- A Boston-based research team has developed a viable set of digital patient engagement measures to determine how well patient portals and health IT activate patients in their care, according to a report in the Journal of Medical Internet Research.
The researchers, hailing from Boston-area hospitals and Boston University, assessed patient portal use at the VA. The team specifically looked at the secure messaging functions on the MyHealtheVet and the patient data access functions in Blue Button.
The VA developed the Blue Button Initiative to allow veterans to download their medical records online, thus improving veteran patient engagement.
“Moving beyond adoption, measuring the nature and extent of patients’ use of portal tools is a priority for the US Department of Veterans Affairs (VA) and other health systems,” the researchers explained. “This emerging focus on measuring digital patient engagement follows organically from—and is inextricably linked with—measuring clinician meaningful use of health information technology (HIT) as supported by the US Centers for Medicare & Medicaid Services' ‘Meaningful Use’ rules.”
However, such a measure for digital patient engagement does not yet exist, the researchers wrote. The research team developed a preliminary set of potential patient engagement measures through an assessment of MyHealtheVet, the Blue Button Initiative, and expert interviews.
The researchers introduced the preliminary measures to a set of 12 health IT experts following that preliminary stage. The experts completed a Delphi panel, a research method traditionally used to collect expert perceptions of certain test measures. In this case, the researchers surveyed for expert opinion about the effectiveness and value of the digital patient engagement measures.
The Delphi panel proved successful, the team reported. All 12 of the experts completed each of the three rounds of Delphi surveying, yielding two robust sets of digital patient engagement measures. The team completed the study with 58 secure messaging measures and 71 Blue Button and patient data access measures.
The high volume of digital patient engagement measures is exhaustive, the research team asserted. Some of the measures are based upon a four-step process that includes knowledge level, persuasion, decision-making, and confirmation. If a digital tool fulfills these measures, the researchers explained, then health IT experts can predict whether a patient will use the digital health tool and with what level of loyalty and persistence.
The measures also encompass widely-recognized levels of patient activation, including “(1) belief in having an active role in care, (2) confidence and knowledge to take action, (3) taking action, and (4) staying the course under stress,” the researchers said.
The patient engagement measures also include patient demographics, processes, and outcomes, the researchers explained.
Although the research team did not publish its complete list of digital patient engagement measures, they contended that the measures are poised for piloting in specific healthcare settings. The means by which the team developed these measures was extensive, the team argued, and yielded a full set of measures that are likely to yield an accurate picture of digital patient engagement.
“Establishing a valid and reliable scale is the first step to measuring digital patient engagement and its role in health and health care quality, outcomes, and effective, efficient implementation by health care providers and health care systems,” the researchers said.
“These measures and the scales they constitute can thus be tested empirically to examine their psychometric properties and may ultimately be used in measuring the extent to which patient portals and other patient-facing technologies can engage patients in their health care,” the team concluded.