Healthcare Analytics, Population Health Management, Healthcare Big Data

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How to Leverage the Internet of Things for Patient Engagement

- Increasing meaningful, effective patient engagement is such a high priority for the healthcare industry that it is included as one of the three branches of the Triple Aim.  Along with reducing spending and improving population health management, however, the process of reengineering the patient experience of healthcare to produce better outcomes is not a simple or speedy task. 

Patient engagement with the Internet of Things

Luckily for providers, health IT and consumer technologies are both advancing to the point where patients stay connected to the Internet of Things more often than not, giving healthcare organizations a prime opportunity to leverage that constant engagement for their own needs.

Patient portals are already familiar to many patients, and their demand for mHealth-based solutions for basic care problems is off the charts.  As smartphones, wearables, home monitoring devices, and other internet-enabled tools continue to drive the sense that healthcare help is only an app away, providers must develop the skills and techniques to assimilate and analytics patient-generated health information without overwhelming their workflows.

With so many devices producing so much big data that could have an impact on how patients interact with their healthcare system, how can provider organizations turn the burgeoning Internet of Things environment into truly meaningful patient engagement?

Understand your particular Internet of Things landscape

Securing uniformly high levels of patient engagement has been so difficult for the nation’s healthcare providers that CMS has proposed slashing its Stage 2 meaningful use patient portal requirement from 5 percent of patients to just one single user within the reporting period.  While this change may seem drastic to some providers who are lucky enough to have a tech-savvy population of patients and an effective outreach program, it’s indicative of how important it is to know your limits and set reasonable goals.

Smartphones may seem ubiquitous, but the reality is that only about 80 percent of adults own an internet-enabled mobile device.  For providers operating in low-income areas, that number is going to be significantly lower, and may be coupled with a lack of home internet access, poor computer literacy, and restricted access to community resources like public libraries that can supplement a patient’s connection to the web. 

That doesn’t mean that the Internet of Things is absent in these environment, or that patient engagement is a lost cause.  It simply means that providers and their partners may be more responsible for developing a patient engagement infrastructure than those organizations operating in areas where patients purchase tablets, iWatches, and Bluetooth scales themselves.

Pilot programs that provide tablets to patients seeking help with chronic disease management for diabetes or veterans and their families coping with post-traumatic stress disorder have proven highly successful, while sending teams of telehealth professionals into the homes of seniors to deploy remote monitoring technologies can help elderly patients develop the skills to become engaged while staying out of the hospital.

In order to succeed with a patient engagement strategy based on the availability of connected devices, healthcare providers must remember to develop their programs in accordance with their patients’ resources, not only their own. 

Provide simple tools and meaningful functionalities

One of the biggest stumbling blocks for providers looking to boost their patient engagement numbers is the selection of inadequate technologies.  Flat, featureless patient portals and mHealth apps that don’t give users a reason to come back – or leave them too confused to try – can send even the most earnest providers awry. 

Patients, especially younger ones with innate Internet of Things experience and expectations, desire a rich, seamless, tailored experience that does most of the work for them.    “When we think of millennials, we know that they want to see things that are individualized for them,” said Tamara St. Claire, Chief Innovation Officer of Commercial Healthcare for Xerox in an interview with HealthITAnalytics.com.  “Engaging them is about providing them with an interaction that really suits their lifestyle, whether that’s through smartphones or tablets or other devices.”

As of late last year, nearly one-fifth of adults planned to add a wearable tracking device to their personal technology suite.  That number includes more than 30 percent of so-called millennials in a poll conducted before Apple even threw its hat into the smartwatch ring.

While wearable devices vary in sophistication from glorified pedometers to streamlined, data-driven tools for developing the quantified self, they require relatively little input from the user in order to fulfill their promises.  Passivity is the key to establishing lasting relationships between a patient and a technology, says John Halamka, CIO at Beth Israel Deaconess Medical Center.  Few patients actively keep their online personal health records up to date, Halamka says, “because it requires time and energy to maintain that data.”

When devices collect information automatically, however, and integrate the data into a single portrait of a patient’s various vitals and statistics, the process of engagement becomes a significantly more attractive one.  “There is nothing I have to do,” Halamka says, when his bathroom scale measures his weight and BMI and sends that data to the manufacturer’s cloud, which then routes the results to an iPhone app and personal health record account.  

