Technology is rewriting the relationship between patients, their caregivers and the health system. Tools for patient empowerment, education and self management are providing more meaningful opportunities for patients to manage their own health and care, with the potential to reduce transaction costs in the short term, and treatment in the longer term.
Engage patients at an early stage of their lives when they are well or may be at risk for a chronic condition and we can start helping them get into patterns of behavior that are going to put them on a path to minimize or delay the onset of chronic conditions in the future. That’s where the huge savings are going to be in the long term. That’s where the major productivity improvements will be as well.
— Richard Bakalar, KPMG in the US
Many healthcare providers, particularly in the US, have created Patient Portals. These give patients access to their medical information such as discharge summaries, medications, immunizations and lab results. More advanced portals now enable patients to develop and track their personal care plans, request prescription renewals, schedule appointments, access their health education library and exchange secure messages with their provider. While productivity savings have not yet been evidenced, the experience of movements like OpenNotes in the US has been positive so far. Patients with direct access to their providers’ clinical notes report that they have a better understanding of their health, can better self-manage and adhere to treatment. Medical errors have been shown to be spotted earlier too. In the UK, leading NHS general practice organization The Hurley Group implemented a ‘WebGP’ system for patients to access pharmacy advice, out-of-hours services, complete administrative transactions and have e-consultations with their doctor. Evaluation of their pilot showed 60 percent of the eConsults (which typically last less than 3 minutes) were resolved remotely. Nine months after implementation, consultations at one walk-in center dropped from 30,000 to 18,000, saving them £360,000 p/a and allowing them to close the facility.
An increasingly important source of advice and information is online patient networks that leverage the insight and experience of patients themselves. PatientsLikeMe is perhaps the most well-known network, with over 350,000 members covering 2500 conditions. It allows patients to search for information and advice about their condition (provided by other patients), connect with peers and track their symptoms to discuss with their healthcare team. The data collected is proving a valuable tool for research, with over 60 published studies now generated from the network.
There has been a recent explosion in apps and health-sensing wearable technology. However, it is unclear what impact these will have on population health and the types of interactions people will have with healthcare providers. Devices such as FitBit smartwatch collects a huge amount of personal health data, and patient portals such as Patients Know Best (see page 20) are starting to allow this to be integrated in the EHR.
To date there has been a real focus on apps and devices to promote wellness such as step and calorie counters, sleep and heart rate trackers as well as those focused on a single disease, rather than tools for complex costly patients. One interviewee said developers shy away from those types of apps because “they’re too complicated, too unappealing, the ROI is too unclear, the time to pay off is too long [and] they need to know too much about these patients in order to develop these applications.” (David Blumenthal, Commonwealth Fund). Given this market failure, there is a question about how far the healthcare sector should stimulate innovation to fill the gap. There is clearly a potential role for this data in health promotion, self-management and behavioral modification, but the current focus on devices or biosensors — rather than the information they produce — is a major barrier to meaningful applications. There also remain security concerns around the use of mobile technology, particularly in unregulated markets. A 2015 systematic assessment of 79 apps certified as clinically safe and trustworthy by the UK NHS Health Apps Library found that 66 percent of apps sending identifying information over the internet did not use encryption.1
Ensure patient-facing technology is easy to use: When designing patient portals or other patient tools it is essential to ensure they are both easy to use and appealing to patients — or risk low uptake.
For health apps and wearables, think carefully about how to turn the data into useful (and useable) information: Transferring data from patient devices into EHRs will only pay dividends with significant investments in analytical capability. Benefit is most likely when targeted at and designed for specific groups.
It’s fairly soon that it’ll be absolutely feasible to monitor people almost at a critical care level within their own homes.
— Richard Ashby, Metro South, Australia
One size does not fit all. The sooner we can accept this as truth, the better we will become at creating and rolling out meaningful programs that optimally engage patients in their own care.
— Aaron Berk, KPMG in Canada
Online consultations in Denmark
Since 2009 general practitioners in Denmark have been required to offer their patients consultations by email. In 2013, the number of email consultations was 4 million — equivalent to 11.2 percent of all primary care consultations in the country. Patients report benefits of being able to quickly access their GP, not being constrained by time of day and finding it easier to discuss embarrassing issues. GPs appreciate the benefits of being able to answer straightforward questions quicker, although some express concerns around loss of personal contact and misunderstandings that may come about through written communication.
1Huckvale, K., Tomás Prieto, J., Tilney, M., Benghozi, P-J., and Car, J. (2015) Unaddressed privacy risks in accredited health and wellness apps: a cross-sectional systematic assessment. BMC Medicine 2015, 13:214