Do we have patient engagement backwards?

trompe-l'oeil a Paris - PalgretBlog post by Leonard Kish

We hear a lot about patient engagement, including from me, but have we been getting it backwards? Patients are looking for answers, they’re looking for advice, it’s just that there is too little access, increasing out of pocket costs and too often little ability to “Do It Yourself”, but DIY will become more and more common. PWC picked DIY as the leading trend in health care in 2015 ( With higher deductibles, many health care consumers will look for less expensive alternatives to entering the health system at all.

There was a great post, “Why We Are Getting Patient Engagement Backwards” this week on the The Health Care Blog by Joe Smith, MD (hat tip to @JoeBabaian). Smith asks: What if patient engagement isn’t about the patient, but about the health care system engaging with them?

According to Smith:

Our healthcare system inadvertently, yet potently, discourages engagement. It ignores the fact that the patient is already the most engaged person in healthcare.

Without engaging, the health system may find itself doing new work, as Vinhod Khosla has famously predicted.

I’ve made the argument in the past that “Quantified Self will become medicine” in relation to Apple. So, with patient enablement in mind:

  • T1 When does patient engagement become DIY health care? Will patients go around the hc system?
  • T2 As tools & tech improve, what will we do for ourselves in 5 years and will no longer require visits to physician offices?
  • T3 There are 20% who are #quantified selfers, there are 20% who may never engage, what is the most critical time for engagement of the other 60%?
  • T4 What can we do about multi-morbidity, when people become overwhelmed with multiple chronic conditions and can no longer DIY?

Please join me on the next #hcldr weekly tweetchat – Tuesday December 9th at 8:30pm Eastern (for your local time click here).


“Quantified Self Will Become Medicine: New Hopes for Apple’s HealthBook”, Leonard Kish, HL7 Standards, April 2 2014,, accessed December 6 2014

“20% doctor included: Speculations and musings of a technology optimist”, Vinod Khosla, Khosla Ventures Blog, July 16 2014,, accessed December 6 2014

“Why We’re Getting Patient Engagement Backwards”, Joe Smith MD, The Health Care Blog, December 4 2014,, accessed December 6 2014

“Top health industry issues of 2015”, PWC, December 2014,, accessed December 6 2014

“Get to know iOS 8: HealthKit and Apple’s new Health app”, Ryan Faas, MacWorld, October 6 2014,, accessed December 6 2014

“Patient Engagement is a Strategy, Not a Tool”, Leonard Kish, HL7 Standards, November 2014,, accessed December 6 2014

Additional resources on this prior HCLDR post “Patient Experience and Patient Engagement – is one more important?

Image Credit

trompe-l’oeil a Paris – Palagret


  1. Reblogged this on HealthcareVistas – by Joseph Babaian and commented:

    This week on #hcldr Leonard Kish (@leonardkish) & community discuss: Do we Have Patient Engagement Backwards? Timely & cogent topic for today’s healthcare environment – something not to miss.

  2. One big problem with your thesis Leonard, we do not have a healthcare system. A system is something with many moving pieces working together towards some common objective. Healthcare industry is a far cry from that – Sadly

    Love to make it to your chat but 8:30pm ET is 2:30am here in Vienna. Will encourage Naveen to join in

  3. Reblogged this on healthcare software solutions lava kafle kathmandu nepal lava prasad kafle lava kafle on google+ <a href="; rel="publisher">Google+</a> and commented:
    #hcldr @deerwalkinc #healthcare #leadership #twitter #chat 8 30 pm #tuesdays

  4. […] Kish (@leonardkish) – Do We Have Patient Engagement Backwards? – Dec […]

  5. Richard Jordan · · Reply

    Interesting conversation and valuable insight from John. Throw into the mix increasing patient autonomy to point their healthcare questions/desires in multiple directions with DIY technology, have to contemplate what the impact on pay-for-performance reimbursement mechanisms will be. The ideal model of one patient = one record managed by one primary physician manager may well meet a different reality.

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