In my last post, I
reviewed the evidence that patients are less engaged in their healthcare
decision-making today than they have been in the past. I also listed a number
of ways that this disengagement is being addressed including: patient access to
healthcare information & communication with their providers through patient
portals, Patient-Centered Medical Home certification, Meaningful Use Stage 2
qualification, etc. I don’t believe that any of these will be particularly
successful at creating patient re-engagement, & I suggested that peoples’
surprising preference for using public social media (Facebook, Twitter, YouTube,
G+) to share personal health information (PHI) & create communities around
diagnosis & shared experience is a trend that has already taken off. The
cited pwc study[1]
showed that 90% of 18-24 year olds (28 million people[2] 2) would trust healthcare information on
public social media sites & that 56% of 45-65 year olds would engage in
healthcare activities on public social media sites (that’s 47 million people
aged 45-65[3]).
Adding in estimates for the rest of the population it appears that somewhere
around half of the U.S. population has or would share PHI & engage in
healthcare activities on public social media. It seems shortsighted to not plan
to utilize this fact as part of healthcare reform. Patient re-engagement
specifically could benefit from using this tendency for trusting & using
public social media.
There are two other
aspects of the effort to use peoples’ engagement with electronic activities to
affect patient re-engagement. The first is electronic gaming. According to the Entertainment
Software Association, 58% of Americans play electronic games[4].
Games are starting to play an increasingly important role in healthcare,
especially in the treatment of chronic or serious conditions[5]
& could be incorporated into the interactions of patients, caregivers,
providers & community members to provide a new type of engagement. Finally,
there are an estimated 6000+ healthcare & fitness apps available for
smartphones & other platforms. The FDA reports that approximately 500
million people will be using such apps by 2015[6].
How could these
three trends be used to re-engage patients in making their healthcare decisions?
The first possibility I can think of is to integrate information &
interaction people have with public social media into their healthcare
provider’s clinical workflow. I know, there are a lot if issues with this, but
if half the population in the U.S. is ready to interact on public social media
regarding their healthcare, it seems foolish not to try this integration. There
seem to be a number of real impediments that would have to be addressed.
· The
first is that providers (doctors & other healthcare professionals who
interact with patients & make clinical decisions about their care) are not
at all fond of having their workflows, that is exactly how they interact with
patients, changed – especially if they are not initiating the change. Providers
are about improving outcomes for patients & many of them feel that they
have already made huge changes in adopting electronic health records (EHRs)
into their workflows without seeing much measurable improvements in patient
outcomes. Now we would be introducing an entirely new (for the vast majority of
providers) dimension of interaction, one that is more immediate, & possibly
more intense than their current interactions.
· Another
part of the workflow issue is that clinical workflows are not standardized,
even within specific areas of medicine. They are more so now with the use of
EHRs that have an implied workflow associated with them, but most EHRs are
configured differently for different specialties: primary care, cardiology,
behavioral health, etc. This would have to be taken into account in the
integration.
· Second
is that providers are very skeptical of patient &/or caregiver provided
information, especially in Personal Health Records (PHRs) & online. Part of
the issue with PHRs is that they are not a good medium for use of both patients
& providers – they must be simple enough for patients to use but not so
simple that they are ineffective for providers to use in treatment. This is
even truer of information that patients post online as they may have other
motives (than provision of information for treatment) such formation of
community.
That’s probably
enough limitations. It seems as if the benefits outweigh these limitations so
that a real effort can be made to overcome them. These benefits include:
- The possibility of using both public social media interaction & the information posted in social media streams as part of the task flow for the provider/patient relationship, & that this would improve the providers’ ability to react, both clinically & personally.
- The possibility of having information to work with that a provider would not normally have; such as the patient’s work/life balance, family issues as expressed in social media, patient’s interaction with community of people with similar medical problems (uncovering their opinions of current & past treatment, fears & hopes for treatment, etc.).
- The possibility of creating a more trusting & therefore more reliable means of facilitating provider-patient communication & interaction.
These are not the
only potential benefits, but they do provide the very real possibility of more
informed, reliable & productive provider-patient interaction that could
result in measurably improved outcomes. This would require education &
evolution of attitudes & behaviors on both sides in order to work (&
possibly changes in the written HIPAA guidelines or their interpretation &
enforcement), but the fact that up to half of the U.S. population may already
be using public social media or may be predisposed towards using it for
healthcare purposes makes this an easy – although hard to implement &
deploy – recommendation.
Two additional
aspects of this evolution might make it easier & more palatable; at least
for patients. The first of these is gamification. This does not mean that all
or most interactions are done in the context of a game. Actual games, for
instance, are not very effective at information gathering & transfer. It
does mean that principles of game design & play are used to design the interactions.
These would include: goal setting (self), leveling, reward structure,
meaningful choice & narrative feedback[7].
Using these design principles for patient interaction (through social media)
may result in greater engagement by patients, as interaction becomes both more
effective & interesting to them.
Another aspect of
information gathering & provider-patient interaction is the use of
healthcare related apps on smartphones & other devices. If, as the FDA
estimates, there will be 500 million users (worldwide) of such apps by 2015,
they also should be integrated into clinical workflows in order to take
advantage of the information stored in such apps & the interaction style
provided by them. Many of these apps are already “gamified” to some extent & store information in formats that should
be easily shared with PHRs & even EHRs. The introduction of such apps, or
more likely, the development of such apps for integration into clinical
workflows could be a game-changer in terms of patient & provider engagement.
One other thing to
take into account is that there are several commercial efforts underway to
provide private social media for healthcare organizations, see, for instance
WellFx (www.well-fx.com) or PathCare (http://www.pathcare.co/). Many large
organizations (Kaiser Permanente, Partners Healthcare, etc.) are also
developing & providing their own private social media apps, either as
add-ons to their patient portals or as stand-alone applications. I believe that
these efforts will not succeed unless they are connected in some way to the
public social media that people are already committed to using.
Of course, the only
way to really know if the integration of public social media & gamified
healthcare apps into providers workflows can be effective is to do it. Pilots
will allow the evaluation of the feasibility of such integration & provide
vehicles for testing a variety of paths to achieve such integration. Let’s
“just do it”.
Look for my next
posts:
- What exactly is workflow integration in healthcare?
- Exclusive – I talk with the Future!
[1] Social Media “Likes”
Healthcare – From Marketing to Social Business. pwc Health ResearchInstitute. April 2012.
[2]
http://www.research2guidance.com/500m-people-will-be-using-healthcare-mobile-applications-in-2015/
[3] http://www.census.gov/population/projections/data/national/2012/summarytables.html
[4] http://www.theesa.com/facts/pdfs/ESA_EF_2013.pdf
[5]
http://www.rwjf.org/content/rwjf/en/search-results.html?u=&k=games
[6] http://www.research2guidance.com/500m-people-will-be-using-healthcare-mobile-applications-in-2015/
[7] Reality is Broken, 2011,
Jane McGonigal, Penguin Group (USA) Inc., NYC
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