Who would have thought eight years ago that patient engagement would become one of the catch phrases for healthcare transformation. Yet, there it is, carefully laid out in the government’s proposed rule for meaningful use of electronic health records.

It turns out that lots of movers and shakers might have thought it. They were discussing the critical role of patients in their own care long before patient engagement became part of rulemaking. They may have called it consumer empowerment then. But the concept is the same.

At a conference in Washington D.C. back in December 2004, a panel of futurists saw patient engagement in their crystal balls:

Joseph Coughlin, founding director of AgeLab at the Massachusetts Institute of Technology, spoke of a time in the not-so-distant future when healthcare information technology systems would be used not only to collect data, but also to make consumers accountable for their own health.

He predicted a transfer of technology "from white coats to users – the empowerment of consumers."
Jonathan Peck, vice president of the Institute for Alternative Futures, predicted the conversation around healthcare would shift from "right to care" to "responsibility for yourself."

Clem Bezold, president of the Institute for Alternative Futures, saw a fast-moving shift toward consumer accountability. Payers and providers would be looking more closely at behaviors, he said.

Fast forward to Feb. 2012, and the nation’s fourth health IT czar, Farzad Mostashari, MD, delivers a rousing keynote at HIMSS12 in which he talks about engaged and empowered patients changing everything. To ensure the vision matches reality, patient engagement was made a critical piece of the Stage 2 meaningful use rule.

It’s a promising move for engagement, but there’s no guarantee engagement will be easy – or fast.
As Eric Dishman, director of health innovation and policy for Intel's Digital Health Group, told Healthcare IT News Managing Editor Mike Miliard (see P. 4): "It's a big challenge. It’s not enough to engage patients with their health. To do that first they have to engage with the technology – and they have to want to do that."

It seems that many patients are ready to engage, but old habits are hard to break. Patients are used to regarding physicians as having all the answers – undisputed experts, almost godlike when it comes to healthcare.

And, what about the physicians?

Some have said they are concerned about meeting even what seem to be modest requirements in the meaningful use rule. Not only would physicians be required to provide patients electronic access to their information, but also they would be required to use secure electronic messaging to communicate relevant information to 10 percent of patients during the reporting period for Stage 2.

A recent study by the Deloitte Center for Health Solutions indicates physicians are not using IT broadly to engage patients. No more than 20 percent of doctors are providing online scheduling or test results for their patients and just 6 percent are using social media to communicate with them, according to Deloitte.

Joseph Kvedar, MD, who as founder and director of the Center for Connected Health in Boston (part of Partners HealthCare) has made it his life’s work to engage patients. You might say he’s ahead of the times. Kvedar acknowledges the reluctance on the part of some physicians to partner with their patients.

“Physicians are comfortable in a setting where they are the experts and where they control the flow of information, he says. “Their workflow is built around maximizing the number of patient interactions each day and their perceived value is built around their expert knowledge. Patient-facing IT tools disrupt both of these concepts, so health IT is bound to be perceived by physicians as either a nuisance or even potentially a drag on quality.”

But the nation is in the midst of creating a new workflow, one based on collaboration, shared knowledge, accountability.

The existing paradigm is worth changing. In spite of the slow progress studies have uncovered, patients and physicians are poised for change. It may be hard, but they know it’s the way to go. It’s a way to reduce runaway costs in the long run, to improve health – and to save lives.