Point of Care Engagement 5/16/12

Thanks for the clarifications and comments on my last post about telemedicine and evidence. As I said in the post, the more data we collect, the more we’re learning what questions we really need to ask and answer. Hopefully we’ll see more good data being published to address these new questions.

One issue that was highlighted by reader C. Gresham Bayne in his comment pertains to house call patients, an area that fascinates me. I need to write a post about physicians delivering care in the home and the associated technology that enables it. This comment motivated me to do the research and get it done. It’s not for today, but it’s coming.


For today I was motivated by the picture above. I had the unfortunate experience of being in the hospital last week with one of my kids. It was only day surgery and all went well, thankfully. The experience wasn’t unfortunate because of the treatment we received but, let’s be honest, being in a hospital as a patient or family member is not pleasant. The center was an academic center, if that matters to anybody.

In the recovery room, I glanced next to the bed and found the tape deck in the picture above chained to the wall. I can’t really imagine what it is used for today, but maybe there are still tapes on the recovery floor that patients can rent out, sort of like borrowing a DVD to play in your room. I love that it was chained to the wall, either to prevent it from being stolen or from being thrown across the room out of anger, frustration, or maybe psychosis.

[As a side note related to physical media, doesn’t it make sense to eliminate all of it – including DVDs — from hospitals ASAP? Bringing them from room to room probably brings unneeded contamination. I know they are cleaned with wipes, but still. The technology to replace the media certainly exists today, although I realize it is not at the top of the priority list or fires-to-be-put-out list for hospitals.]

Back to the original reason for the post. My initial thought in seeing the radio was that a lot of the stuff I write about and read about in health IT is not standard operating procedure. We have an extremely long way to go. All the companies with cool ideas and services that people like me report on have a lot of executing to do to become a part of our health system. It was a good reminder to me how far certain aspects of medicine — on both the patient and doctor side — are from today’s technology. It’s also good news for investors and innovators, because opportunities abound.

My next thought was how poorly we engage patient when we actually have them sitting in front of us or lying in beds in our facilities. iPads and smart phones are a long way from tape decks, but as we push to give people ownership over their own health and wellness, doesn’t it make sense to start that ownership in the hospital or office?

What would giving somebody ownership and engaging them at the point of care really look like? I think it can take many forms and I think we’re starting to see people trying it.

From a totally low-tech point of view and in the inpatient setting, why don’t we give patients printed daily information about what the medical team is doing for them and how there care is progressing? The information could be high level and not specific, and it could also include targeted educational material.

The paper forms could also include daily medication lists, with nurses helping patients check off each med as they are given or taken. This gets them used to monitoring adherence and practicing what they should be doing at home. Also, include a way for patient to document questions they have, and even encourage it. I’m sure you could gamify this if you wanted to encourage the behavior.

Smart TVs or tablet devices could make that paper process high tech. I’m not sure if GetWellNetwork or LodgeNet are doing this, but it certainly makes sense. GetWellNetwork is extending services to post-acute care and that is a step in the right direction.

In the case of the VA pilot, in which iPads are issued to family caregivers, why not build apps and tools to make appointments and hospital stays more meaningful and care seemingly continuous, not episodic? Or why not start patients using the mCare platform for health communications when they are still at the VA?

You could do the same thing with office appointments. Require patients to document — along with MAs and nurses — their weight, blood pressure, and any other biometric data. Obviously both paper and apps could do this. The idea is to get patients used to having some responsibilities and ownership of their own health and health data.

I’m interested to learn who is doing these things. Maybe this is something that has been tried and doesn’t work, or something that is working swimmingly. 

In my next post, I’ll discuss similar concepts that are more socially enabled.

Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Travis,
    Great to see discussion of Interactive Patient Services – use of TV and iPads for patient engagement and education – an evolving market ripe for innovation.

    Med schedule printouts problematic (even by shift) in hospitals with continual changes/updates (locally & remotely) rendering them outdated (error prone) on print in many cases. We see this with RNs printing eMars and task lists rather than accessing on-line.

    However, with est. 1 med error per day per patient, igilance of patient and family/friends is great idea. Are we ready culturally and technically to expose them real time to eMar /iVar or summarize current med info – display in pts room (White Board, tablet or TV?)

    Hope to hear audience views re future role of TV-based systems particularly related to role of IPS vs EHR vendors in patient education across continuum of care.


  • Tom Klopack


    Good article on interactive patient services. I’d like to add that Skylight Healthcare out of San Diego has been the pioneering company in this area and is already doing many of the things you discuss in patient engagement. They now have several years data linking pre admission, in-patient, and post discharge information at several sites that engage patients when scheduled, automatically feed them information via their TV in the hospital and follow them home with the web allowing them to view education, fill out forms, and provide outcome information. The automatic white board is particularly cool.

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