Demand is growing for patient engagement, as the health care landscape shifts toward more shared decision-making. As more health care organizations adopt technology such as electronic health records and patient portals, meeting those expectations has become easier.

Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle set out to see whether opening clinical notes to patients would enhance patient engagement. Sometimes the concept is called “open notes” — making notes readily available to patients, generally through an EHR or portal.

The results were encouraging, and researchers said the message to physicians was loud and clear: “There’s little to worry about,” said Jan Walker, RN, MBA, a health services researcher at Beth Israel Deaconess Medical Center, Harvard Medical School in Boston. Walker was a co-author of a study in the Oct. 2 Annals of Internal Medicine.

Physicians and patients in the pilot program at Beth Israel received no training or preparation before going live, Walker said, but that will change.

“When we started, we were thinking we’ll teach the patients about the notes and we’ll teach the doctors about what not to write, and we’ll do all this educating. Then we decided not to do all that, simply because if it worked, we wanted anybody to be able to do it,” she said.

Information from the pilot will help shape educational materials and programs for physicians and patients, but the materials may look different for each organization that adopts this approach.

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In the United States, we are now short approximately 9,000 primary care doctors. These are the general internists, family doctors, geriatricians and general pediatricians, the doctors responsible for diagnosing new illnesses, managing chronic ones, advocating preventive care and protecting wellness. And health care leaders predict that that deficit will worsen dramatically in the next 15 years. Specialties like general surgery, neurosurgery and emergency medicine will also become critically understaffed; but primary care will be hardest hit, with a shortfall of more than 65,000 doctors.

While the demands from a growing and aging population and an influx of 40 million patients newly covered by insurance are considered the main drivers of this crisis, there is no shortage of issues on the physician supply side.

For starters, only 2 percent of all medical students in a recent study expressed interest in practicing primary care as a general internist. Most continue to flock to subspecialty fields like dermatology, anesthesiology, radiology and ophthalmology.

And once trained, primary care practitioners are particularly vulnerable to burnout and more likely to leave clinical practice than doctors in subspecialties like cardiology or gastroenterology.

It’s like the patient is bleeding faster than we can transfuse.

Experts have proposed several solutions to the doctor shortage. But for many worried patients and doctors, the best answer is seemingly the most obvious one: churn out more young doctors and funnel them into residency programs that train for primary care.

Unfortunately, according to a new study published in The Journal of the American Medical Association, it’s not that obvious.

Researchers asked more than 50,000 doctors training in internal medicine about their career plans. As expected, the majority of these young doctors planned on becoming subspecialists.

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The human gallbladder is a three inch-long organ found on the upper right side of the abdomen, just beneath the liver. Cholecystectomy, or gallbladder removal surgery, is called for in cases such as cancer, inflammation, gallbladder disease, or severe gallstones. This procedure rarely leads to long-term complications, since the organ isn’t an essential component of healthy digestion. Most surgeons will utilize minimally invasive surgery to remove a gallbladder. In the United States alone, more than one million patients undergo gallbladder removal each year; making this type of surgery the most widely performed minimally invasive procedure in the world.

Recovery plans in traditional practice differ from what they are today. Thirty years ago, open surgery was used to remove the gallbladder, which was only accessible through a large abdominal incision. This called for two to three days of observation post-surgery and up to two weeks of bed rest at home. The practice was revolutionized in the mid-1980s with the introduction of minimally invasive surgery. Even though the minimally invasive procedure may take longer than its traditional counterpart, patient outlook is greatly improved.

Starting with four small incisions in the patient’s abdomen, the surgeon will begin the minimally invasive procedure. Each incision is less than one centimeter wide! A typical minimally invasive surgery for gallbladder removal takes an hour or less to complete.

It is a known fact that patients who receive minimally invasive surgery report less pain following the procedure than those who receive open surgery. Minimally invasive surgery also allows surgeons to make smaller incisions, as opposed to one large one, so the appearance of scar tissue is greatly reduced.