“All of this just happens as part of my activities of daily living,” he explains.  The data is simply available when and how he wants to use it, whether it’s to track his progress, make decisions about his lifestyle, or schedule a visit to a clinician when something seems amiss. 

That is the promise of the Internet of Things in healthcare, and the challenge for healthcare providers who must invest wisely in the right tools to entice patients to engage.

Consume and analyze patient-generated health data within the EHR workflow

Simplicity and automation aren’t just important on the consumer side.  Healthcare providers have been wary of the patient-generated data (PGHD) influx since the EHR Incentive Programs were just a twinkle in the federal government’s eye. 

There is no question that PGHD contains significant opportunities to make patient engagement meaningful – if providers can figure out how to integrate it into their workflows.  “Data rests at the heart of health IT’s capacity to help improve care quality and health outcomes: standards-based, interoperable electronic systems make it possible to access, share, use and re-use information that was once locked in paper charts kept by individual providers,” wrote ONC Program Analytics Michael A. Wittie, MPH and Simone Myrie in a blog post earlier this year.

“As more and more consumers engage and adopt mobile health technologies to help them better track their daily health and wellbeing, it will be increasingly important to consider how those data can flow seamlessly from consumers to providers – and back – to help everyone achieve better health.”

The proposed Stage 3 meaningful use rule, which would require more than 15 percent of patients to contribute patient-generated health data from a non-clinical setting, is going to push providers to develop these new big data analytics and interoperability competencies very quickly indeed.

EHR vendors are helping by retooling their products with patient engagement and PGHD in mind, and providers are beginning to understand the critical importance of having access to data about patients that reflects their experiences outside of the provider’s office.  Rulemakers and payers are doing their part by making satisfaction with the patient-provider interaction a key metric for value-based reimbursement and public quality rankings that can have a direct impact on the revenue cycle.  It is up to providers to ensure that the patient is getting something meaningful from their contact with the healthcare system – and PGHD can help.

“If I don’t have an objective measure in my communication with you, then our communication is much less powerful,” Joseph Kvedar, MD, Vice President of the Center for Connected Health at Partners HealthCare, told EHRintelligence.com. “When we’re communicating remotely, it’s so much better to have an objective measure and that’s what the sensors and monitoring are all about — just creating that effective feedback loop that we can use as a tool to both educate consumers and patients about their health but also hold them accountable to care plans.”

But providers who are already feeling overwhelmed with clumsy EHR interfaces, data collection demands, overstuffed calendars, and a diminishing sense of job satisfaction don’t always feel like they need more input sources in order to make their best clinical decisions.  “Doctors have said for about a decade now as we have been talking about this and doing it, ‘I am not sure I want all this data,’” Kvedar said. “But what they’re really saying is, ‘Don’t give me data; I want information.’”

Turn actionable insights into real actions

As patient engagement technologies continue to rapidly evolve, and the Internet of Things becomes less of a futuristic prediction and more of a commonplace reality, healthcare providers cannot be satisfied with just having the tools in place and the data available to them.  They have to actually do something with it.

While Stage 3 meaningful use hopes to jumpstart the industry’s abilities to turn big data into meaningful care improvements, plenty of providers, vendors, and other organizations are already harnessing the concept of the IoT to make patient engagement a reality. 

From the OpenNotes project that makes it significantly easier to allow patients to view and add to their personal health records to Apple’s ResearchKit, which collects large-scale PGHD from smartphones to further academic study, the integration of mHealth devices, wearables, patient portals, and other engagement technologies into the daily work of healthcare providers has already begun. 

Population health management programs that connect providers with patients through text messaging, mHealth apps that reduce hospital readmissions by tracking chronic disease management or even identifying prescriptions with a picture can significantly improve the quality of life for patients who now rely on their smartphones for everything from mobile banking to hailing a cab or ordering takeout.

The mobile revolution has already swept through the majority of other industries, and healthcare is next.  Healthcare organizations who wish to put the Internet of Things into action for patient engagement should focus their efforts on the development of a simple, integrated, attractive suite of health IT features that can meet consumer demand without overwhelming providers.  If the industry can manage to embrace the idea of patient-generated health data from connected devices as the foundation for meaningful patient engagement, providers will be taking a significant step towards achieving the goals of the Triple Aim.

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