What will it take to move from many promising but disconnected pilots in digital health to a world where technology holistically advances patient engagement? That’s the question that Brian Eastwood, an analyst at Chilmark Research, was grappling with as he took the stage at the inaugural Patient Experience Symposium in Boston this week.

“A chronic patient who sees a number of different specialists may have 10 different portals to log into with 10 different passwords, may have 10 different user experiences,” Eastwood said. “That can be incredibly frustrating, especially for a person who has a condition to manage on top of everything else. Beyond that, even if you’re just looking to try to engage with patients that are not chronic, who are healthy or at risk, there’s a slew of devices and apps and there’s no way to determine what will be best for a given patient in a given scenario in a given length of time to accomplish a specific goal.”

The only patient engagement technology that’s really pervasive at hospitals right now is EHR patient portals, he said, and those barely qualify as engagement tools.

“Much of the technology that is used in healthcare to interact with patients, not only is it episodic, but it’s a very retrospective. When you go into a patient portal you’re looking at information about a visit that already happened. This doesn’t really begin to build a relationship,” he said. “In addition, a lot of these tools have been designed to build onto EHRs, they’re still very web-based, they don’t meet patients where they are –  on their smartphones – and they don’t give them the type of ongoing engagement experience they want.”

A number of newer technologies do engagement better. Eastwood talked about virtual coaching and disease management programs as one strong example.

“These solutions allow systems to move away from managing everyone who has a condition to just managing those who are at risk; the part of the population that has moved from the middle to the high cost patients,” he said. “And being able to identify them and enroll them in a program before this happens has a little bit of upfront costs, but has tremendous opportunities to create savings and improve their quality of life.”

Other promising opportunities include medication adherence tools and patient relationship management tools that work like CRM tools in the sales industry. But to get these tools to have widespread adoption, Eastwood thinks providers need to increase their bet on value-based care.

“What’s necessary, market-wide to get organizations and the industry, in general, more interested in improving technology? A lot of what it comes down to is value-based care or an absence of it,” Eastwood said. “Absent a shift to value-based care there are actually disincentives to improve engagement, because without good engagement people have to come see you and that increases volume, increases revenue, and pleases the shareholders. Absent a shift to value-based care, it’s still easier to present a short-term convenient solution at the point of care rather than put the patient into a situation where there’s more ongoing, longitudinal coordinated care focused on behavior change. Absent a shift to value-based care, engagement is still focused on surveys and scores rather than what patients really need to begin to execute behavior change.”

According to Eastwood, true patient engagement is a three-step process. Engagement is the first step, education is the second, and activation is the third and most important.

“That’s when understanding occurs,” Eastwood said. “When they have the skills, knowledge, and confidence to better manage their condition. It’s when they feel like they have a voice and can set goals for themselves instead of just going from one appointment to the next and wondering what’s going to happen next. And if they can go through to that phase, … they realize they have a responsibility to manage their health. They are no longer passive recipients of care, but active participants in care.”