Point of Care Engagement – Part 2 5/23/12

Last week I wrote about engaging patients at the point of care (POC). It’s something I think is lacking in our efforts to engage patients, and it’s something I’d personally like to see more of, at least with more pilots and studies.

I think both low- and high-tech approaches could be used engage patients at the POC, but tech-oriented ones make the most sense. Tech is more easily continued post-visit or post-stay. The focus of the post last week was informing patients about what is happening to them and giving them an active role in following in their care.

Reader Ann Farrell brought up a great point about patient having access to medication. “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printouts problematic (even by shift) in hospitals with continual changes/updates (locally & remotely) rendering them outdated (error prone) on print in many cases…However, with est. 1 med error per day per patient, vigilance of patient and family/friends is great idea.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?). It’s a good question. I think it depends where you stand on patient ownership and access to data. If we think the paternalistic approach is not the one healthcare should be taking in caring for patients, shouldn’t we be exposing patients to their data as much as we can, including eMar — even if it’s dynamic data? I’m not that well versed in the technical challenges around pulling real time, or near real time, from an eMar.

Today I wanted to shift a bit and write about something that I’ve been curious about for a while related to engaging patients at the POC. I’m a big fan of using social features on health apps to hook users and keep them engaged. I think patient social networks hold great value and promise for improving engagement and ultimately health. I wrote about PatientsLikeMe last summer, and think it’s a very powerful tool for patients with certain conditions. At the time, I questioned the value for patients with chronic diseases like diabetes or hypertension, or at least its ability to attract and retain those patients.

These chronic disease patients are hard to engage, yet engagement is key with these conditions. For many of them, lifestyle (or the decisions they make in the 99% of the time they are not in front of a healthcare provider) have a huge impact on their conditions. Engaging them in their health and helping them make better decisions on a day-to-day basis is powerful. I think you can get them to make those better decisions just by having them think about their health more regularly.

How do we do that today? Best case is an SMS campaign or a fairly static, disconnected app or service. Some offerings have social components, but just adding a "Stream" or "Community" feature doesn’t engage this group of users, or at least I’m not familiar with any services having success at scale with this. Some of the newer services, like Jiff or Avado, are interesting in approach, but it remains to be seen if they can really engage patients.

What I keep wondering is if there isn’t some way to connect consumers / patients to other consumers / patients starting at or around the point of care. If you tried this with the older, more acutely ill and advanced disease patients, there are some very strong potential applications, though I’m not sure of how well these older users would take to social media. Since grandmas are increasingly on Facebook, maybe the older population would love it.

When I think of this older group, I think of inpatients and not ambulatory, mostly because of the magnitude of the event and corresponding opportunity when users are feeling vulnerable and have lost most control. With that in mind, have hospitals ever tested out the concept of internal social networks to connect patients currently admitted or recently discharged? Sort of like a connected version of CarePages? You could create networks around conditions, demographics, or even floors. The goal would be to create meaningful connections and establish a support network that patients could take with them, assuming they have some form of access in the post-acute setting. This approach also requires some form of connectivity in facility, something I don’t think is a given.

Internal hospital patient networks open up a whole Pandora’s box of privacy concerns, but if patients agreed to join these networks and they were exclusive and secure, much of that would be be mitigated. The other Pandora’s box is patients complaining to each other. It’s almost like an internal, hospital-based 311 system (like texting potholes or graffiti that you see while driving.) I can’t only imagine the nurse and food complaints patients would share.

I’m not sure hospitals are ready for this. They would certainly need resources in place to police and respond to users. It’s certainly an interesting concept, though. At the same time, you might get patients complaining more to each other and less to staff. You would gather more meaningful feedback on hospital performance and patient satisfaction and could link to specific floors and staff and maybe even events or processes.

In the ambulatory environment, it could work for certain groups like pre-diabetics or expecting and new moms. Expecting and new moms are probably the best, because the course of pregnancy and post-partum are pretty much the same, at least for the majority. Dialysis or chemo might be another good target. I’m not sure how you’d create connections around the ambulatory POC because, by definition, it’s ambulatory and not extended stay. You could do it based on the same condition and day of visit, though I’m not sure how effective that would be. If reform provided codes for getting reimbursed for support groups (does it?), linking social networks to in-person support groups would be a great way to extend the support group and add value to patients.

Clearly the ambulatory side needs to be worked out and there need to be incentives to do some of these things. Social networks hold the most value when they enable virtual connections that extend in-person experiences and interactions. I don’t know how to best do that, but it seems worth exploring.


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

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