DOING BUSINESS
Improving Outcomes Filling the void with patient engagement systems BY STEPHEN PUNZAK, MD
The potential for improved outcomes greatly increases as patients become more involved
in their own care. As health care pro-
viders look for new ways to engage patients, patient engagement technol- ogy is becoming increasingly popu- lar. While many people are excited about this technology, it is interesting to note that these systems are still in their infancy and have yet to be truly defined. In fact, even the term “patient engagement” can mean very different things to different people. To some people, patient engage- ment simply means sending a few text reminders to patients. To others, it means a robust patient education sys- tem or sending individualized follow- up to a patient via email. To others still, it is meaningful two-way communica- tion between patients and providers. Although no one has fully figured out what patient engagement is, let alone what patient engagement systems truly are, it seems everyone wants to say they are using them.
Defining Patient Engagement Systems The recent history of surgery offers a unique perspective on what a patient engagement system for a surgical patient should be. Thirty to 40 years ago, there was no such thing as outpa- tient surgery. All patients, even those having simple elective surgeries, got themselves admitted to the hospital the day before a procedure. The doc- tors and nurses took care of whatever needed to be done in advance of a pro- cedure the night before the surgery. They also did all postoperative pro- cedures because patients stayed in the hospital following the procedure. As
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a result, patient engagement was not necessary. Pre-surgical and post-surgi- cal care was consistent and uniform as well as very expensive. Fast forward to today, when nearly
two-thirds of all surgery is done on an outpatient basis, according to the Centers for Disease Control and Pre- ventions’ National Center for Health Statistics. While significantly more cost-effective, outpatient surgery has created a void in the way patients receive care. Doctors and nurses no longer manage every last detail of pre- and postoperative care, it is now largely the responsibility of the patient. Nurses call patients in advance of their procedure to gather medical histories and review surgical preop instructions and, before discharge, provide them with printed handouts detailing postop care instructions. Finding a solution that replicates the
uniformity and consistency the indus- try had when everyone was inpatient is a big challenge. Doing so in a man- ner that allows for individualized care
The Possibilities Are Endless Patient engagement systems have the opportunity to truly change the way perioperative care is delivered. For example, consider the different needs of a 20-year-old college athlete undergoing an anterior cruciate liga- ment (ACL) reconstruction versus a 70-year-old, morbidly obese patient with sleep apnea also undergoing knee surgery. These two patients will need markedly different levels of care and instructions before, during and after their procedures. Many surgery centers provide detailed information for a par- ticular type of surgery or for a partic- ular group of patients, such as patients with diabetes. Rarely, however, do patients get information truly tailored to their unique needs. The potential for patient engagement systems enabling centers to get to this level of individu- alized care is exciting. Consider also the paperwork pro- vided to patients. While many cen- ters are making the move away from paper to electronic systems, it often is an internal move only; patient com- munication is still mainly paper-based. With patient engagement systems, there is the opportunity to get rid of all this clutter and the one-size-fits- all approach, in meaningful ways. For example, patient engagement sys- tems offer the hope of being able to reach out to patients at specific times to remind them what they should be doing along the way. The goal is to empower patients to do a better job at caring for themselves, which means providing them with tailored pre- and postop protocols. Patient engagement
is an even bigger challenge. The hope is that patient engagement systems will address these issues and more.
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