§1. Overview

This post outlines several steps the federal government has taken to empower consumers to use health information to make healthy choices and better health care decisions. Here, ONC is looking for feedback on these steps so far, and for ideas on how the federal government should proceed in the future.

§2. Health IT education

Consumers and providers often look for reliable, easy to understand resources to help explain disease management, how a drug or device works and what side effects to watch out for, and what a certain procedure or test involves. Providers also can use decision aids (such as websites or online brochures) to help educate consumers about their health issues and possible treatment options.

To provide information about how health IT can be a health education resource, ONC is promoting the use of the HealthIT.gov website as a “one-stop shop” for the public to learn about health IT and eHealth tools, and to hear stories about how people have benefited from health IT.

In addition, ONC has partnered with Sharecare, an interactive health site where people can go to find reliable answers to frequently asked questions about health care and health IT. ONC is a featured “expert” partner on Sharecare, helping to answer questions visitors raise about EHRs, eHealth, and other health IT-related topics. ONC’s partnership with Sharecare allows people to get information from a trusted source and it helps ONC gain a better understanding of the types of questions people have about health IT.

  • How can ONC further improve HealthIT.gov?
  • What other partnerships like Sharecare should ONC consider to enhance its consumer outreach and educational efforts?

For other discussions about developing educational and training materials, see

Current Efforts: Enabling information access

Decreasing health disparities through health IT

Current Efforts: Shifting attitudes

§3. Healthy behaviors and patient self-management

Several government and private-sector programs are testing technologies that help consumers to learn about healthy behaviors and to manage their health conditions outside of their medical visits. Projects include:

  1. Txt4Health, a service that allows users to build a personal profile of health concerns (e.g., weight loss, diabetes); the service then sends users 5-7 text messages a week with information and ideas targeted to their personal concerns;
  2. remote monitoring, such as an electronic scale that checks for water retention that might signal complications for someone with congestive heart failure; and
  3. telehealth efforts, such as the Indian Health Service and Veterans’ Administration “virtual” primary care office visits in remote areas or to provide visits with a specialist.

ONC is working with Federal partners and private organizations to encourage development of eHealth tools.

  • What are the most useful ways for federal regulations and partnerships to encourage the private marketplace to develop eHealth tools that enhance people’s ability to manage their own health care?
  • What other initiatives, like challenges and prizes, could further encourage developers to engage consumers and create more eHealth tools that allow them to maintain and improve health?”
  • How can government policies encourage creation of educational materials using health IT that clinicians could use to teach consumers about health issues (e.g., a prescription’s potential side effects or how to manage a new diagnosis)?
  • How can government policies support creation of educational materials using health IT that consumers could use to learn about health issues and how to manage their own health care?
  • What other ways would consumers like to use their health information, and what activities should ONC be aware of?

For discussion about how health IT can empower consumers to take an active role in their health care, see

Decreasing health disparities through health IT

Identifying useful health information

Supporting new health care delivery models

§4. Consumer-provider communication

ONC is working with private industry and other federal agencies to improve the ability of consumers and clinicians to communicate with one another through secure email messaging and patient portals.

New federal regulations require providers participating in the “meaningful use” program to (i) use secure messaging in their practice and (ii) communicate with their patients in ways that are consistent with the individual’s recorded preferences (such as email, regular mail, or through a patient portal). ONC is also encouraging health IT developers to make communication resources easy for providers and patients to use.

  • What additional policies and standards would help product developers design eHealth tools to make it easier for patients and providers to communicate with each other about the patient’s care?

For other discussions about the role federal regulation should play, see

Current Efforts: Shifting attitudes

Identifying useful health information

Supporting “shared decisionmaking” through health IT

Patient-generated health data

For discussion about how health IT can empower consumers to take an active role in their health care, see Identifying useful health information

For discussion about helping providers integrate into their workflow the information that they receive from patients through new eHealth tools, see Patient-generated health data.

§5. Privacy & security

ONC recognizes that privacy and security concerns may impact the willingness of consumers and providers to use health IT to increase access to health information. Privacy and security are the topic of a separate section of the Strategic Plan (Goal 3), since these concerns cut across all areas of health IT. Although this public comment period is not targeted at updating Goal 3, ONC will be revising that section of the Plan and your discussion of these concerns, and ideas about addressing them, will help the federal government decide on appropriate future steps.

(You can read the current version of Goal 3 by clicking the Background Documents tab at the top of this page, and selecting 2011-2015 Federal Health IT Strategic Plan).

Check out all the available topics to consider privacy and security in particular consumer health IT contexts.

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March 27, 2013 6:32 pm

Facilitate bill evaluation. Create a “2nd Billing Opinion” service that will independently look at the patient’s bill and determine whether the charges are reasonable or not, and provide useful benchmarks that the patient can use in negotiations regarding their medical bill. Make it easy to submit a bill to this INDEPENDENT service – in fact make it the DEFAULT. Bills in excess of $1000 over a one year period should be automatically electronically submitted by the healthcare provider to this SECOND OPINION INDEPENDENT BILLING EVALUATION SERVICE – with a report going to both the patient and the provider. (Some providers will probably try to strongarm patients into waving their right to an Independent Second Opinion on their medical bill. This sort of bullying… more »

…behavior should be actively investigated and discouraged.

