Patient Engagement 2017
Where Do Vendors Make a Difference?

What Is Patient Engagement?

Patient engagement is the process of motivating and enabling patients to participate in their own care with the expectation that, over time, outcomes will improve and costs will be reduced. Provider organizations also want to know what impact engagement has on the overall patient experience. Engagement efforts are broad and varied but may be viewed in terms of five areas, four of which are related to patient care and one concerning administrative tasks.

Why Do Provider Organizations Invest in Vendor Solutions?

HIT solutions promise needed productivity improvements, but when vendors promote their solutions, they often describe a nirvana in which technology integrates providers into the everyday lives of their patients, proactively empowering and motivating families to ever higher levels of well-being.

Today, such visions of wellness outpace reality. Pockets of experience and experiments exist, but most patient engagement tools are used to support episodic medical care followed by basic chronic-disease management. Half of study respondents say technology helps with wellness, but most solutions are shallow, simply opening doors to a few additional resources, like patient education and messaging, with a few providing occasional nudges in the form of electronic reminders. Often, it is efficiency and compliance that are the real drivers of automation.

Reclaiming Patient Engagement from Meaningful Use: Portals Dominate while Outreach Tools Compensate

For many, meaningful use changed the goal of patient engagement from the active participation of patients in their care to the ability of providers to manipulate patients into logging in to a portal—leading one study participant to associate patient portals with patient harassment rather than patient engagement. Portals are now omnipresent, but their passive nature and the complexities of enrollment make patient adoption a challenge, neutralizing much of portal technology’s potential. To compensate, outreach tools—which use telephones and smartphones to push messages directly to patients—are growing in popularity. At the most basic level, these tools are used for (1) financially motivated appointment reminders aimed at reducing no-shows and (2) clinically motivated reminders aimed at closing gaps in care.

Most Impactful among EMR Vendors: athenahealth and eClinicalWorks

Encouraged by EMR integration and meaningful use, provider organizations have accepted EMR vendors as the de facto source for patient portals. Despite their foothold, solutions from EMR vendors have not lived up to their potential. Of the seven fully rated EMR vendors, only two—athenahealth and eClinicalWorks—have solutions that earn an overall patient experience rating higher (barely) than 7 (out of 9). Both are praised for offering a variety of patient communication options (e.g., voice, SMS text, email, etc.) and connections with other web-based solutions, such as QueueDr for scheduling (athenahealth) and healow for locating physicians (eClinicalWorks). Early feedback from a limited number of MEDITECH users notes the ease with which results and care summaries can be delivered to patients. Epic receives an average rating for patient experience despite being the consecutive Best in KLAS Patient Portal winner since 2014. Customers say MyChart has been “groundbreaking” but that the lack of patient interest hampers value. Only two independent portal vendors remain on KLAS’ radar: Influence Health and Medfusion. The former has failed to deliver easy integration with multiple EMRs, while the latter survives in a small niche for bill payments.

Early Customers Say HealthGrid Adds Breadth to Traditional Best-of-Breed Depth

As a rule, provider organizations value best-of-breed vendors for their ability to fill EMR vendor gaps with deeper, more focused capabilities. Within their various niches, a majority (10 of 15) achieve ratings higher than a 7 (out of 9) for improving the overall patient experience. Early customers of HealthGrid say their solution delivers both breadth and depth: a majority use it in four of the five patient engagement areas, and they rate its impact on the overall patient experience a 7.9. They say the patient adoption driven by HealthGrid’s proactive outreach tools greatly exceeds that of previous efforts. CipherHealth and Elsevier are next at delivering both broad use across patient engagement areas and a deep patient experience impact (both rated 7.7), but they do so in different ways: CipherHealth is highlighted for facilitating real-time patient feedback and Elsevier for customizable patient education.

