If I can access my bank account and manage my finances online, why can’t I take similar ownership of my healthcare?
For today’s digitally empowered consumers, it’s a fair question. And in fact, more than 80 percent of the over 9,000 adults polled by Accenture in a recent nine-nation survey affirmed that they would like to be able to access their medical records online (see Sidebar 1).
An overwhelming majority also favored more self-management. Fully 82 percent said they would value the ability to book, change or cancel appointments online, for example. Three-quarters (76 percent) wanted to receive electronic reminders about preventive or follow-up care. More than 70 percent felt they should be able to update their own electronic health records with such important information as the side effects experienced with different medicines. And 76 percent of respondents to our global survey said they should have full access to their electronic health records.
But right now, few consumers enjoy such services. Slightly less than a quarter of adults in our nine survey countries have electronic access to their medical records, for example. And only 37 percent can book appointments online. In some jurisdictions, the gap between what consumers demand and what healthcare providers are prepared to give them is especially wide. In France, for example, only 25 percent have some level of access to their electronic health records.
Why do so many healthcare providers seem to be on the wrong side of the digital debate? For one thing, some doctors tell us they fear that they will be spending too much of their valuable time online with their newly empowered patients, reducing productivity and adding to costs. Clinicians also have understandable concerns about data privacy and patient safety.
A few providers, however, are taking a different view. They have recognized that the benefits of empowering patients electronically outweigh the risks; that far from endangering data privacy and safety, giving people electronic access to their medical records can induce them to take better care of themselves, deepen their understanding of both prevention and cure, and make them more motivated to participate in treatment programs.
Author Sid Kosaraju speaks about how patient engagement is essential for population health advances to take hold, and how patient participation contributes to health outcomes improvement.
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Consider, for example, the results of the OpenNotes initiative in the United States, in which 105 primary care doctors at three major health centers—Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle—invited more than 19,000 of their patients to read their visit notes online.
Before the onset of the yearlong trial, some doctors feared that granting such access would disrupt their workflow or worse, perhaps even damaging their relationship with patients by confusing, worrying or offending them. In fact, however, quite the opposite occurred. For most doctors involved, email traffic during the trial did not increase. But most important, many reported strengthened relationships with patients, between 77 percent and 85 percent of whom said they had gained a better understanding of their health and medical conditions.
A majority of patients also said they were taking greater care of themselves. Perhaps most telling, 99 percent of them wanted the OpenNotes program to continue.
Participating doctors, to be sure, were less enthusiastic. Between 17 percent and 26 percent of them preferred not to continue—though when offered the chance to stop, none did. This is perhaps not surprising, since as many as 89 percent of patients participating in the OpenNotes trial said that the availability of transparent access to their records would influence their future choice of both doctors and health plans.
A global force
Patient power, indeed, promises to be a potent force. More than half of the consumers without online access who responded to our survey said they, too, would consider switching providers to get it. And while that threat really carries substantive weight only in jurisdictions such as the United States, where healthcare provision is split between multiple private providers, we believe it’s only a matter of time before consumer pressure transforms attitudes about healthcare globally, just as it has in other industries.
Meanwhile, for some pioneering players, electronic medical records are no longer merely repositories of shared clinical information—they are morphing into a platform for shared decision making. Case in point: Kaiser Permanente, the Oakland, California–based nonprofit integrated health system, whose more than 9 million patients can view most parts of their medical records online, and are actively collaborating with doctors in the management of their care (see Sidebar 2).
Consumers plainly want to play a bigger role in their medical care—and the evidence to date suggests that engaging with them has important benefits. Empowered patients are more informed and motivated patients. What’s more, the healthcare providers that empower them are differentiating themselves in an increasingly competitive marketplace as the challenges of 21st century healthcare—aging populations, rising rates of chronic disease and increasingly expensive treatments—intensify. By working with patients as co-managers of their health, leading providers are forging a path toward better, more effective care.
