Internet interventions engage patient, physician online

Patients who are well informed about options are more involved in their care.

Major marketplace transformations are occurring in health care, driven in large part by employers and the government’s demands for quality-based compensation and greater transparency regarding provider performance and pricing.

As a result, cardiologists need to engage patients in their own care decisions and management at new levels and in new ways. Patients are increasingly charged with financial responsibility for their health care and are also approaching physicians for guidance about information found on the Internet. It is a crucial time for clinicians, as these and other marketplace transformations require new strategies and new tools for including patients in an efficient and effective manner.

New Internet interventions

Cardiology practices are increasingly adopting a new sort of digital instrument, or Internet intervention, as a highly-leveraged tool for productively engaging patients in their care and delivering higher-quality results. An Internet intervention, also known as an interactive health communication application, is a dynamic, interactive, Web-based patient portal designed to inform, motivate and support patients in their care to engage them. Cardiologists use these portals to prescribe clinical information to the patient about that patient’s condition, tests and treatment options in a manner that supports and involves the patient outside of and between office visits.

Eleanor Herriman

Spencer B. King III

These secure portal platforms are also being used to collect patient information online before visits; provide online scheduling, prescription and billing conveniences; and support patient self-management with interactive components such as self-assessment tools, behavior change, and peer and/or decision support.

Performance goes public

Unsustainable spending on health care and reported variations in quality of care are two major catalysts leading to changes in the medical system. An executive order by President George W. Bush that went into effect January 2007 mandates that Medicare collect and report quality and price data from all providers who serve Medicare beneficiaries.

As patients are held more financially accountable for their health care and are accustomed to using the Internet for most services, they are demanding more from their clinical providers. In addition, patients search the Web for health information, much of which is unreliable, and turn to their physicians for validation and clarification of the information. The brief, episodic nature of physician visits makes this type of interaction difficult; it also makes it difficult to engage patients in their own care.

Performance measurement of quality of care affects the cardiology practice, as reimbursement is increasingly tied to it and providers are tiered on these measures. Pay for performance programs that link a portion of payment to performance scorecards now operate in the majority of HMO programs. Performance measurements vary but generally include clinical quality, patient experience and adoption of information technology. Estimates project that by 2008, half the pay for performance programs will publicly report results to consumers.

How the Internet can help

As patient experience is one of the pay for performance measurement areas, tools that help cardiologists more effectively engage their patients can return real value to a practice. Clinician in-office educating and instructing has limited effectiveness because of the rushed, face-to-face nature of an office visit. Studies show that, on average, patients recall about half of what health care providers tell them. Up to 45% of patients cannot remember the risks of surgery, 44% do not know the exact nature of their operation and many are unable to answer basic questions about the procedure or services they agreed to receive.

Courtesy of iStock International Inc.

Internet interventions have proven more satisfying to patients and more effective in educating patients throughout a consult, motivating them to adhere to treatment plans, and offering self-care support. One published review of the impact of Internet interventions analyzed studies in the Cochrane database and determined that use of these tools produces statistically significant, positive effects on clinical outcomes, patients’ knowledge, social support and behavioral outcomes. Patients who are well informed about their options are more involved in their care, more satisfied with the experience and more likely to comply with prescribed therapies than patients without access to Internet intervention tools.

Most patients or their family members want to be more deeply involved with treatment decisions and condition management. Thus, these Internet informing services are major drivers of patient satisfaction and appropriate expectations. A number of studies found that patients who are more satisfied with the care experience and their relationship with the provider may be less likely to sue for malpractice. Satisfied patients are less likely than those who are dissatisfied to solely blame the physician if adverse outcomes occur.

Adding the Internet to the clinician’s intervention toolkit may make business and clinical sense given the market trends toward transparency regarding provider quality, patient satisfaction, and service efficiency. High-quality, interactive health information delivered through the Internet may offer a viable solution to the new market-generated challenges of engaging patients in their care and optimizing performance results.

Eleanor Herriman, MD, MBA, is Chief Science Officer at NorthPoint Domain, Inc.

Spencer B. King III, MD, is Chair of Interventional Cardiology at the Fuqua Heart Center of Piedmont Hospital, Atlanta, and Chair of NorthPoint Domain’s Cardiology Advisory Board. He is also Section Editor of the Interventional Cardiology section of Today in Cardiology.

For more information:

• Bush GW. Executive order: Promoting quality and efficient health care in federal government-administered or sponsored health care programs. Aug. 22, 2006.
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• Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs. Rewarding provider performance: aligning incentives in Medicare. Washington, DC: National Academy of Sciences; 2007. Pathways to Quality Health Care Series.
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