Making Consumer eHealth Better

Part 2: A Better Approach

This second blog of a two-part series investigates the positives of consumer e-Health solutions. I will look at what makes for a successful solution, and propose some ideas to guide policy development around consumer eHealth.

In my last blog post, I examined the current state of consumer eHealth solutions in Canada and concluded that many popular system types deployed by healthcare organizations:

  • Fail to satisfy all three dimensions of the IHI Triple Aim of Care [1];
  • Raise concerns among some clinicians;
  • May increase the privacy risks these organizations assume; and
  • Present some significant access equity issues.

So, what makes for a successful consumer eHealth solution? In a word, focus:

  • Focus on a specific patient population; a population known to derive measurable benefits from the system
  • Focus on the available evidence and solutions proven to be effective
  • Focus on enabling patients and the public to find and access accurate information
  • Focus on the Triple Aim of Care as a lens for assessing investments in consumer eHealth solutions

First, let’s take another look at the popular types of consumer eHealth solutions I discussed in my last post. It turns out that the evidence of success is much stronger when these systems are targeted at specific patient populations; for example, when they are used to support patients with chronic health conditions like COPD or diabetes. Remote patient monitoring solutions have been shown to improve a patient’s quality of life, decrease hospitalizations and reduce the overall cost of delivering care [2]. Another American paper documents the effectiveness of personal health records in improving outcomes for patients with chronic conditions including diabetes, hypertension and congestive heart failure [3]. Clearly, when deployed in a focused, targeted way, these systems can satisfy all three dimensions of the Triple Aim of Care.

Even when directed at specific patient groups, many popular consumer eHealth systems are expensive, complex, and involve storing and transmitting personal health information – all factors that raise risk. Fortunately, simpler, less expensive and less risky solutions are available. Text messaging-based systems, such as Text4baby [4] in the United States or British Columbia’s WelTel [5] program, have proven benefits ranging from improved medication adherence to earlier detection of medication induced side effects. Benefit evaluation also shows these systems are effective in reaching patients regardless of their socioeconomic status and improving access to care for marginalized groups. Solutions do not need to be technically complex in order to be effective; text messaging systems are relatively simple, inexpensive and come with few privacy concerns (when implemented carefully) – a winning combination in terms of the Triple Aim of Care.

The media playback function of modern consumer electronic devices offers another low-risk and inexpensive way to educate and engage patients. A World Health Organization report on mHealth [6] noted the potential to use audio and/or video content functions on mobile devices for patient education. Currently, the Miami Children’s Hospital is exploring using videos optimized for mobile devices to provide

customized discharge instructions [7] to help support patients’ understanding of and compliance with their doctor’s directions. Healthcare organizations could also release podcasts addressing health issues that arise in the media, or provide patients with links to mobile educational videos or audio recordings, in addition to brochures or pamphlets. 

Creating audio and video content is easy and inexpensive; better still, it raises no privacy concerns. It is accessible to patients with literacy challenges; those who might have difficulty with written educational materials or discharge instructions. By helping patients to better understand health information or clinicians’ instructions (hopefully both improving the patients’ experience and their health outcomes) at minimal cost, consumer-facing audio and video content looks promising in terms of the Triple Aim of Care.

By providing easier access to health information, healthcare organizations can support their patients in managing their own health. A list of mobile apps vetted by a clinician and technical expert (to ensure they provide accurate information and take steps to protect personal health information [PHI]) could be valuable to many people [8][9], as could a curated collection of links to reputable sources of health information. There is a growing trend toward seeking health information online or using mobile devices [10], and healthcare organizations should help their patients (and the general public) locate trustworthy apps and sources of information.

Some organizations may even want to consider creating publicly accessible, standards-compliant web service application programming interfaces (APIs) to expose health data sets (avoiding any confidential or sensitive information), and encouraging developers to create mobile and Web applications to take advantage of these APIs by holding contests and hackathons. By leveraging popular, open frameworks like SMART on FHIR [11], healthcare organizations can create great consumer-facing apps at relatively minimal cost using developer-friendly technologies.