In the decades since it was first widely practiced, minimally invasive surgery has gone beyond the abdomen for cases of gallbladder removal. Patients are treated for conditions in their chests, pelvises, limbs, throats, and heads. Planting an optimistic smile on the face of any minimally invasive surgery patient, surgeons can now assure their patients of reduced pain and scaring, reduced risk of infection, reduced hemorrhaging and less possible need for blood transfusions following the surgery, shortened hospital stays, and faster recovery times.

Often the worst part of a visit to the doctor isn’t the awkward hospital gown, needle sticks or embarrassing physical exams — it’s the drawn-out wait, camped out in the reception room in the company of sick patients and old magazines.

That realization led Mr. Oks to create Appointment Status, a Web site devoted to improving appointment efficiency and providing patients with information to avoid long waits. Working with three teenagers from Staten Island Technical High School, where he had gone, Mr. Oks aims to make it easier for patients to schedule appointments — and to find out how far behind the doctor may be before settling into a waiting room chair.

It’s one of several innovations meant to help patients. While many digital developments — electronic medical records and mobile medical encyclopedias — have streamlined doctors’ work, new tools for patients are starting to hit cellphones and the Internet offering help in keeping track of medications, recording heart rate and glucose levels and managing personal and family medical history, among other tasks.

Appointment Status is designed to assist patients before they even take a seat in a waiting room — a sore point for many patients, as doctors well know. In a survey conducted by the doctor-review Web site Vitals, patients reported an average wait time of 21 minutes to see a doctor. Mississippi had the longest reported wait time, at just over 25 minutes.

Some patients say that’s about as long a wait as they will tolerate.

“I’m willing to wait to see a doctor for about 20 minutes before I go talk to the receptionist, and after a 45-minute wait, I always leave and reschedule,” said Maureen Green, a journalist from Syracuse. “Everybody’s time is valuable, not just the doctor’s time.”

Developers and entrepreneurs are starting to tap into this frustration, as well as other rifts in doctor-patient relations. Mr. Oks said his next step is a mobile app to inform patients about delays.

For patients, navigating the medical system is a struggle — even when they are relatively well. It’s worse when they’re sick, such as patients with complex medical problems requiring urgent attention, like work-ups for cancer. Simply trying to coordinate appointments between specialists can be incredibly frustrating and time-consuming. And because specialists often work in individual silos, they don’t communicate with one another, leaving hapless patients and their families to shuffle themselves and their reams of information from one specialist to the next.

A recent survey commissioned by ZocDoc, which is trying to apply an OpenTable-style online scheduling model to health care, found that young adults are especially frustrated with the current health-care infrastructure. More than half of 2,000 18-to-34-year-olds surveyed said they delayed getting medical care because the process is a “pain.” More than 60% of these tech-savvy Gen Yers — who are accustomed to scheduling their lives with the touch of a screen — said they felt they were at the mercy of their doctor’s receptionist just to make an appointment.

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Thomson Reuters has released its annual study identifying the 100 best U.S. hospitals based on overall organizational performance.

The Thomson Reuters 100 Top Hospitals study evaluates performance in 10 areas: mortality, medical complications, patient safety, average patient stay, expenses, profitability, patient satisfaction, adherence to clinical standards of care, post-discharge mortality and readmission rates for acute myocardial infarction, heart failure and pneumonia. The study has been conducted annually since 1993.

For the fourth year, Thomson Reuters has also recognized the 100 Top Hospitals Everest Award winners — those hospitals among the 100 winners that delivered the greatest rate of improvement over five years.

