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Regulatory & Market Place

Symptom Checker - The Pivotal Tool for Patient Engagement Some years ago I asked a primary care doctor in Chicago what he thought about making our company’s diagnosis decision support system available to patients. He simultaneously made a gun out of his hand and growled, “patients coming in with lists!” We have moved on since then, but most doctors still do not actively embrace patients doing their own research, particularly on diagnosis, and ‘coming in with lists’. My view is that, in an era of a shortage of medical resources and time, patients are a vast untapped resource, and engaged patients are a valuable asset that overburdened doctors should make use of. It’s time to make a virtue out of a perceived vice, and the symptom checker is one of the key tools to effect this. As the patient engagement juggernaut gathers pace across many developed countries, the National eHealth Collaborative in the US has recently weighed in with a Patient Engagement Framework. This is set out in a very simple and useful tabular format, and highlights the symptom checker as a key tool to engage the patient. Significantly, it includes the tool under the “Engage Me” column supporting “engage and attract” and “retain and interact” activities. This really shows how the movement has matured from believing that the patient could be informed by just providing a depository of information but no real means of making sense of it. Now, the proponents of patient engagement realise that an engaged patient must also be an informed and empowered patient, and tools must be provided to the patient to help them make sense of the information. Personally, I have always believed that helping the patient to research their own diagnosis with tools, like a powerful symptom checker, elevates the whole patient engagement movement another few notches. It really is crossing the Rubicon, as it encourages patients to engage in the crucial but rarefied domain of formulating a differential diagnosis and clinical reasoning. Since the patient is an expert on their symptoms, why shouldn’t they be actively encouraged to do this? In addition, the US Bipartisan Policy Center’s recent report, Improving Quality and Reducing Costs in Health Care: Engaging Consumers Using Electronic Tools, found that engaging consumers more fully in their own health and healthcare not only improves the experience of care for patients and their families, but also improves the quality and cost-effectiveness of care. There is now an increasing body of evidence to show that more informed patients cost less, and recently the journal ‘Health Affairs’ ran a study entitled ‘Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’, which showed how well-informed patients cost significantly less. “This fact is noteworthy from both a clinical and a policy standpoint. Patients who have more knowledge, 16 Journal For Patient Compliance Strategies to enhance Adherence and Health Outcomes

skill, and confidence in managing their health, and who are more adept at navigating and using the healthcare system, appear to incur lower costs.” The new Accountable Care Organisations in the US and Clinical Commissioning Groups in the UK would be well advised to read these documents and make sure that they are offering these tools to their patients. Lastly, some fascinating results from the latest Pew Research survey, “Health Online 2013”. They now call those who search online for health information “online diagnosers”. “When asked if the information found online led them to think they needed the attention of a medical professional, 46% of online diagnosers say that was the case. Thirty eight percent of online diagnosers say it was something they could take care of at home and 11% say it was both or in between. “When we asked respondents about the accuracy of their initial diagnosis, they reported: • 41% of online diagnosers say a medical professional confirmed their diagnosis. An additional 2% say a medical professional partially confirmed it. • 35% say they did not visit a clinician to get a professional opinion. • 18% say they consulted a medical professional and the clinician either did not agree or offered a different opinion about the condition. • 1% say their conversation with a clinician was inconclusive.” Volume 3 - Issue 1


Journal for Patient Compliance