Consumer eHealth, designed and deployed correctly, can be a powerful tool for improving outcomes, engaging patients and reducing the cost of delivering quality healthcare. Progressive healthcare organizations should continue to explore the possibilities of consumer eHealth solutions, but should always keep in mind the Triple Aim of Care, and be sure to look carefully at the available research and evidence before deciding where to invest.

 

Chris Nickerson is a Technical Analyst with Gevity’s Architecture & Standards Branch, with over five years’ experience in health informatics. His areas of expertise include healthcare interoperability, risk assessment and process design. Chris is interested in emerging interoperability standards and their applications in the consumer and mobile spaces, as well as the intersection of health policy and technology.

 

References

  1. Institute for Healthcare Improvement, “IHI Triple Aim Initiative”. http://www.ihi.org/engage/initiatives/tripleaim/Pages/default.aspx; accessed June 27, 2016
  2. Canada Health Infoway & EY, “Connecting Patients with Providers: A Pan-Canadian Study on Remote Patient Monitoring Executive Summary”. https://www.infoway-inforoute.ca/en/component/edocman/1890-connecting-patients-with-providers-a-pan-canadian-study-on-remote-patient-monitoring-executive-summary/view-document; accessed June 27, 2016
  3. Ozbolt, J; Sands, D; et al, “Summary Report of Consumer eHealth Unintended Consequences Work Group Activities: Building Better Consumer eHealth”. https://www.healthit.gov/sites/default/files/final_report_building_better_consumer_ehealth.pdf; accessed June 27, 2016
  4. Hoff; Nunez-Alvarez; et al, “Maternal & Newborn Health Text4baby San Diego – Evaluation Overview: October 2011 – October 2012”. http://www.csusm.edu/nlrc/documents/report_archives/Text4Baby_SanDiego_Evaluation_Overview.pdf; accessed June 27, 2016
  5. Mahal; van der Kop; et al, “Mobile health: an update on BC projects that use WelTel to enhance patient care”. http://www.bcmj.org/bc-centre-disease-control/mobile-health-update-bc-projects-use-weltel-enhance-patient-care; accessed June 27, 2016
  6. Mechael, P & Sloninsky, D, “Towards the Development of an mHealth Strategy: A Literature Review”. http://www.who.int/goe/mobile_health/mHealthReview_Aug09.pdf; accessed June 27, 2016
  7. Dvorak, K, “How Miami Children’s Hospital embraces mHealth to engage patients, parents”. http://www.fiercehealthcare.com/mobile/how-miami-children-s-hospital-embraces-mhealth-to-engage-patients-parents; accessed June 27, 2016
  8. Canada Health Infoway, “Mobile Computing in Clinical Settings: Using mobile devices to obtain seamless extension of the health enterprise’s digital ecosystem”. https://www.coachorg.com/en/communities/resources/CTF/mhealth_white_paper_full_report_final_en_2013-12-05.pdf; accessed June 27, 2016
  9. PWC, “Making care mobile: A roadmap to the virtualization of care”. https://www.pwc.com/ca/en/healthcare/publications/pwc-virtual-health-making-care-mobile-canada-2013-11-en.pdf; accessed June 27, 2016
  10. HIMSS, “Consumer Engagement Current State”. http://www.himss.org/consumer-engagement-current-state?navItemNumber=30070; accessed June 27, 2016
  11. SMART Health IT, “SMART: Tech Stack for Health Apps”. http://docs.smarthealthit.org/; accessed June 27, 2016
  12. Government of Canada, “Learning – Adult Literacy”. http://well-being.esdc.gc.ca/misme-iowb/.3ndic.1t.4r@-eng.jsp?iid=31; accessed June 27, 2016
  13. Conference Board of Canada, “Adults With Inadequate Literacy Skills”. http://www.conferenceboard.ca/hcp/provincial/education/adlt-lowlit.aspx; accessed June 27, 2016