Why Patient Engagement Sucks…and it’s not Necessarily the Provider’s Fault

John Oliver’s most recent report on 911 has inspired this post. I would recommend viewing it for context: https://www.youtube.com/watch?v=A-XlyB_QQYs

I had the awesome opportunity to join hundreds of digital health startups, thought leaders, and major healthcare institutions this week at Prime Health Collaborative’s Innovation Summit. At one of the panels about innovating for institutions, the discussion turned to patient engagement apps and their relative value to those institutions. There has been some significant push-back by institutional healthcare and consumers alike for implementing solutions in this area because of their lack-luster performance and value. But with the need to engage patients / consumers so high, why is this one particular area a nut that digital health hasn’t cracked, yet. John Oliver’s story on 911, I think, holds a key component to the issue.

Pervasiveness of technology for consumers. Antiquated technology in the system.

As Oliver mentions in his story, mobile technology is virtually everywhere. The number and sophistication of devices is such that when there’s a fire you can overload the 911 system with calls and if you want to check in on Facebook at an event, your phone’s app can fairly accurately find you, despite the phone number not being so easily tracked through the cell towers.

This same issue plagues the healthcare system. While I can order a cup of coffee from Starbucks on my way into the office, there are limitations to the amount of information that I can get out of an Electronic Health Record (EHR). This is in many ways intentional (due to legal constraints), ethical (due to professional opinions about what should be shared with patients — paternalism), and practical (some EHRs simply do not lend themselves to going outside their own wall.

Additionally, while you can collect all kinds of information on your phone that you’d like to share with your doctor, many systems are simply not prepared to make that data useful, or even really readable, before or during a meeting with you. This has to do with the data design in the EHR as well. Some are better than others, but we definitely have much work to do.

On top of that, sometimes our system is even disjointed among groups that regularly work together. A group during the same panel pointed out that among their various providers, there were something like 27 different EHRs being used across different locations. To solve for this, those patients are coordinated through an entirely separate platform for communications between providers and with their patients. Since this is disjointed from the EHR, it’s really only a stop-gap solution.

While many apps are advancing to be more and more consumer-friendly, Healthcare has a number of hurdles, including significant legal ones, to overcome to get to a point where apps are reasonable, safe, and useful. And while 911 suffers from a decrease in funding problem because the resources are diverted elsewhere, healthcare had the recent influx of Meaningful Use dollars that resulted in the adoption of technology that wasn’t centralized or even particularly interoperable.

The Butt Dial and Human Behavior

One point brought up during Oliver’s story is that butt dials (when someone accidentally engages a 911 call unintentionally, often because it is in someone’s pants) have contributed to a significant influx of calls that do not warrant services. While most patients are not requesting unnecessary surgery, we do have a common issue of individuals making it to the Emergency Room for non-emergency needs. The reasons for this vary, but again, I’d venture that this has as much to do with the access that we are used to for a number of other services and the knowledge or wisdom to engage healthcare services at the appropriate level.

While there are some solutions that are making headway in this area, there is still a gulf between our own individual knowledge as patients and the wisdom of where to enter a system that has become so complicated that we can’t even identify who can tell us where to go between Providers, Provider Networks, and Payors.

Providers are like Dispatch

One thing that I can tell you from every conversation that I’ve had with these providers, though, is that more often than not, the reason for the problems isn’t on the provider. Similar to the short at the end of the clip where the child asks why they don’t just try harder, providers are usually doing the best they can with limited resources, technology, and personal bandwidth.

Each step that Health Information Technology takes to get closer to a solution that will help patients and consumers, often adds more constraint to the providers that have to use the systems. Sometimes that’s because of the other players in the system and sometimes they are just not well-designed systems.

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