Are patients buying into patient-centered, personal care?
By Rick Dana Barlow, Editor-at-large, May 2014
Health Management Technology posed a creative challenge to nearly a dozen IT executives: Reveal some of the overt and covert warning signs that healthcare IT isn’t “selling,” if not enabling, that patients should participate in and take more responsibility for their own care, and then how they might nudge patients to take more of an ownership stake in the care they receive. Their noteworthy insights follow.
When patients are not convinced or allured by healthcare IT to take part in their care, three warning signs come to mind: Low utilization, difficulty of use and obstacles between the patient and provider. Poor usability, or not offering the functionality that patients look for, is often symptomatic of low utilization. Patients are also unlikely to use healthcare IT for their care if they find the technology difficult to use. Lastly, obstacles between the patient and provider further decrease healthcare IT adoption. For example, a once trusted physician can turn into a “computer operator” if poor IT becomes a problem.
– Joanne Rohde, CEO, Axial Exchange
It is difficult to attribute success or failure to HIT. The human condition is so complex and involves so many other elements that determination of change is complex.
If you want to monitor the effectiveness of HIT, the IT systems that are put into place should gather the data resulting from their nominal use. For example, how often is a patient, consumer, or member actually taking the actions that are part of the care plan? HIT can monitor and record adherence, or lack thereof, to a plan. For example, has a patient actually gone to the pharmacy to fill the prescription, and more importantly, is the patient actually taking the medication as prescribed? HIT can help in both ways. Is the patient, consumer, or member-generated data providing insights that treatment or maintenance regimens having the desired effect? Glucose levels or blood pressure measures are a couple of examples. Changes in baseline measurements could be enabled by HIT or simply by a care team member.
– David Muntz, CIO, GetWellNetwork
IT does not allure patients or convince them. IT can be engaging, exciting or easy to access. But it is the value of the information combined with how much the individual cares about the information that defines the value of IT.
– Dan Riskin, CEO and Co-founder, Health Fidelity, a board-certified surgeon, critical care physician and clinical informaticist
We’re starting to see a huge shift in the mindset of patients toward more ownership of all parts of their care. From scheduling your own appointments and shopping for insurance to demanding data access via health portals, patients now have the technology in their mobile devices to control the methods, times and location of their own healthcare delivery in a way that hasn’t ever been possible. This shift has been facilitated by some of the major work being done in the health IT industry to standardize and democratize the flow of information and has been accelerated by the widespread adoption of smart phones and other devices that allow much faster access to this newly shared information.
With this groundwork now laid, we are starting to see health IT finally enter the mainstream. The next step will be unifying all of this functionality so that patients can easily access information in one central location. This is Mana Health’s focus with our patient portal. In the way that Google is utilized for search, Facebook and Twitter for social, patients can go to Mana Health for all health data needs. Since we know that health means different things to different people we have focused on allowing patients to plug into all of the different devices they may use daily, including fitness trackers such as FitBit. This achieves two things: Allowing patients to see all their data all in one place and giving them more reasons to interact with that data. Interaction with alternative healthcare data is especially important for healthy patients with limited clinical data.
– Chris Bradley, CEO and Co-Founder of Mana Health
One of the most overt signs is the still low Meaningful Use Patient Engagement –View, Download, Transmit records – threshold, which is 5 percent, and the difficulty provider organizations still face in meeting that number.
A more covert warning sign is the fragmentation that still exists among IT systems in any given healthcare community. For example, one of Orion Health’s clients that has become an ACO and uses our technology to connect its 800 employs and affiliated physicians, found that it has 22 different EMRs to connect. That typically also means many different patient portal technologies. It certainly does not encourage adoption of the technology by patients and hinders their ability to manage their health in a holistic fashion – unless the systems can become “virtually integrated” via advanced interoperability technology, such as ours.
Another covert sign is the fact that sharing of action plans and pathway tasks across care coordinators, providers and the patient is still in its infancy. Again, the fragmentation of IT systems and the relatively few cross-community systems that have integrated care coordination and patient engagement solutions, mean that provider organizations are still not involving the patient as much as they could be in managing their own healthcare.
– Suzanne Cogan, Vice President, Sales and Client Relationships, Orion Health
One of the biggest warning signs we’re seeing is that MU healthcare systems are worried about even reaching a 5 percent adoption rate for portal technology. One recent research article noted that only half of hospitals and 40 percent of physicians currently own portal technology. This means that portals are being used by a tiny minority of the patient population. Editor’s Note: Bau refers to a Frost & Sullivan report accessible here: [http://www.prnewswire.com/news-releases/market-disruption-imminent-as-hospitals-and-physicians-aggressively-adopt-patient-portal-technology-225498752.html.
Also, consumer apps for personal tracking are not yet tied into the healthcare system. With these technologies siloed, there is little incentive for patients to adopt personal tracking and therefore its value to their care is limited.
These, combined with the failures of other programs such as Google Health, have lead to additional unease about personal health projects.
