A new report from Chilmark Research shows that the state of affairs in patient engagement is best summed up by the overused paraphrase of the William Gibson quote: The future is here, it's just not very widely distributed.

After speaking to about a dozen healthcare vendors and their customers, report author Naveen Rao found that for any given patient engagement technology, outside of the most basic patient portals, it exists and you can find a demo of it. But an overwhelming majority of patients won't be able to find them in their doctors' offices.

Rao's most optimistic estimate for when patient engagement technologies -- like telemedicine, chronic disease management tools, patient generated data, and mobile apps -- will be widely deployed is 18 to 24 months. He says the delay is a result of providers waiting for vendors to step up, while vendors are still finding that the most reliable money is in basic, meaningful use-driven tools like patient portals.

"I wouldn’t call it a standoff, but it’s kind of like both sides are waiting for the other one to move," he told MobiHealthNews. "You have these healthcare systems who are basically sticking to a portal and they’re kind of looking to their health IT vendors -- who they’re already paying lots of money --  to roll out mobile apps, telemonitoring solutions, and things like that. And the vendors are like, 'The doctors and the hospitals they tend to want things to get them the meaningful use dollars.' So it’s like, who’s going to move first to these newer technologies?"

The biggest culprits among vendors, Rao said, are the EHR vendors. And not necessarily the market leaders like Epic and Cerner, who have the resources to innovate more freely, but the smaller vendors not focused on newer technologies. These companies might provide patient portals, but when it comes to interoperability between portals, the technology is well beyond the times.

"The default is, as one vendor said, you go with the radio that comes with the car," he said. "You use the patient portal that came with your EHR. It’s free, you paid for it, it checks off meaningful use, you move on."

Rao believes that because innovative approaches to patient engagement get more press coverage than the status quo, patients and providers may believe these tools are more widely deployed than they actually are.

"A lot of the progress does tend to come from the smaller companies, the startups and the people who aren’t held back by the baggage of having so many customers they have to be servicing and keeping happy all the time," he said. "What that means is they’re usually backed by venture firms that have an interest in them getting good press and being bumped up. So it’s sort of the nature of the game."

These companies, like Ginger.io, Wellframe, or Twine Health, are developing the technology, piloting it, and building out their teams to get ready for scale. Rao believes a natural shift in the market will pave the way for them to finally scale.

"So as we see this develop over the next couple of years, what we see [coming is] two waves of adoption of infrastructure and IT and technologies. And patient engagement, for better or for worse, is not really a part of that first wave," he said.  "The first wave is infrastructural stuff -- building out analytics, building out registries, figuring out how to basically take on the management of populations of people. This is new territory for a lot of the providers. ... So once they get the first level built, the foundation, then patient engagement, connected health, telemonitoring, smarter care planning tools, and mobile apps [can follow.] Those pilots that are out there today are going to spread from one-office practices to five-office practices, and from one department to three or four departments in an organization, and we’re really going to see a lot growth."