By providing an informed, easy to use, independent medical bill evaluation service, you will put downward pressure on absurdly high outlier bills that are ruinous for the poor and underinsured. « less

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March 28, 2013 10:45 pm

A “2nd Billing Opinion,” sounds wonderful! My HMO has taken six months to settle a contested bill, and three months to identify when I met my high deductible. My Colorado HMO stated that they don’t have the software in place that can bring together billing from the clinic, pharmacy bills, and outside providers. The HMO has grown so fast by taking on new plans and consumers and are now just implementing the systems. It’s the consumer that is left out in the cold, stressed out, calling the HMO getting transferred multiple times, with few answers and little resolution. Allowing insurance companies to over market themselves with little ability to support their services, should be blocked from adding consumers.

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    March 28, 2013 11:30 pm

    Thank you for your comment, sandra. Under this section of the plan, ONC is focusing on empowering patients to use Health IT to make healthy choices and better health care decisions. At the moment, ONC is not looking into patient billing practices. However, do you have any ideas about how ONC could encourage HealthIT that does not leave the consumer out in the cold?

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      March 29, 2013 12:10 am

      As some clinics have identified clinic infection control staff, patient advocacy staff, let’s have a IT consumer advocacy staff. In my large HMO, my typical response after sending a note to my HMO IT is no or limited response. Often they will send a form e-mail, or they will described a consumer website application that exists in California, but not in Colorado. It took about three HMO customer service staff to say, no you can’t do this in Colorado. It appears as these on-line applications are cascaded thru this large HMO, it is done with limited staff training to answer consumers questions. Colorado’s is the IT step-child of California in my HMO. It creates inequalities in service and access. It makes me want to move to California for the better IT services.

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March 31, 2013 10:34 am

Medication compliance costs more than $300 billion in waste. It has been proven that more than 70% of the cases are because of forgetfulness and simple procrastination behavior of the patient. This needs meaningful approach that is effective and measurable.

Drug utilization review at the point of dispensing eliminates some aspects of the problem along with patient counseling which makes them knowledgeable and aware.

But this is hard to measure because providers (PBMs, Pharmacies and Physicians ) have no tool to monitor if patient is taking medication on time till next refill is performed. Study from NACDS, NCPA and others suggest that more that 50% of the medications under possession stretch by 50% of the time allocated. That means 50% of dosage are missed or skipped.

Medicines… more »

…work only if they are taken on time. Often missed medication dosage contribute to serious side effects.

This needs serious consideration while devising consumer engagement strategy.

How to achieve this?
A medication therapy management program that
1. Empower and enable patient with easy and auto scheduling with daily dosages using a connected electronic platform. – Take away the responsibility of patient to remember and make it easy on them.

2. Alert patients with unobtrusive signals in terms reminders during the course of medication including future refills. – Alerts prompt action. Unobtrusive alert make less interfering and easy on their lifestyle.

3. Create right incentive strategy for healthy behavior – Incentives always influence behavior.

4. Remotely monitor daily drug usage pattern and intervene with appropriate channel.

Time is right to address this by leveraging mobile technologies. Over 40% of beneficiaries of Medicare/Medicaid have some kind of smartphones ( Over 28% of Medicaid and over 12% Medicare recipients) as of 2012 data. Access to these devices are going to be doubled in next 3-5 years.

Note: I represent RxNetwork – a start up on consumer engagement to improve medication adherence. « less

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    March 31, 2013 2:20 pm

    Thank you for your comment gyan patra, and welcome to Planning Room. Can you provide any examples of how patients might be unobtrusively given reminders regarding their medications? Do you know of any existing mobile technologies that provide the alert or scheduling features you suggest?

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      April 1, 2013 4:19 pm

      I have NFC tags stuck on my meds, when I tap the lid with my Smart Phone, I avoid an annoying reminder.

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        April 2, 2013 10:16 am

        Thank you for your comment. Can you explain how you use NFC tags on your medications to avoid reminders? Do you agree with gyan patra’s suggestion that medication management programs should include auto scheduling?

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April 1, 2013 8:58 am

In my opinon HealthIT.gov is not going to get many eyeballs. Most people Google and are more likely to land on WebMD – why compete? Why not partner with WebMD or Mayo for website info? Agree that trusted sources are key, but I don’t think the Feds will ever have that level of trust from a branding perspective so why waste resources to duplicate that?

And let’s focus on mobile apps – not websites. Mobile is where it’s at – especially when it comes to reaching folks in underserved areas where access to Internet is an issue.

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April 1, 2013 9:44 pm

I was very excited to read everybody’s comments as I had written a paper about medical apps a month and a half ago. I did a quick Amazon and Google apps search for medical records apps and did not find anything significant. I would recommend attaching healthcare apps to personal exercise apps and as to confidentiality. I think different generations have different attitudes towards medical confidentiality. Maybe it’s just a generation speaking. I would recommend having a confidentiality lever on the apps so that individuals could choose how liberal they wanted to be with their own medical information. I think having an application available on Amazon apps and Google apps would enhance advertising the program as people start questioning what is all about. I would like to command whoever’s in charge of this website. It is very well done.