For further reading
"An app a day: Enabling the digital doctor," Outlook 2014, No. 1
"The Digital Doctor Is “In,” Accenture, May 2013
"Accenture Doctors Survey: How Do US Doctors Perceive Healthcare IT?” Accenture, May 2013
Sidebar 1 | About the research
Accenture conducted an online survey of 9,015 adults to assess consumer perceptions of their medical providers’ electronic capabilities across nine countries: Australia, Brazil, Canada, England, France, Germany, Singapore, Spain and the United States. Harris Interactive carried out the survey in July 2013. Where relevant, we compared consumer responses with those of 3,700 doctors, surveyed by Harris Interactive in 2012 to assess their use of healthcare IT, in all of the above countries, with the exception of Brazil. For a complete methodology, including weighting variables, please contact firstname.lastname@example.org. (Back to story)
Sidebar 2 | Kaiser Permanente: Enabling patient self-management
Kaiser Permanente is one of the largest integrated healthcare delivery organizations in the United States, serving more than 9 million members from California to Washington, DC, and encompassing 37 hospitals, 618 medical offices and more than 17,000 physicians.
In an effort to drive organizational excellence across its vast network, Kaiser began building a common, enterprisewide electronic health record—KP HealthConnect—back in 2002. At the same time, it defined a common goal: to put the patient at the heart of primary care provision. Indeed, Kaiser envisioned the patient’s home as the hub of early diagnostics and service, with caregivers serving as facilitators and advisors on service options, clinical efficacy and cost considerations.
KP HealthConnect provides instant and continuous real-time access for medical records—not only for clinicians but also for patients and designated family members. It securely connects members’ medical records across both outpatient and inpatient settings, and with finance and insurance systems.
In addition, an online portal, My Health Manager, allows members to view most parts of their medical records online, and to perform a number of key tasks—including sending secure messages to doctors, scheduling or canceling appointments, requesting prescription refills, completing an online health risk assessment and receiving customized feedback, accessing tailored behavior change programs, viewing health and drug information, and managing their health benefits.
The benefits of allowing patient access and self-management have been multiple. For example, three-quarters of online users in the company’s Pacific Northwest region reported that the portal enables them to manage their healthcare effectively and makes interacting with the healthcare team more convenient. The secure messaging service has also reduced the number of physician office visits and of no-shows for appointments.
And as members have embraced the use of secure email, the positive impact has been gauged against certain measures of the Healthcare Effectiveness Data and Information Set (HEDIS), such as “effectiveness of care,” specifically for patients with diabetes or hypertension, or both.
A study of 35,423 adult patients with these conditions in Kaiser Permanente’s Southern California region compared the rates at which nine HEDIS measures were met two months after patients began using secure email with providers. They observed 2 percent to 6.5 percent improvement on all nine measures. The association between use of email and HEDIS scores, as well as the reduction in primary care office visits from members using secure messaging, suggests that secure email can help improve individual care experiences and the health of populations while reducing per capita costs of care.
More than 4.3 million Kaiser Permanente members are now registered to use My Health Manager, and 41 percent of patient primary care contacts are now conducted via secure email messages or scheduled telephone calls (versus face-to-face visits). What’s more, as many as 80,000 new members sign onto My Health Manager each month.
Small wonder, then, that Kaiser Permanente plans to extend patient self-management capabilities further still. Indeed, by offering more sophisticated care in patients’ homes—virtual consultations in real time, for example, as well as in-home monitoring devices—and by using web-based questionnaires to help patients manage their own health better at home, the provider reasons that healthcare can be made both more convenient and considerably less costly. (Back to story)
About the authors
Kaveh Safavi is the managing director of the Accenture Health industry group. He is based in Chicago.
Sid Kosaraju is Accenture’s global lead for the company’s Health Management business service. He is based in New York.
Rick Ratliff is the global managing director for Accenture Connected Health Services. He is based in Washington, D.C.
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