Summary: How can healthcare leverage mHealth and the parallel movement towards consumerism to better patient engagement?
In 2012, my passion for healthcare deepened when my wife, Janet, was diagnosed with Stage 1 breast cancer. She received wonderful care from her healthcare providers, but Janet and I often felt that we were left to make critical decisions—such as treatment types and the number of chemotherapy doses—all on our own.
Janet and I were ready to put our lives on hold for this healthcare journey, but we found that the process was tedious, confusing, and frustrating. We needed more information and more collaboration from Janet’s providers. We wanted engaging to be easy.
These and other experiences have confirmed to me that patient engagement and the entire healthcare industry must be improved. Knowing that, I’m increasingly grateful that mHealth has come into the picture.
What exactly is mHealth? I like the following explanation: As defined at the [mHealth Summit], mHealth is ‘the delivery of healthcare services via mobile communication devices.’ Much more than just a subset of eHealth, mHealth offers an unparalleled opportunity to reach individuals and affect change” (Torgan 2009).
mHealth has the potential to make healthcare what most people wish it could be: simple, clear, and effective. With so many mHealth tools entering the market, providers wonder whether mHealth will revolutionise patient engagement.
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The concept of patient engagement has been around for quite some time, but with consumer-grade technologies have come enhanced expectations. Patients and providers have grown accustomed to interacting with data, businesses, and each other in new ways. All parties must leverage mHealth if they are to create strong partnerships.
With that being said, mHealth is no silver bullet. It introduces unique challenges and may frustrate healthcare IT leaders who don’t understand how to leverage it. Healthcare providers make it clear: The key to the successful use of mHealth technology is to incorporate it as one piece of a foundationally sound patient engagement strategy.
What makes an effective patient engagement strategy? What do early mHealth trends tell us? How can adopters of mHealth technology avoid potholes and find benefits? The following are some answers from hundreds of providers throughout the U.S.
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The Pillars of Patient Engagement
In October 2018, a group of healthcare IT leaders gathered to establish a framework for patient engagement. That framework is shown below and available in the Patient Engagement Keystone Summit Whitepaper (Cherrington and Buckley 2018).
While best practices will be discussed later on, this chart gives an outline of what falls under the patient engagement umbrella and what should be included in a patient engagement strategy.
Only a limited imagination and cursory look at the chart are needed to see that each task listed could be accomplished, at least in part, with the help of a mobile device. But what is actually being done with mHealth today?
Current Trends in mHealth
Tools Being Created
Many vendors are simplifying healthcare by cutting out the middleman and going straight to patients’ devices. Some examples include real-time updates on appointments and wait times, automated referral outreach, remote check-in processes, real-time status boards, and cloud-based platforms that integrate with third-party data sources.
Tools Being Used and Considered
In the research for a recent report, KLAS asked providers which patient engagement HIT tools they were currently using and considering using in the future. The tools were grouped based on the patient engagement pillar from which they originated (Cherrington and Buckley 2019b).
It was interesting to note that the tools that fell under all three aspects of the Partnership pillar (Knowing the Patient, Patient Empowerment, and Patient Experience) are being highly considered by provider organisations. Encouraging tools that patients are ready to use is critical to helping patients become healthier. For many patients, those tools are their mobile devices.
Apple Health Records
Healthcare stakeholders moved to the edge of their seats when Apple announced their Apple Health Records feature in January 2018. Four months later, KLAS published a report entitled, “Apple Health Records 2018: Early Participants Weigh In” (Cherrington and Buckley 2019a). For this report, KLAS interviewed executives from all 12 of the early adopter health systems that had partnered with Apple by that point in time.
Many are convinced that Apple truly created this tool for patients. Despite the highly competitive nature of the IT market, Apple doesn’t charge provider partners any money for their Apple Health Record partnerships. Today, hundreds of institutions support health records on the iPhone (Applecom 2019). The following excerpt from KLAS’ Apple Health Records report gives a good overview of providers’ feelings about Apple’s offering:
“Early participants say that Apple’s move is not just a marketing ploy and that it has both short-term benefits and long-term potential to impact how provider organisations interact with patients and how patients manage their health. Immediately, Health Records is expected to help solve the intractable challenge of interoperability by allowing iPhone users to store their health records on a device that is already omnipresent in their lives. This convenience is expected to increase patient satisfaction and also engender in patients an expanding sense of self-ownership and self-involvement in their own care. In the long term, making health records available on the iPhone promises to speed innovation by breaking down the door between healthcare and consumer fields” (Cherrington and Buckely 2019a).
Despite (and sometimes because of) the increasing technology in the world of mHealth, provider organisations face many significant challenges. The following are some worries commonly expressed by healthcare providers.
