Engaging The Patient

Often I enjoy discussing the behavior and purpose behind health technology/communication companies.

Why we’re here and what we’re hoping to achieve.

For many of us, we have a sense that we can influence the way healthcare is either received or delivered.

That we can make it better.

We simply often have different ways of going about it.

Yet, as more and more heath tech companies appear in this already crowded industry, I start to wonder if some ambitions are helpful or a hindrance.

It always seems positive to want to influence an important industry like healthcare, yet are there some elements that should go unchanged? Or, if not unchanged, not entirely replaced?

For example, many technology companies involve communication between patient and provider, but I would argue that sector of the industry should be supplemented by technology, not replaced.

A recent blog post I came across on The Healthcare Blog, discussed this very situation. It is entitled, “Online Won’t Ever Replace Face-to-Face. Or Will It?”

In it, Katherine Leon, a survivor of heart attack from Spontaneous Coronary Artery Dissection (SCAD), a WomenHeart Champion, and SCAD Research Board member, discusses her ability to improve discussion and awareness of SCAD through technology.

Yet, she also accurately describes the ways in which technology cannot replace the value of true, personal communication.

For one, she discusses the power of personal experience. In her story, personal experience means the power of testimonials from SCAD survivors -hearing them discuss the influence it has had on their lives and what individuals are doing to improve their futures.

The same can be said for our industry – very little compares with the power of the patient testimonial. Whether discussing a condition or even our products, individuals are far more likely to listen to and be influenced by personal testimonial than promotion from a technology vendor. Continue Reading »

In the healthcare industry, especially amongst the mhealth space, there is often chatter about patients and their want and willingness to become more involved in their own care.

We build tools surrounded around this premise, in hopes of empowering patients to take such active roles.

We especially promote Shared Decision Making when appropriate, and encourage a mutual and greater understanding between patients and providers of how to proceed with treatment plans.

So, it’s always uplifting to come across an article like one from Healio, that shows our chatter is right on track.

According to the article, researchers from Yale School of Medicine collected data from and interview 6,636 AMI patients, and “more than two-thirds…indicated a preference to play an active role in the medical decision-making process.”

Specifically, 68.4% favored a SDM approach and, among that percentage, 60.3% felt patients and providers should share in the process equally, while 15.3% said the patient should have a greater say than physicians, and 24.4% saying patients alone should make medical decisions.

So a majority of patients agree with our sentiments, that Shared Decision Making is the preferred approach.

As the researchers stated in JAMA Internal Medicine, “The results of this study highlight that a majority of patients want to be involved in decision making, while also showing that there is a marked minority of patients who would prefer to be passive.”

Patients want to be involved in their own care!

Yet, this research may also tell us that the definition of SDM can be interpreted differently.

Shared Decision Making is a process that can occur when a treatment decision is preference-sensitive – that is, there’s no single best answer, and what’s best depends on the patient’s goals, realities of their life, and what they prefer. Patients help the clinician understand their preferences, goals, and values, and the clinician provides information about the treatment options; then together they determine the best course of treatment.  Continue Reading »

It’s quite a common phrase here at Emmi Solutions:

“We reach patients where they want to be reached, when they want to be reached, and on the devices they already own.”

So naturally, a recent blog post we came across on how texting patients can produce positive outcomes caught our eye.

According to the post, a series of studies was conducted among 30 randomly chosen asthmatic children, ages ranging 10-17 years old. Over a period of 3 months, one group of children received text messages every day, another received them on varied days, and a third group did not receive texts at all. Among those who received text messages, the content required them to return simple responses about their health.

The study revealed that the patients who received daily text messages had “improved psychological and physical outcomes,” indicating that “cell phones can be used effectively to improve health outcomes.”
(Which is affirmation for the thousands of mhealth companies pursuing this angle that they could be on to something substantive.)

However, the blog admits more research needs to be done.

“While our data are far from conclusive they do provide an interesting road map for other researchers to pursue. Among the open hypotheses that we are investigating is whether this simple text-based system leads to improved outcomes in other chronic diseases such as diabetes, or whether symptom awareness and knowledge improvement lead to improvements for patients suffering from mental health issues…A related set of research questions aim to understand whether the patient’s text based responses (in the time between office visits) can be provided to the healthcare professional to improve point of care interaction.”

Our Take

It’s important that this type of research is being conducted.

As more and more patients become increasingly active in their own care, and as there is a need to provide higher quality care, it is essential to make the health conversations easier.

If we want to keep track of patient condition, get them engaged, and stay engaged, it seems natural to assume reaching them at their convenience is the first step. Continue Reading »

Featured Guest Blogger: Dave deBronkart, also known as “ePatient Dave.”

Dave deBronkart, also known as “ePatient Dave.”

In the business of medicine, one of the brightest hopes is the potential for re-optimizing our spend around what patients want. That’s important because decades of research in the field of shared decision making have shown that when there’s a range of options to treat a condition, informed patients choose less spending and less invasive treatment.

That’s a good thing.

Unfortunately, the University of Chicago press release for a new study released in JAMA Internal Medicine botches the headline, which has already (at this writing) resulted in thousands of pages parroting, verbatim, something the study doesn’t say. The false headline:

“When doctors and patients share in decisions, hospital costs go up”

The study didn’t even look at what happens when decisions are shared. If press releases had licenses, this one’s should be revoked:

• The study measured attitudes, not what happens when decisions are shared.
• Contrary to the headline, the study did not claim causation; it reported a possible correlation (“may be associated with”). Any student of statistics knows that a correlation doesn’t prove cause and effect; this headline is wrong.
• It creates an impression – no, it explicitly states – that patient engagement increases cost, contrary to all prior evidence. That is, simply, bad journalism.

