Our most recent NEJM Catalyst Patient Engagement survey asks Insights Council members about the benefits, barriers, and promise of patient engagement technology tools. Carol Peden, MB ChB, MD, FRCA, FFICM, FFMLM, MPH, Executive Director of the University of Southern California’s Center for Health System Innovation, is excited for many aspects of patient engagement technology tools, but none more than predictive analytics.
Peden, who also is a professor in the Department of Anesthesiology at USC’s Keck School of Medicine, says having clinicians and patients contributing data about the recovery experience could help inform the effectiveness of post-operative protocols.
“Patient engagement technology tools might enable us to learn more about a patient’s pathway back to health,” she says. For example, providers looking at post–30-day data might see that certain patients are taking longer to get back to their normal life and work, and be able to adapt treatment plans accordingly.
Peden, like half of her Insights Council peers, says the top benefit of patient engagement tools is that they “create [an] ecosystem that allows for better predictive analytics around patient health and more timely intervention.” Garnering even more support from survey respondents are “support patients in efforts to be healthy” (identified by 67% as the top benefit) and “provide input to providers on how patients are doing when not in clinic” (60%).
Insights Council members also weigh in on the most effective patient engagement technology tools. Peden says medical apps, which 75% of respondents say are effective, could be useful in preparing patients for surgery. When coupled with respondents’ top choice for effectiveness, biometric measurement devices such as wireless scales and glucometers (85%), apps could prompt a dialogue between clinicians and their patients about how to get fitter for surgery, including eating better and quitting smoking. For example, Peden says, “We could send [patients] alerts about potential ways to improve their outcome, such as doing exercises or deep breathing ahead of surgery.”
But if providers are to robustly recommend patient engagement tools, they must first see the impact on quality outcomes, Peden says. “Unclear impact on quality outcomes” was the second-highest barrier to recommendation (chosen by 42% of survey respondents). “We need to understand what the optimal amount of data is versus continuously dumping data from engagement tools into the system,” Peden says. For instance, clinicians would want to know the key metrics for patient engagement success among their patient population, including how often the tools are used as well as the minimum use required for data to be valid.
For these tools to be widely adopted, they have to be designed with patients in mind. Peden points to older patients who might be less tech-savvy as a potential hurdle. “For them, engagement with some of these technologies can be very difficult, so they should be in the room when [the tools] are designed, not just a 25-year-old tech wizard,” she says.
Kevin Fowler, President and Founder of The Voice of the Patient, Inc., a Chicago-based consulting firm providing patient engagement and patient advocacy services, is adamant that patient engagement tools must be conceived of and designed in collaboration with patients. Before a health care organization can determine what technology to use, it has to understand its users, he says. “The starting point should be, ‘What do you know about your patient population?’ And that is the step most often overlooked.”
Fowler, who is himself a kidney transplant recipient for polycystic kidney disease, says he uses a couple of medical apps, but mostly as a way to receive and organize his lab results. He also uses email, which survey respondents scored at 65% in effectiveness, to communicate with his care team. He considers himself a very engaged patient and finds apps that support medication adherence unnecessary — even though survey respondents rate this technology the second best-suited application for patient engagement tools. “I know what’s at stake if I don’t take my medication, so I don’t need an app to tell me what to do,” he says.
He cautions those who lead the charge for patient engagement technology tools to avoid considering disease categories as homogenous populations. Instead, providers should segment patients within disease categories to understand how best to engage with them.
He also worries that the direction many health organizations are currently taking around patient engagement technology is tactical rather than strategic. For instance, chronic disease management, a tactical task, was listed as the application best suited for patient engagement technology tools, far ahead of the more strategic vision of readmission prevention. Extracting the maximum benefit of patient technology tools will require a shift in thinking, he says.
Meridithe A. Mendelsohn, PhD, Program Manager for Cancer Survivorship and Palliative Care at Swedish Cancer Institute in Seattle, which is part of Providence St. Joseph Health, is a believer in the power of apps for patient engagement. She even developed an app to help cancer patients keep a record of treatments to have on hand in case they fall sick when they travel.
Mendelsohn says that physicians have to champion the use of patient engagement technology projects for them to have any impact. She emphasizes good implementation of technology, including having staff taking the time to walk patients through apps and other tools.
The benefit, she believes, will be keeping patients “high touch” without taxing providers. She is surprised that survey respondents ranked “augment current capabilities of bricks-and-mortar health system” as only the fourth-highest benefit (at 47%), as she would have placed it higher.
“Even for our own institution, patient engagement technology tools could be a way to keep patients in the fold without them having to visit our campuses,” she says, explaining that traffic congestion and expensive parking can be daunting to patients.
She is in agreement with Peden and Fowler that patients should be involved in discussions of technology tools, and points to a patient committee recently started at Swedish Cancer Institute. “We get so busy pushing information out there [to patients], we forget to ask if it’s what they need,” she says.
Robert Henkin, MD, FACNP, FACR, Professor Emeritus of Radiology at Loyola University Chicago’s Stritch School of Medicine, says he already is seeing change in his own profession. “The American College of Radiology is encouraging radiologists to become more patient-engaged, and it’s a good thing,” he says. “Radiologists have the best idea of what their examinations can and can’t do, and can clear up misunderstandings about what results mean.”
Henkin, who is diabetic, says he appreciates the role of patient engagement technology tools in helping manage chronic disease, including apps and portals to receive his own lab results and communication tools such as email and texting to ask questions of his physicians. “It’s nice to be able to quickly communicate with your doctor when you’ve noticed some change such as a rise in blood pressure,” he says.
In the survey, mental health / behavioral treatment and risk behavior mitigation were considered least suited as applications for patient engagement technology tools (at 55% of responses). Henkin explains, “These tools could work well for medication adjustment but are not well suited to an in-depth therapeutic discussion.”
The big obstacle to wider use of patient engagement technology tools, as he sees it, is the burden on physicians. Like half of the survey respondents, he cites a need for better integration with clinical workflows and easier-to-use-products so physicians aren’t wasting their limited time on dealing with complex technology. “It’s a big job getting patients to learn how to use these tools,” he says, adding that physician compensation will eventually have to incorporate the additional time and effort it takes for these interactions.