– Ben Bau, Vice President and General Manager, Patient Self-Service Solutions, Vecna
The lack of demonstrable accesses to information (i.e., portal logins) and lack of compliance and failure to change quality measures or outcomes are warning signs. This will be difficult to assess because many efforts are being simultaneously directed at quality improvement, and the overall health of a panel of patients will not change simply by making the information available to the patients in the absence of other efforts. If you are making a number of interventions, it will be interesting to see and assess if simple access to information influences care decision-making, or if involvement of providers and care intermediaries remain key to better decision-making. My guess is that disintermediation of care givers via simple information sharing will not be effective.
– Jeffrey Rose, M.D., CMIO, TriZetto Corporation
With the triple aim and focus on increasing quality, increasing financial savings and patient satisfaction, one of ways we can overtly measure if IT is alluring or engaging is if everyone is going to be serving patients on their satisfaction levels. Tools they can use to engage providers must be on there. Everyone is acutely aware of patient log-ins. On any portal our technology allows a patient to view his/her records online. Physicians are going to be measured against how many log-ins for those patients that they have in their panel.
– Mason Beard, Senior Vice President, Solutions, Wellcentive
There are some things in healthcare that are more on the physician or other care providers. There are certain things in medicine that are more on the patient. It is more difficult to determine if things not going well where it is breaking down. For example, managing complicated patient conditions or readmission rates for those conditions. Some of the work that we do in population health management is more on the patient.
If you have your population health management system and it knows what patients are due for the more straightforward procedures such as a mammogram or colonoscopy. Your automated phone system is calling and reminding those patients, but the patients are not following through with it. If you notify and the patient does not follow through, it is a warning sign. You can track and measure that. You can put that on the patient for not being engaged. Some things are more measurable on the patient side.
– Paul D. Taylor, M.D., CMIO, Wellcentive
Warning sign 1: Care providers that have access to healthcare IT but are not using it due to fear of providing too much information to the patient and introducing liabilities. Witholding information from patients isn’t very convincing to the patient.
Warning sign 2: Much of healthcare IT has been designed for the most part to enable clinicians to do their job more efficiently and to reduce the overall cost of care delivery. This is not a quality-centric design. It is a cost-control design. Moving away from this type of design may be very difficult as efficiency of workflow for clinicians has often become a hardwired concept. Healthcare IT needs a redesign to help improve patient involvement, and that means changing the concept of efficiency to be central to personalizing care process while balancing the standardization and efficiency of care.
Warning Sign 3: Silos. While health information exchange is growing, much of the health information is kept in silos and prevents the patient from getting a full longitudinal view of their own record so that they can help design their care process. Agfa HealthCare’s ICIS platform is designed to help reduce these silos and help deliver a more comprehensive record to both the care provider and the patient themselves. Imagine if patients were able to review their entire longitudinal health record across every facility, vendor, state, country or doctor they have ever been to. This warning sign has been overt for many years, and still persists.
– Paul Lipton, Senior Market Segment Manager, Imaging Clinical Information System (ICIS), Agfa HealthCare
How might IT ideally be improved further to encourage patients to “own” the healthcare they receive?
In many cases the technology is excellent, but what’s missing is consideration of the human factor, i.e., how patients with varying degrees of comfort with technology use these self-management tools. It’s not just about having a pretty interface, although that helps. It’s also about how easy it is to use the device.
Look what happened to BlackBerry. Just a few years ago it was the market leader in mobile phones, especially for business. It essentially introduced the idea of being able to work from anywhere. But the way it worked took some getting used to. Compare that with iOS and Android devices. Both were purposely designed so you didn’t need to read a 50-page owner’s manual to use it. They were far more intuitive, and in a short time they made BlackBerries a very niche product. And now all the software for use by healthcare professionals is being designed for iOS and Android.
Patients will do things that are easy and enjoyable. How many people go to WebMD to look for answers? Not because it’s better than going to the doctor but because it’s easy. There is a big push right now for wearable technologies – not just for health and fitness but for all sorts of applications. People want them because they’re easy to use and they perceive them as “cool.” Google Glass is expensive and ugly right now, but people are buying it anyway. Business Insider intelligence predicts that nearly 4 million units will be sold by 2016, increasing to 21 million units by 2018. Editor’s Note: Fickenscher refers to a Business Insider report accessible here: http://www.businessinsider.com/google-glass-sales-projections-2013-11.
Healthcare IT needs to learn from these examples. Make the devices easy to use. Make them fun – perhaps make it less like giving a health report and more like playing a game. Or we can design the interfaces to give patients a feeling that they’re competing to improve their numbers the way a golfer tries to lower his/her handicap. Give patients a reason to want to use the technology – outside of their health alone – and you’re far more likely to get them engaged.
– Kevin Fickenscher, M.D., Chief Medical Officer and President, Healthcare Division, AMC Health
Patients are encouraged to ‘own’ their healthcare when the interface and content is specifically tailored to the individual. Increased personalization achieves this [via] relevant content to the patient based on their conditions, availability of language translation, providing resources and a single resource for information across providers.