Bad timing and misconstrued sequellae
The study was released on a Monday holiday (Memorial Day) – the journal’s usual weekly schedule. By 9 a.m. Tuesday, thousands of sites and media outlets had already posted it, with no critical analysis of the study itself – reporters only saw (and often parroted) the press release. As Health News Review has often reported, that’s sloppy reportage, and it can cause real harm.

Careful writing is important for many reasons, not least that intelligent but hurried reporters will trust the presser, resulting in a cascade of secondary damage. Example: as I write this, if you Google shared decision making costs the top result searchers get is this:

• Modern Healthcare: “Shared decision making may spur higher costs, longer hospital stays: researchers”

That’s a weak conclusion: the study’s own data, published in its Table 1, only reports a correlation. There wasn’t even any attempt in the study to compare what happens when decisions are or aren’t shared; they didn’t even report on whether any decisions were shared in the 21,000 cases studied.

Note, too, that “may spur” does not match the heading’s blanket assertion that it does. It’s a claim not supported by the evidence. Continue Reading »

As the healthcare market transitions from fee-for-service to fee-for-value, there is a push to increase the quality of the care process and simultaneously improve its efficiency.

Therefore, much attention is being placed on making the time spent between patient and provider more personal.

For those building supplemental technologies, the goal is to free time for health professionals that, without an excess of work outside of the examination room, would otherwise be spent interacting with their patients.

Yet, a recent study shows that technology may not be enough. Time is a conflict for many of those providing care, but the solution goes beyond what can be built.

An article in the New York Times provides context to this conflict, tracking back to the 1980’s. A study conducted during the decade revealed that doctors only spent roughly 20 percent of their time getting to know their patients and their conditions. The majority of time was devoted to paperwork and other responsibilities not typically done by doctors today.

The remedy was to hire additional people in the health care system that could assist in these tasks. Yet, eventually concern arose that young providers-in-training were spending more time than was advantageous at the workplace. Restrictions were placed on the number of their working hours still exist today.

The result? A conflict of efficiency yet again.

Either work isn’t fully completed by young doctors and is left to consume the time of others, pulling them away from patients, or interns are stretched to complete all their work in the restricted allotted time – lessening their time with patients and ultimately their hands-on learning experiences.

With these restrictions, a new study by researchers at Johns Hopkins University and the University of Maryland discovered that interns are spending approximately only eight minutes each day with patients. Most of intern time is instead spent at the computer, handling patient documentation.

According to Leonard S. Feldman, senior author of the study and assistant professor of medicine and pediatrics at the Johns Hopkins School of Medicine, “If you’re only spending eight minutes talking to and examining a patient, something is certainly going to be missing.” Continue Reading »

HealthLeaders Media Magazine recently reviewed a book by our friend, Dave deBronkart, or e-Patient Dave as he’s more widely known, entitled, Let Patients Help! 

The work dives into the meaning behind the “e” in “e-patient.”

Typically understood to mean “electronic patient,” deBronkart says the “e” means much more.

As stated by HealthLeaders, Let Patients Help! is a “quick but enlightening read that will inform you that the “e” also means empowered, engaged, equipped, and enabled. ‘Today some add educated, expert, and anything else ‘e.’”

Among those other “e” definitions exists “expectation.”

This “e” typically doesn’t get as much attention as engaged or empowered, but expectation is one of the most important “e’s” when it comes to addressing current challenges in health care.

Patients rightfully expect a lot from their health care providers. However, at times those expectations may go beyond what is reasonable.

Globally health organizations are struggling to appropriately address unrealistic patient expectations, in which they often anticipate, regardless of condition, a perfect outcome.

As it is with many current health care challenges, effective patient engagement tools can assist providers with presenting realistic care plans and plausible outcomes to patients. Continue Reading »

A few weeks ago on Engaging the Patient, we touched on the “patient engagement enigma,” and the lack of consensus among industry professionals about the term’s definition – and the point seems to be catching on.

We’ve seen articles offering definitions of patient engagement, and others that simply reinforce the idea that so many of us spend our day-to-day in search of how to most effectively engage patients, and yet there’s no real conclusion of what that is.

A recent article in Venture Beat discussed, “What Do We Mean When We Talk About Patient Engagement,” stating:

“Since health care entrepreneurship became “sexy,” people are consistently using the term “patient engagement” at health technology conferences. But what exactly does this mean? Like online consumer engagement, is it simply when a company maintains a relationship with a patient through technology? Since this is health care and situations are often complicated, there is little consensus over the definition of a term that everyone is using.”

However, the article goes on to conclude there doesn’t need to be just one definition of patient engagement but, when discussed, it should widely encompass many different factors.

“For patient engagement, there should be a more robust definition that includes positive health outcomes, where engagement encompasses interactions with technology that lead to some ancillary or direct health benefit.”

Now, it is evident that the article is written from a standpoint of patient engagement derived from technology, and this is a common discussion amongst innovators – who can create the next best thing to engage patients?

But I consider this kind of approach too simple; missing a significant point that will leave innovators continuously searching if “the next best thing” is their sole ambition. Continue Reading »