Agreeing on a Strategy
New tools mean new questions from providers: How can we best engage our patients in their care? Which patients should we focus on? What about the family and insurance company? Is it best to jump right in with mHealth or wait and watch what other organisations do with it? The answers will be critical but possibly difficult to determine.
Too Many Options
As one CIO friend recently told me, “There are too many shiny, new objects.” Many healthcare IT leaders are overwhelmed by the number and variety of tools available. That’s one reason that agreeing on a strategy is so important. Provider organisations should set patient engagement and mHealth goals and then choose the technologies that will help them achieve those goals, not the other way around.
Education and Adoption
Some patients are confused or intimidated by the option to access their records via mobile devices. This worries healthcare IT leaders. In fact, according to the attendees of the Patient Engagement Summit, patients’ lack of education is the second most significant obstacle to activating individuals in their own care. First on the list was a lack of convenience for patients (Cherrington and Buckley 2019a).
When asked what healthcare hurdle would be most difficult for their organisation, 45% of the providers surveyed for the Apple Health Records 2018 report said educating and onboarding patients would be their top challenge. Second on the list was educating and onboarding providers (Cherrington and Buckley 2019a). Clinicians might not immediately grasp what mobile tools can do and which use cases could be helpful.
Data Ownership and Security
Most Apple Health Records partners and users are confident that the patient data is safe because Apple never actually holds the data (Cherrington and Buckley, 2019a,). However, providers don’t necessarily have the same peace of mind about other mHealth tools. In KLAS’ 2018 report about the security of medical devices (several of which fall under the umbrella of mHealth), about 20% of the surveyed providers said that “the inherent risks of medical devices—several of which are outside of their control—will prevent them from ever feeling confident” about the security of those devices (VanDeGraaff and Czech 2018).
In addition, the ownership of patient data is still being disputed. One CMO put it this way: “When we look at national surveys, physicians on the whole are not interested in people having full transparency into their medical records even though they legally belong to the patients. The law says that I can get a complete copy of my medical record. However, we make it difficult for patients to do that” (Cherrington and Buckley 2019a). Provider organisations with this mindset won’t succeed with mHealth; a primary need driving effective patient engagement is to help patients interact easily with their own data.
Success Principles Applicable to Both Patient Engagement and mHealth
The best way to navigate the aforementioned potholes of mHealth is to create a robust patient engagement strategy. Such a strategy must be based on an understanding that mHealth is simply a means to improved engagement and not the end goal itself. Participants at the Patient Engagement Summit created the following list of principles that create the foundation of a successful patient engagement strategy (Cherrington and Buckley 2018). The principles also apply to the use of mHealth and cover many of the provider-reported best practices KLAS has heard in our research.
Too often, providers force tools on the patient to fit the needs of the healthcare organisation. Health systems should gather patients’ feedback about which mHealth tools would be most meaningful to them.
A provider organisation should plan for different patient personas. They should offer patients the option to use mHealth tools according to their needs and try to choose tools that patients can easily personalise.
Ideally, a provider organisation’s mHealth tools will integrate with the EMR or other relevant systems. If nothing else, the tools should help patients feel connected to their caregivers and healthcare organisation.
Healthcare IT leaders should choose mHealth tools that are easy to use and explain to patients. Consumerism is here to stay, and now that patients have experienced the simplicity of platforms like Amazon’s, they want healthcare to catch up.
In the world of mHealth, only real-time data is timely data. Healthcare IT leaders should implement tools that help patients and providers upload and access real-time data.
Healthcare organisations should make sure their mHealth strategy focuses on assisting patients in their everyday lives, as well as at multiple stages of care. Patients need guidance before, during, and after episodes of care. Solutions that can promote a holistic relationship between the provider and patient will be successful.
Healthcare IT leaders should track not only their utilisation of mHealth tools, but more importantly, whether they are spurring changes in patient behaviour and ultimately achieving the needed outcomes. This will show which tools are effective and which tools should not be emphasised.
Leveraging mHealth to Improve Patient Experience
Some stakeholders argue that mHealth is pushing “consumerism in healthcare” and therefore removing compassion from the industry. I disagree. I think the vast majority of physicians really care about patients’ health; they just aren’t yet as good at engaging with patients about healthcare as they’d like to be. mHealth can only help with that.
No provider organisation can do everything for all of their patients. However, by graduating from basic patient engagement to a well-thought out strategy that capitalises on mHealth, health systems can help make a patient’s healthcare experience almost as easy as ordering an Uber ride.
- We can benefit from mHealth technology by incorporating it into a well-structured patient engagement strategy
- Patients want simple and usable technology in healthcare
- mHealth tools are being introduced, by companies like Apple, to increase patient involvement and satisfaction
- mHealth providers face challenges such as: choosing tools; education and adoption; and data ownership
- Effective patient engagement and mHealth strategies focus on giving a personalised healthcare experience