There are several challenges with mobile devices. One is “real estate” or the screen size where messages can be delivered. Too often results or explanations of medical and health conditions need context to be fully understood. It can be challenging to read long text with embedded pictures that accompany or elucidate the text. To offset the problem, it would be more effective for a patient, consumer or member to receive simplified communications provided in a culturally sensitive manner. In addition, the ability to ask for further clarification immediately via the mobile device should and could be added to facilitate further understanding. Even if the provider is not willing to take such communications, providing [an] “Infobutton” capability in messages would help address this concern.
Mobile devices are not often secured – many are provided by employers. Creating segmented storage on mobile devices would be helpful. Simply storing the results in the “cloud” to avoid problems with compromised, lost or stolen devices would be advantageous.
Current IT systems related to healthcare are difficult to use, confusing and often poorly aligned with the science behind healthcare. To be useful, consumer-facing healthcare systems will be easy to use, accessible where they prefer – computer, mobile, etc. – and provide robust, scientific and useful information.
The next big step will make the capture of personal health data effortless. This will mean that the sensors will have to integrate into your lifestyle without requiring any additional actions on the part of the user. When we reach this level of data flow, health data will become another essential component of all the other data that you use to map your life. Just like you monitor your bank balance to make sure you maintain financial health, you’ll be able to effortlessly monitor personal health data to maintain physical health.
The key tenets are:
Convenience – anytime, anywhere access across multiple devices
Ease of use – consumer-friendly apps – think gamification
Useful content – medical records automatically pushed to the app without manual creation/uploading by patient; intelligence to push patient-specific, e.g. based on diagnosis and education materials to the app
Interactive – ability to communicate with provider(s) and share the care plan with tasks and action items pushed to both patient and clinicians
Content curation so it’s patient friendly and appropriate. Patients vary widely in their ability to understand clinical content. Of course, patients with higher levels of educational attainment are better able to understand complex information. As providers we should not underestimate a patient’s ability to understand material relevant to their particular condition. For instance, there are studies showing many patients with complex forms of cancer are able to understand material around phase three clinical trials in depth.
– Chris Hobson, Chief Medical Officer, Orion Health
It’s important to start out by fixing the “broken windows,” meaning patients should be able to act on information as it compels them to be responsible. This translates to providing a single experience for the patient where they schedule an appointment, prepare for the appointment, check-in, pay and leave with electronic support throughout the process. IT needs to provide these touch points throughout the continuum of care by providing online access via a patient’s preferred device – mobile, tablet, computer – and on-site access via kiosks, tablets, etc. This also means opening the door for the patient to dialog with their entire care team around medications, lab results and appointments for a specific problem.
But on the other side of this, an IT solution must be flexible for providers as well. Providers need the ability to design and share workflows, content, and questionnaires that are most relevant to their patient populations rather than relying on one-size-fits-all solutions.
Be more accessible. Most people will be able to access information from their phones. Even in impoverished areas, people do have phones. I do not know if that will move the needle. If they get the information, we will have to measure whether to act on it or not. Clinicians act on information they collect from mobile devices for specific kinds of patients.
It is not about IT or mobile devices. I feel the absolute major challenge to engaging patients is data quality. It is trust in the information that they can access through the technology. To get physicians engaged in quality improvement initiatives, they must have trust in the quality of the data, and that trust flows down to a patient. A patient is not going to interact with any technology unless he or she sees value in it as well. For a patient engagement platform, the value is the quality of information contained in there. Their access and their compliance increase if they see value in the tool.
Patients ask the questions, “What’s in it for me? Why am I going to get engaged with this IT tool?” If the technology could serve up something to tell patient how his or her actions are going to benefit them – either in terms of outcomes improvements they may have with their health or how following through with an action will translate into lower monthly portion they must spend in their healthcare. An example is the new American Heart Association and American College of Cardiology’s lipid treatment guidelines, which in part require a calculation of a patient’s cardiovascular risk based on his or her clinical profile – some of which is within the control of the patient. The IT tool that can tell patients how much their risk of cardiovascular disease would go down if they lose weight and are able to stop medications for hypertension, quit smoking and the like. This provides something tangible and meaningful to help get patients engaged.
In an ideal world, patients, providers, researchers, caregivers, motivational organizations and communities are all interconnected so that personal health can be advocated, encouraged, designed and organized such that patients can take greater control of the health they experience. Automation and simplified patient-connected applications and devices allow patients to quickly and easily monitor their health. User experience design needs to improve to help patients engage with health information. Working with clinicians and patients over the last five years has taught me a great deal about using health IT to improve engagement, and in my experience I think that some of the biggest challenges for engaging patients still lie within the hospital walls due to the inability to easily publish information to the patient. One of my constant goals is to deliver the most comprehensive, highest quality of information to the clinician and the patient to enable more informed patients.