Patient Engagement
Talk
Behavioral Medicine’s Ether Dome Moment (09:17)

In the mid-1800s, the Massachusetts General Hospital Ether Dome pioneered ether as an anesthetic. Surgeons could now operate on tumors, for example, that they could never touch before. “This incredible innovation, a technology innovation called ether, opened up amazing acceleration in the field of surgery,” says Sean Duffy, the Co-founder and CEO of Omada Health.

The present day is seeing similar acceleration: the advent of the Internet and mobile devices is changing our lives and influencing our behavior in rapidly evolving ways. As Duffy puts it, we’re at an “Ether Dome moment” for behavioral medicine.

We see this on the consumer side: mobile apps where design matters, user experience matters, and technology matters — all the “little baby user interaction details that add up to matter,” explains Duffy.

Design is often behind the scenes, and good design reduces anxiety, says Duffy, which there is a lot of from both the patient and provider standpoint in health care. Ride-sharing apps like Uber or Lyft, for example, reduce consumer anxiety at every moment on the user journey through good design and technology.

A counter example within health care is inhalable insulin, launched in the 1990s. The product failed because it violated social norms, according to Duffy. “It’s pretty awkward to use a device like that in front of your friends,” he says. “You can’t violate social norms. Google Glass violated social norms. You don’t want to interact with a human if they’ve got a little camera looking at you in a piece of glass over their eye.”

So, how can you use design to create an experience that influences behavior and delivers valuable clinical outcomes? “The world has been trying, yet what folks find, and the reality of behavior science, is that there’s not one single instrument that can do it.” You can’t just put a steps tracker on someone and expect a clinical result, for example, or hand out an information pamphlet, prescribe a food tracker, assign a health coach, or direct someone to a message board and hope that one act will shape their behavior in a meaningful way. “It’s really a combination of all those discreet elements tied together in a narrative, just like a symphony, that can shape behavior,” says Duffy. “And when you do that, you can really tune and be the conductor of the instruments in that symphony, and see data at a massive scale.”

To help people at high risk of diabetes or heart disease, for example, Omada Health will drop weight readings on a scatter plot, which allows them to see patterns — where a program was successful for someone, or where it wasn’t. “You can create clusters, and you really start to tune and accelerate the innovation in behavioral medicine through this introduction of a new technology — really the ether of behavioral medicine,” explains Duffy. On an individual patient level, you can see how someone engages with a specific subcomponent of the program you’ve shaped, run real-time correlations to see what might result in a positive outcome, and dial up or down elements of the experience based on that information.

“This is about tuning, and about personalization. And it’s spawning an incredible, incredible wave of potential, in the way that we work to improve the health of the country writ large,” says Duffy. “You point a data science team at some of these interactions, mix them with a design team that can shape a really solid consumer feel, and all of a sudden you’re mathematically measuring what in yesterday’s behavioral science world wouldn’t be possible to measure.”

From the NEJM Catalyst event Hardwiring Patient Engagement to Deliver Better Health at Kaiser Permanente Southern California, April 13, 2017.

More From Patient Engagement

Survey Snapshot: Health Care Providers on the Problems of Patient Engagement Design

Members of the NEJM Catalyst Insights Council say reimbursements must value providers’ time spent on patient engagement.

Data Graphic: CMOs and Staff Physicians Lead Patient Engagement Efforts

Survey respondents say CMOs and staff physicians head patient engagement efforts within health care organizations, but it’s important to note who does the ranking.

Data Graphic: The Two Most Effective Patient Engagement Initiatives

NEJM Catalyst Insights Council members say the only broadly effective approaches are time spent with patients and shared decision-making.

How Chronic Pain Treatment Falls Short of Patient-Centered Care

Healing the opioid epidemic requires nothing less than a comprehensive theory of patient health.

Patient Engagement versus Patient Experience

The difference between the two terms is muddled but important, says Cleveland Clinic’s Chief Experience Officer.

Evaluating Complex Care Programs: Is It a Zero-Sum Game?

Policymakers see programs for complex patient populations as a way to bend the health care cost curve, but are reduced health care utilization and costs the right measures of success?

Toyin Ajayi Talk Still: The Difference Between Noncompliance and Defiance

The Difference Between Noncompliance and Defiance

How do we align our goals for patient engagement with even the most complex, difficult patients?

Hardwiring Patient Engagement to Deliver Better Health

Imagine a world in which health care was not “one size fits all,” but customized for each patient individually.

Health Care — A Final Frontier for Design

Design must move beyond narrow projects and encompass complex systems.

Engineering Social Incentives for Health

It’s important to engineer social engagements that promote health, but we must also test their acceptability and effectiveness.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Patient-Centered Care

166 Articles

Walking with Our Patients in the…

Mobile integrated health, a disruptive home-based delivery model, repurposes existing resources and addresses critical care…

Walking with Our Patients in the…

Mobile integrated health, a disruptive home-based delivery model, repurposes existing resources and addresses critical care…

Patient Incentives

50 Articles

Why Real-World Results Are So Challenging…

User engagement outside of clinical trials is the critical factor.

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now