Analysis of the third NEJM Catalyst Insights Council Survey on Patient Engagement. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.
Views about technology tools for patient engagement are evolving rapidly. The use and payment of these tools is changing, and there is more work to be done to understand the efficacy of using patient engagement technology to help manage chronic disease and improve health behaviors. The ultimate test is whether these tools succeed in engaging patients to help them change behavior.
In our most recent NEJM Catalyst Insights Council survey, we polled members about the value of patient engagement technology tools, the barriers to recommending them, and how these tools are being financed. Patient engagement technology tools encourage patients to be accountable for their own health and to identify and curb the behaviors that result in poor health. They form a link between the provider, patient, and third-party information, creating feedback loops, offering insights about disease and disease management, and building support systems. Ideally, patient engagement technology tools fill the gap between patient visits; they could even preclude unnecessary office visits, trips to the ER, or hospitalization.
Patient-Centric Tools Help with Chronic Disease
The top two benefits of using technology tools for patient engagement, according to our survey, are to support patients in efforts to be healthy (tabbed by two-thirds of respondents) and to provide input to providers on how patients are doing when not in clinic (60%). What’s telling about the direction health care is moving is that both of these answers are distinctly patient-centric, not focused on benefits to the provider or health system.
As one respondent says, “The technology needs to provide motivation to the patient to continue with the desired behavior. If the technology can show to a patient that a desired metric correlates with their improved symptoms, then the patient will be more likely to adhere to a given regimen.”
Just over half of respondents say patient engagement technology tools can create an ecosystem that allows for better predictive analytics around patient health and more timely intervention. For example, data from wireless monitoring devices such as a weight scale can alert a physician to early warning signals, such as a congestive heart failure patient’s sudden weight gain, to enable more timely early intervention. This type of feedback loop can not only avoid unpleasant complications for a patient, but it can also avoid the cost of emergency room visits and hospitalizations. More executives (63%) than clinical leaders (56%) and clinicians (42%) rank this as a top benefit.
Patient engagement technology tools are a growing field with a range of perceived effectiveness. Eighty-five percent of respondents, including most clinical leaders, rate biometric measurement devices, including wireless scales and glucometers, the most effective tool. Apps for smartphones come in second place (75%). Texting, which can be used for appointment and medication reminders, was identified as the most effective tool by 70% of overall respondents and 77% of executives. Wearables, email, Web-based interactive programs (e.g., cognitive behavioral therapy), and portals have perceived effectiveness as well. Portals scored the lowest, which may be because providers are less likely to see portals as transformative compared to some newer approaches.
The survey responses suggest that these tools are most helpful with the management of chronic disease. Respondents rank chronic disease management (at 81%) and support for medication adherence (66%) as the applications best suited for patient engagement technology tools.
In their written responses, NEJM Catalyst Insights Council members note that these tools can change the course of chronic disease management, including asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension, and obesity, by creating “self-awareness” and “accountability.” One respondent says, “There is great potential [for these tools] in those patients with chronic diseases to better track and interact with the provider as to how they are doing or if they have any concerns.” Another says these tools “will enable a system to intervene earlier at less cost to patient and health care system.”
VERBATIM COMMENTS FROM SURVEY RESPONDENTS
Where do you see the greatest potential for technology to enable patient engagement and improve health?
“Humans want to know what and how much they can get away with before harming themselves, rather than what action they can take to improve health. Can that be addressed?”
“Baby boomers and those easily able to adopt and integrate technology into their daily routine. I think biggest impact is in chronic disease management and those not easily able to travel.”
“Potential is greatest in elderly with chronic illness. They are not 25-year-old nerds. If we think this will work on chronic illness now — we’re dreaming. Need to engage the population that needs it.”
“Homebound patients with chronic conditions.”
“On-demand data retrieval makes continuous feedback to patients possible.”
“Direct actionable feedback to patient and non-disruptive integration to provider workflow.”
“I see it in a specific population, not a specific disease state. A technology-accepting patient with any disease state.”
“Improved communication with relevant data between health care providers and patients.”
“Very sick patients. I don’t think “improving” the health of healthy people is a high value use of medical training.”
“I don’t — we’ve been hearing that tech is going to make a big difference for two decades now — other than the glucometer and home blood pressure cuff, nothing useful has materialized.”
“Only in patients who voluntarily will use it, and only in disease states where it might actually have any relevance (diabetes, etc.) None of the current tools have any impact on outcomes at all.”
Cost Is the Top Barrier to Adoption
Patient engagement technologies face hurdles to widespread adoption, not the least of which is that many are not covered by insurance, which survey respondents consider the top barrier to implementation (listed by just over half of respondents). Lack of integration with electronic medical records (46%), cost to patient (45%), unclear benefit (37%), and complexity of use (33%) also inhibit broader use of these tools.
Providers themselves shy away from recommending patient engagement technology tools primarily because they don’t know what to recommend, according to two-thirds of respondents. Others cite an unclear impact on quality outcomes (42%) and a lack of process for them to recommend the tools (37%). A third of respondents call integration with EMRs a roadblock. While nearly half of clinicians point to the cost to the patient as a barrier, only 38% of executives feel similarly.
More than 60% of respondents believe payers should cover the cost of patient engagement technology tools. Executives, clinical leaders, and clinicians were strongly aligned on this point. The remaining respondents either say “no” (10%) or they “don’t know” (29%).
So how can the health care industry strengthen its case for using patient engagement technology tools? Half of respondents say that several factors are required, including better integration between technology and organizational engagement strategies, tighter integration with clinical workflows, and easier-to-use products.
A big challenge will be to figure out how to fit incoming data streams neatly into clinical workflows, and not be disruptive or a huge burden. “Telling me that some technology will automatically send me [a diabetic patient’s] numbers is not helpful; I need to see them in an easily readable way at the time I see the patient in the office,” a respondent says.
Solutions should be based on the population that is served. Just like it might be inappropriate to prescribe a complex application to an elderly patient, it doesn’t make sense to recommend a costly device to a low-income patient who has no health insurance.
This field is rapidly evolving, and these results suggest that there is growing interest in incorporating patient engagement technology tools in ways that can improve patient health.
METHODOLOGY AND RESPONDENTS
In November 2016, an online survey was sent to the NEJM Catalyst Insights Council, which includes U.S. health care executives, clinical leaders, and clinicians at organizations directly involved in health care delivery. A total of 595 completed surveys are included in the analysis. The margin of error for a base of 595 is +/- 4.1% at the 95% confidence interval.
The majority of respondents were clinicians (47%), with executives (26%) and clinical leaders (28%) nearly evenly split. Most respondents described their organizations as hospitals (38%) or health systems (13%). These hospitals were predominantly midsized (39% had 200–499 beds) or larger (42% had 500 or more beds).
Only 8% of respondents indicated that their major affiliation was with a physician organization. Those physician organizations tended to be big — 60% had 100 or more physicians.
More than two-thirds of the organizations (69%) were nonprofit, with the remainder of respondents coming from for-profit organizations. Every region of the country was well represented.
Join the NEJM Catalyst Insights Council and contribute to the conversation about health care delivery transformation. Qualified members participate in brief monthly surveys.
This Insights Report originally appeared in NEJM Catalyst on January 26, 2017.