Electronic Health Records

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How could cost prevent health IT from driving patient engagement?

By [email protected]

Too often the conversation about patient engagement is limited to the context of mobile health (mHealth) apps, EHR, and other kinds of health IT. A recent New York Times article touched on some interesting comments regarding the double-digit rate increases from health insurers to policy holders for 2013. It represents a peculiar dichotomy as we move forward with conversations about how to engage patients through electronic forms of health information for better health outcomes and lower healthcare costs.

For the patient, the explanation of benefits (EOB) document received by mail several weeks after the clinic visit has long served as a mystery that provides little information for a person to take an active part in her healthcare experience. One reason is the terminology used for each provided service does not include an explanation that draws a person back to the summary of care given to the patient at the close of the clinic exam. Another reason is the cost associated with each service provided does not include any reference to a standard of costs established by a clinic or hospital.

The negotiation of reimbursement rates with contracted health insurance payers is a cornerstone of the hospital revenue model. What’s interesting from the clinic staff and patient’s points-of-view is the variation or, in some cases, complete lack of knowledge regarding these rates in the context of the patient experience. Another, earlier NYT article cited these variations for patients receiving similar care and even among physicians in the hospital organization. In one example, a patient was charged six times the fair price for an appendectomy.

Whether it’s an act of omission or commission on behalf of the stakeholders in the provision of care, the reality of one patient’s cost to another may be quite different for the same procedure at the same clinic. The availability of this information during the patient experience is a real-time concern that should be as important to building a patient’s trust in care as the interaction with medical professionals.

The national dialogue about patient engagement has included much talk about the use of health IT to revolutionize the dialogue between patient and physician. While accessibility to protected health information (PHI) and the use of mHealth technologies has great potential both for involving patients in their care and capturing more data for improving health outcomes for the population at large over time, it is also critical to increase the intelligence with digital health environment to include costs.

While it is true that the actuarial reviews do represent the reality of the “four-letter word called math” regarding the costs of patients’ insurance premiums, there is another appropriate ten-letter word in this evolving digital health environment within the patient experience called “disclosure.” If we are going to lift the veil on a patient’s health records in the clinic and expect meaningful interactions both in person and via HIT tools between physician and patient for better health outcomes, it is equally important to do the same with the associated financial information in this patient experience.

Patient engagement is a process that is facilitated in many exciting ways by EHR, mobile apps, and other health IT tools, but it is likewise affected by another key aspect of the patient experience — cost. For some patients, it is the nature of costs that prevents them from even considering engaging with the clinic. As we evolve as digital health community, the relationships between patient, physician, and insurer must also evolve if we are to realize truly better outcomes for all stakeholders.


Robert Green is the author of Community Healthcare: Finding a Common Ground with New Expectations in Healthcare. Through his physician client relationships, Bob has gained substantial insight regarding the daily challenges that medical professionals and their staffs face, such as regulatory issues, financial management, and clinical collaboration through the use of health IT. His process of making both interpersonal and purposeful connections within the organization results in improved employee performance and confidence and enhanced client experience.






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