The Role of eHealth in Patient Engagement and Quality Improvement

Despite accounting for 16% of annual Gross Domestic Product (Anderson, Frogner, Johns, & Reinhardt, 2006), the $1.88 trillion American healthcare system does not rank among the top nations of the world on several key dimensions with respect to healthcare quality, including infant mortality and healthy life expectancy (Schoen, Davis, How, & Schoenbaum, 2006; The Commonwealth Fund Commission on a High Performance Health System, 2006). Although a recent report from the National Committee on Quality Assurance (NCQA) describes improvements in preventive services and treatments known to enhance chronic disease management for people enrolled in health plans (National Committee for Quality Assurance, 2006), consistent evidence indicates that for most health conditions for which there are established evidence-based standards of care, Americans receive those treatments only about 50% of the time (Asch et al., 2006; McGlynn et al., 2003). Recently, Wennberg, Fisher, Sharp, McAndrew, and Bronner (2006) demonstrated the substantial regional variation in practice patterns and outcomes with respect to quality of care for Medicare recipients. Notably, the quality of care observed in regions with excess capacity of hospital and provider resources, and which were perceived as exemplary, was no better than regions with lesser capacity or reputation, and in some cases for certain conditions, worse. Hence, consumers increasingly are becoming worried about the relentless growth in healthcare costs year-to-year and about quality and safety issues (ABC News/USA TODAY/Kaiser Family Foundation health care poll, 2006). However, their primary concern is reducing the cost of their health insurance premiums (ABC News/USA TODAY/ Kaiser Family Foundation health care poll; Harris Interactive, 2005a).