Evariant and Influence Health CRM Tools Activate Patients and Prospects

Evariant and Influence Health—the two vendors most associated with engaging prospective patients—both offer CRM solutions for healthcare-specific marketing. Evariant customers emphasize the insights they have gained from the consumer and patient data in Evariant’s marketing database. Influence Health customers praise their ability to track the results of community outreach campaigns. Neither vendor is considered highly impactful for engaging existing patients. athenahealth and eClinicalWorks users appreciate their vendors’ connections, e.g., athenahealth’s partnership with PatientPop for targeted marketing and eClinicalWorks’ healow for patient acquisition through a provider directory. Some Epic customers have stirred up consumer interest by featuring the successful MyChart patient portal in their advertising.

Inpatient-Focused Vendors Are Most Impactful for Episodic Care: CipherHealth, Emmi, and GetWellNetwork

CipherHealth, Emmi, and GetWellNetwork are the fully rated vendors most highly rated for engaging patients during episodic care. All three are frequently used for inpatient care, but they serve different purposes. Emmi customers say their ability to send links for specific educational videos is effective in preparing patients for surgical procedures. Nurses say GetWellNetwork allows them to assign videos to patients while in their hospital rooms in preparation for discharge. CipherHealth’s Voice product helps users follow up with patients post-discharge to see whether they can do anything to aid their recovery—customers say this lowers readmission rates and also contributes significantly to general patient satisfaction. HealthGrid customers say broad functionality gives them flexibility in reaching out to both hospital and ambulatory patients.

HealthGrid and Phytel Enable Data-Driven Disease Management

Like other outreach solutions, HealthGrid CareNotify and Phytel Outreach push messages to patients rather than requiring a portal login. The unique strength behind the solutions’ high ratings for engaging patients with chronic disease is the use of patient data to automatically identify, segment, and contact chronic-disease patients for testing and follow-up care based on preset schedules. CipherHealth customers say their solution works just as well for checking in on chronic-disease patients as it does for post-discharge follow-up. Cerner and Epic users give two reasons for their relatively high ratings in this area: 1) the HealtheLife and MyChart patient portals contain data that self-motivated patients can use to track their health and treatments, and 2) their EMRs provide data and workflows that help clinicians guide chronic-disease patients.

Hints at Innovation: eClinicalWorks and Epic

While vendor marketing includes visions of proactive patient/provider partnerships, the reality is that engagement with well patients happens in shallow pools. For most vendors, it consists largely of the same generic capabilities employed for episodic or chronic care, meaning almost any vendor solution could be considered a “wellness” tool under the right circumstances. HealthGrid and athenahealth customers say their tools are effective at reminding healthy patients about checkups and vaccinations. Emmi customers can send educational videos about health maintenance. Some GetWellNetwork customers say patients can access wellness-related videos outside the hospital. eClinicalWorks and Epic customers are the only ones to mention integration with fitness trackers. Epic is commended more than any other vendor for pursuing technologies that enable wellness engagement, including device integration and development of APIs that allow users to integrate Epic tools into their own custom efforts.

Patient Portals Outshine Best-of-Breed Solutions for Administrative Tasks

Thanks to integration with the financial and administrative systems that are part of most enterprise EMR suites, EMR vendors are the most deeply used vendors for administrative patient engagement. HealthGrid is the only outreach vendor with many respondents using their solution for administrative tasks; these users praise the self-service features, such as scheduling and bill pay. athenahealth customers say bill payment through their portal offers patients 24-hour convenience. Epic users report successful patient self-scheduling more than any other customers. Medfusion is the only best-of-breed patient portal with administrative capabilities—particularly patient bill pay. Customers say the portal is easy to use and that appointment scheduling is on the horizon.

Niche and Outreach Vendors Drive Further Investment

KLAS asked survey respondents to name other vendor solutions they use for patient engagement. Their responses included scores of additional vendors, only 11 of which were named more than once. Most of these vendors serve even narrower niches than the main vendors featured in this report. The most “frequently” mentioned vendors have established customer bases, e.g., Press Ganey (for HCAHPS surveys), Phreesia (for patient registration), and Krames (for patient education).