Patient Engagement Requires Right IT Tools

9 Mobile Health Apps Worth A Closer Look

Health IT managers could learn a lot from my car mechanic. Mike once explained the difference between "parts changers" and real mechanics--those who are skilled diagnosticians. Parts changers will look at your ailing engine, make a snap judgment about what's wrong, replace the part he suspects is at fault, and hope for the best. A good mechanic, on the other hand, works through a diagnostic process, looking for subtle clues, and bringing his in-depth understanding of the internal combustion engine to bear to find the root cause of your problem.

As most healthcare providers know, the federal government is insisting that hospitals and practices improve their e-patient engagement strategy in order to meet Stage 2 Meaningful Use criteria. Private insurers are already going down this same path. When faced with such mandates, health IT executives and clinical leaders can take the parts changer's approach to patient engagement, or do a deeper root-cause analysis to find the best technology to address the issue.

Before analyzing the issue, it makes sense to carefully define it. Patient Engagement Systems, a company that develops IT tools in this niche, says: "Patient engagement is a process in which patients become invested in their own care. Engagement develops naturally when there is regular, focused communication between patient and provider, and it leads to behaviors that meet or more closely approach treatment guidelines."

[ Read Stage 2 EHRs Require Meaningful Patient Engagement. ]

So how do you get patients more invested in their own care? Technology is only part of the answer. An organization's core mission and its attitude toward patients are even more important. I've heard many people complain about arrogant, distant physicians, nurses, and front desk assistants who give them the impression they are doing them a favor by granting them an appointment.

In this age of customer satisfaction surveys and online provider review sites, that philosophy is woefully out of date. The best healthcare organizations genuinely believe that it's their privilege to serve, not the patient's privilege to walk in the door. And no amount of technological wizardry is going to have much of an impact without this core value.

But even in customer-savvy hospitals and practices that really love their patients, tech tools are no magic bullet. Some providers are placing their bets on mobile apps or active video games--think Wii--to foster wellness and lifestyle changes, encouraging patients to participate in "exergames" to lose weight and improve their cardiovascular system, for example. In theory, that approach should work, but research suggests otherwise.

A case in point: Studies done in a controlled laboratory setting have suggested that such active gaming does encourage adults and children to exercise more. But when Tom Baranowski, from the Baylor College of Medicine, and his colleagues put this theory to the test in the real world, they were disappointed.

When they divided a group of overweight children into two groups, one given access to video games requiring lots of exercise and the other given couch potato games, there wasn't any difference in activity levels between the groups over time.

Similarly, vendors such as Happtique might be too optimistic about the value of mobile technology. Happtique, which offers a mobile health application store aimed primarily at healthcare providers, plans to launch an mRx program that will give hospitals and physicians a mechanism for prescribing mHealth apps to patients. Following a two-month pilot this summer, the company expects to launch its patent-pending mRx technology in the marketplace.

Many providers are ready for mRx now, said Ben Chodor, CEO of Happtique, in an interview with InformationWeek Healthcare, but they lack a mechanism to prescribe apps to patients. "Today, if you asked a doctor for an app, he'd suggest a few websites or maybe send you to iTunes or Google Play. There's no mechanism for a doctor to deliver an app to your inbox with a couple of clicks."

Services such as Happtique have real potential to improve patient involvement in their own care, but the bigger issue is whether patients will stick to any wellness or therapeutic regimen outlined in a mobile health app once the novelty wears off. The public's attention span is short.

Patient engagement vendors such as Eliza Corporation have a more reliable approach. Eliza uses interactive voice response (IVR) technology to motivate patients and improve compliance with prescribed medical regimens. And although many consumers don't like talking to a computerized voice over the phone, Eliza's sophisticated algorithms have to some extent overcome that resistance.

To test the value of Eliza's technology, investigators from Humana, AstraZenaca, and HealthMedia, the digital health coaching company owned by Johnson and Johnson, used IVR, coupled with tailored print messages, to encourage patients on lipid-lowering statins to adhere to their medication regimen. Patients were initially surveyed by automated phone calls to determine what barriers stood in the way of medication adherence.

Then they were divided into two groups of 200+ patients each, with an experimental group given tailored feedback and encouragement based on how they responded to the survey, followed by tailored print materials. Control patients received generic phone advice and print materials on cholesterol control. Patients receiving customized advice were more likely to take their medication over time.

Similar studies suggest that IVR can benefit patients with diabetes and hypertension, and improve compliance with fecal occult blood testing, which can help detect colorectal cancer.

Mike the mechanic might know next to nothing about servers, networks, or mobile technology, but his insights on human nature are nonetheless worth remembering. Snap judgment is no substitute for thoughtful analysis.

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