This year, 12 hospitals received the Everest designation: Banner Boswell Medical Center, Sun City, Ariz.; UC San Diego Medical Center-Hillcrest; French Hospital Medical Center, San Luis Obispo, Calif.; Sarasota (Fla.) Memorial Hospital; Morton Plant Hospital, Clearwater, Fla.; Doctors Hospital of Sarasota (Fla.); Delray Medical Center, Delray Beach, Fla.; Ochsner Medical Center, New Orleans; St. Joseph Health System, Tawas City, Mich.; Clara Maass Medical Center, Belleville, N.J.; Augusta Health, Fishersville, Va.; and Bon Secours St. Mary’s Hospital, Richmond, Va.

To conduct the 100 Top Hospitals study, researchers evaluated 2,886 short-term, acute-care, non-federal hospitals. They used public information: Medicare cost reports, Medicare Provider Analysis and Review data and core measures and patient satisfaction data from the Centers for Medicare and Medicaid Services' Hospital Compare website. Hospitals do not apply for the award, and winners do not pay to market the honor.

If all Medicare inpatients received the same level of care as those treated in the award-winning facilities, according to the study, more than 186,000 additional lives could be saved; approximately 56,000 additional patients could be complication-free; more than $4.3 billion could be saved; and the average patient stay would decrease by nearly half a day.

To view the full list, visit www.100tophospitals.com/top-national-hospitals.

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Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside.

This and other aggressive tactics by one of the nation’s largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country.

The tactics, like embedding debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment, were outlined in hundreds of company documents released by the attorney general. And they cast a spotlight on the increasingly desperate strategies among hospitals to recoup payments as their unpaid debts mount.

To patients, the debt collectors may look indistinguishable from hospital employees, may demand they pay outstanding bills and may discourage them from seeking emergency care at all, even using scripts like those in collection boiler rooms, according to the documents and employees interviewed by The New York Times.

In some cases, the company’s workers had access to health information while persuading patients to pay overdue bills, possibly in violation of federal privacy laws, the documents indicate.

The attorney general, Lori Swanson, also said that Accretive employees may have broken the law by not clearly identifying themselves as debt collectors.

Accretive Health has contracts not only with two hospitals cited in Minnesota but also with some of the largest hospital systems in the country, including Henry Ford Health System in Michigan and Intermountain Healthcare in Utah. Company executives declined to comment on Tuesday.

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In a study published this year in the journal Health Services Research, researchers analyzed the results of a survey that asked nearly two million patients how they felt about their hospitalization. Known as the Hospital Consumer Assessment of Healthcare Providers and Systems, or Hcahps (pronounced “H-caps”), and administered to patients within six weeks of discharge, the survey consists of 27 questions about topics ranging from communication with nurses and doctors and responsiveness of hospital staff to general cleanliness and noise levels.

When the researchers divided the questionnaire results by the patients’ sex, they discovered that men tended to be more positive over all about their hospital experiences. Women were less satisfied with staff responsiveness, their discussions with nurses, communication about medications and discharge plans and the general conditions of the hospital. Among men and women who were older or felt sicker, these differences were even more pronounced.

“What patients require when they are ill and feeling vulnerable is not the same,” said Marc N. Elliott, the study’s lead author and a senior statistician at the RAND Corporation in Santa Monica, Calif. “What’s becoming clear is that we are not meeting the needs of female patients.”

In some cases the extent to which male and female patients differed in their satisfaction levels was substantial, surprising even the researchers. “There was a fairly consistent gender gap,” Dr. Elliott said. “But some of the differences were on the same magnitude as what you might see among patients from different ethnic groups or widely disparate socioeconomic backgrounds.”

One of the more marked differences was the amount of information about medications or discharge plans that patients needed to feel sufficiently informed. Women generally wanted more information than they received, while men were satisfied with what they were told. There were also considerable disparities between men and women regarding cleanliness, with women inclined to be less satisfied with the hygiene of hospital surroundings.

The findings from this study underscore how complex addressing quality and patient experience can be. Currently, most health care improvement efforts tend to treat patients as a monolithic group. It’s an oversight that can be attributed, at least in part, to the relative paucity of research and data on the patient experience.

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