Topic: How education and communication improve treatment plan ownership and adherence

Healthcare has come a long way in the last 5-10 years. The development and implementation of Electronic health records (EHRs) has been on the rise, especially with the enactment of the American Recovery and Reinvestment Act, which encourages all public and private health care providers to demonstrate “meaningful use” of interoperable, certified EHRs for electronic exchange of health information in a way that improves quality and safety, care coordination, and engagement with patients, among other quality of care requirements. Despite this new technology that provides real-time patient records, healthcare providers often feel burdened by having to learn and navigate new complex EHR systems, the laborious data entry involved, and the lack of face-to-face communication with their patients. This, of course, is evidenced by the number of human errors documented, especially when it comes to entering medication information.

Patients, on the other hand, are getting smarter, especially in the oncology space, where their worlds are turned upside down because of a daunting diagnosis. So, they research. They do their homework, sometimes even before seeing their oncologist for the first time. They’re keeping up by downloading helpful apps to manage medications, discovering treatments and clinical trials, and convening on social media, such as in Facebook groups. They’re being proactive in a health care world that has been, and largely still is, reactive.

Now with all of this technology available to almost everyone, physicians often feel insecure and health systems aren’t sure if the technology they’re adopting is actually improving the patient experience. In fact, in a recent Health Information and Management System Society (HIMSS) survey, 64% of IT decision makers at U.S. hospitals and health systems rated themselves as being behind the curve when it came to utilizing digital and mobile technologies. Failure to keep up with the times and/or understand the gaps in digital health education has led to decreased patient engagement, poorer patient outcomes, and weakened physician-patient relationships.

The health care system needs a digital revamp, with its main focus on the customer - the patient. When you think about marketing, it’s all about getting the right product to the right person at the right time. This can be applied to health care by optimizing EHR systems. Here’s an example:

Robert has recently been diagnosed by his primary care doctor with an advanced form of head and neck cancer and will require surgery and chemotherapy. Robert starts seeing both an oncologist and otolaryngologist to help him prepare. His physicians recognize the stress and fear that he is struggling with, so they offer to send him helpful information about the specific surgery and chemotherapy that he’ll be undergoing to somewhat ease his mind against the unknown. They offer to send him the information via different mediums, including text message and email, and to receive a call the day before each procedure with helpful reminders about what to expect. All of these communications are based on key data points in his EHR. Robert feels more at ease and undergoes surgery within a few days. He dreads knowing that chemotherapy is next, but his hospital and care team are already on top of things, serving him timely and relevant information digitally between appointments, which EHR-triggered communications made possible. Before undergoing chemotherapy, he receives an email telling him what to pack, where he needs to be and what time, what foods, drinks and medications he should stop in advance, what drugs he will be receiving, how he will be receiving them, and for how long. At the end of his first chemotherapy infusion, he receives another email explaining the side effects he may feel, how to manage them, and who to contact after-hours (including doctors and nurses). He also receives text alerts about future appointments throughout his treatment course. Because of these digital touchpoints, he becomes more involved in his treatment plan, asks his doctor more questions, and arrives for treatment feeling competent and prepared.

It’s all about getting the right information (patient education) to the right people (the patients) at the right time (at specific touchpoints). Research has shown that when patients are educated about their own health, they become more engaged. More and more health systems are prioritizing patient-centered care based on value, because an informed patient is an adherent patient, and adherence drives better outcomes. When patients like Robert receive educational information that’s relevant and understandable, they feel empowered to play a bigger role in their managing their health, and that’s exactly what patients want.

In the past, physicians were the decision-makers; patients had very little influence on medical decisions. These days, patients research treatment options online and use social media platforms to ask other people about their experiences and opinions. But the world wide web is a vast informational source, where aimless searches can often do more harm than good. If we know patients are receptive to digital engagement and are eager to co-manage their care, why not digitize and personalize patient education to make sure they’re getting information that is accurate and relevant to their individual treatment journey? Seems like a no-brainer, given that most health systems have implemented EHRs.

Of course, patients are going to have questions about the information they receive and research. Therefore, it’s also important that physicians be open to having honest discussions with their patients, especially patients with chronic diseases, such as cancer, who tend to have higher rates of comorbid anxiety and depression. Patients should feel comfortable coming to their care team with questions and be given reliable information about their condition and treatment. Education should be encouraged to supplement the patient-physician interaction, both at office visits and between appointments through a medium of the patient’s choosing, such as video, email, text message, or phone calls. Giving patients different avenues of education, and in a format that is convenient for them, can help them feel more at ease with their treatment plan and make office visits more productive.

Finally, in order to boost patient adherence to their treatment plan, it’s imperative that patients understand what their physician is telling them at each appointment. Physicians who use complex medical jargon, however, risk having their patients feel excluded and confused. And as we all have experienced as patients, doctors appointments are getting shorter, which leaves patients little time to get all of their questions answered in a comprehensible manner. Patients can therefore be proactive by bringing in a list of questions or symptoms they have been experiencing. Physicians, who also feel the pressure of time and may struggle to simplify medical directives, can use the teach-back method to promote understanding and enhance health literacy among patients. For example, doctors can ask patients to repeat directives given or explain how they plan to use the information given to them at the end of their appointment. Doctors can also ask patients when and how they plan to take a new medication that may have complicated directions. These clinical practices can be reinforced by using patient information contained in the EHR to automate personalized communications and motivational messages to patients at the exact time they need it, via multiple digital channels. This is especially important for oncology patients who may have complex treatment regimens or manage multiple medications and may be struggling with fatigue or memory loss on top of that.

When patients understand that they and their doctor work as a team, they're more likely to feel comfortable taking co-ownership of their care. And when patients understand the vital role they play in their health care, we can expect increased patient compliance and improved health outcomes. Fostering trusting relationships between patients and their care providers through evidence-based practices will not only improve the overall patient experience; it will help us to achieve a truly patient-centered system of healthcare delivery.

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