available on the Clinic's patient portal. Levin pointed to the ease with which a variety of information can be shared in this manner, noting also that "in a world defined by healthcare reform, we see a big role for this kind of communication in coaching patients and eliminating unnecessary office visits."
• Patient reported outcomes. Taking patient engagement up yet another notch, Levin said the organization has begun a series of pilot projects in which patients can enter data into their own records. This information, he said, then becomes part of the clinical workflow, enabling doctors to track their patients' progress, and potentially modify their care, between visits.

Of course, Levin and Posk noted that none of these changes would have taken place without an overall plan.

"Some of the initiatives began as experiments," Levin said, "but they're all part of a very deliberate strategy. It seems very clear to us that part of how we're going to get to better outcomes is through this kind of collaboration with patients."

[See also: Cleveland Clinic opens EMR to patients]