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    April 2, 2013 10:43 am

    Welcome to Planning Room, eddie morgan, and thank you for your comment. You mention that you had difficulty finding information in a quick search for medical records apps. ONC would like to use HealthIT.gov as a “one-stop shop” for the public to learn about health IT and eHealth tools. Do you have any suggestions for how ONC can improve HealthIT.gov or what else ONC can do to encourage consumers to use medical apps?

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April 3, 2013 6:29 pm

In order to enable sustained behavior change, patients (people) must be (a) informed of their conditions and risks, (b) educated as to what those conditions and risks mean AND what they can do about them, and (c) supported through things like health coaching so they can achieve a level of responsibility in their own health & wellness.

We (NexJ Systems) continue to prove this model out with researchers in Canada and the US including at Beth Israel Deaconess Medical Center and others.

One key is connecting the patient / person to not only their health information, but to the network of caregivers and advocates they rely on for constant support and encouragement. We do this through our Connected Wellness platform with various Apps running on it which fundamentally link the two parties… more »

…together with imbedded alerting, secure messaging, and dashboards.

The next App on the platform is for Medication Adherence, which will support the individual in taking their medications as prescribed, alert the care give if they have not, and provide warnings and alerts to both of them as appropriate.

They key is in the connection… « less

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    April 3, 2013 11:15 pm

    Thank you for your comment egombrich, and welcome to Planning Room. You mentioned two Apps your company uses to create strong links between health information and the numerous parties involved in patient care. Are their specific ways the government could incentivise other companies to adopt these Apps and other eHealth tools?

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(Q#2) We encourage ONC to continue and expand its innovation challenge and award programs. The advent of Stage 2 of the Meaningful Use incentive program, particularly the ability of consumers to view, download, and transmit their health data, will likely increase the demand for new apps and other eHealth tools. ONC should leverage this development as it unfolds. Additionally, developers should be encouraged, or even required, to work with consumers in the design and development of applications and other eHealth tools in ONC-sponsored challenges. Designing systems with the audience they are built for will help to build consumer trust and buy-in; fostering collaboration may also help ensure that key expectations of consumers are met.

Use these buttons to endorse, share, or reply to the preceding comment by national partnership for women families.

(Q#3) ONC should encourage providers to strive to offer patient-specific education materials in the language spoken by their patients, no matter what that language is. Under the auspices of the Meaningful Use incentive program, we fully support utilizing data collected about a patients’ preferred languages to provide access to meaningful, useful education materials. ONC should consider adding to Meaningful Use a requirement to make patient-education materials available in the top five non-English languages spoken in the state where the Eligible Provider/Eligible Hospital is located. This will promote greater relevance to the community in which an individual lives.

Government policies could also invest more heavily in developing shared decision-making tools which would enable providers… more »

…to partner with patients in considering and selecting treatment options for conditions where there is no clear path for the “best” care.
« less
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May 8, 2013 4:29 pm

What are the most useful ways for federal regulations and partnerships to encourage the private marketplace to develop eHealth tools that enhance people’s ability to manage their own health care?

ONC and Federal partners could partner with private and non-profit organizations to bring together health care providers, app developers and also regulators in non-competitive incubator environments so that eHealth tools are developed for safe and effective use in the home.

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May 8, 2013 4:45 pm

What additional policies and standards would help product developers design eHealth tools to make it easier for patients and providers to communicate with each other about the patient’s care?

ONC should continue to support the development of a longitudinal care plan that would serve as the nucleus for health coordination and patient-centered care as described by the S&I LCC http://wiki.siframework.org/Longitudinal+Coordination+of+Care+(LCC).

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May 8, 2013 8:09 pm

Health IT cannot be accessed or used without appropriate electronic communications technologies, including email, texting, telephonic interactive voice response technologies, telehealth, remote electronic monitoring tools, etc. For example, a limited English proficient individual will not be able to schedule a medical appointment or request a prescription refill online if the patient website/portal and instructions are only in English. The principle of using and making available multiple formats and channels for all electronic communications must be a standard requirement for all patient-facing heath IT. All electronic health information must be available in “human readable AND useable formats”, including appropriate health literacy and numeracy levels, languages in addition to English,… more »

…and formats appropriate for individuals with visual impairments and physical disabilities. If these requirements are not explicit, then the implementation of health IT will only INCREASE disparities experienced by diverse and underserved patients and communities.
-California Pan-Ethnic Health Network « less
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May 9, 2013 4:34 pm

It is absolutely imperative, in my opinion, that we enable and not ‘disable’ our patient population by providing education, training, and most importantly, follow up ! Readmissions are appalling because our discharge process is a disaster, if it even exists in most hopsitals. With that said, ultimately, the only way we’ll change the face of healthcare in America is through the promotion of patient responsibility. By this I mean, we must enable and educate our patients such that they assume accountability for their own health and are rewarded for positive behavioral change.

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