Q&A: The Opportunity for Patient Engagement in the Community (2 of 2)

April 24, 2014
Jan Oldenburg is a leading authority on patient engagement, having edited a book for HIMSS on the subject and worked on developing digital engagement systems for Kaiser and Aetna. She talks about patient engagement in the community in part two of this two-part Q&A.

Patient engagement and health information technology go hand-in-hand.

Or at least they should. The National Committee for Quality Assurance (NCQA) recently released a report outlining how policymakers could leverage health information technology to achieve the Triple Aim. Many, like those interviewed by the NCQA, say that there is a great deal of untapped potential in this realm.

One person that’s likely to agree is Jan Oldenburg. Oldenburg, principal of her own firm, Oldenburg Consulting, edited the 2013 book distributed by the Healthcare Information and Management Systems Society (HIMSS) called, Engage! Transforming Healthcare through Digital Patient Engagement. Before that, Oldenburg worked for a number of organizations including Aetna and Kaiser Permanente developing products that would engage patients through digital platforms.

Healthcare Informatics Senior Editor Gabriel Perna recently had a conversation with Oldenburg on patient engagement as it relates community health. In part one of that interview, she talked about the overall emergence of patient engagement, how it can be used in community health, and the challenges of achieving those kinds of initiatives. For part two, Oldenburg discusses the role technology plays in engaging consumers in community health, focusing on mobile health (mHealth) devices in particular.

Below are excerpts from that interview.

What kinds of technologies can be used to engage patients in a community health environment?

Think about things like community reading programs, where everybody is reading the same books so they can have a discussion about the topics. In terms of how these programs have gotten involved in thinking about problems from a community standpoint, and getting people across the community engaged, we can learn  from those kinds of programs. This is a place where you can get small businesses involved, where you can get the community involved, it’s part of a lot of the value a community might have, how community wants to be depicted, how community wants to be valued, and how you can solve some real community problems. There is a lot of potential in recasting the job of community leadership to incorporate health as a community problem.

Specifically, what about tracking devices, what value do they have in engaging patients?

I am not sure. I come with a bias: I have always been a tracker. I’m the kind of person that finds it motivating and useful. I am a firm believer that tracking works best when it’s a byproduct of living life, when you don’t have to do something separate for tracking to occur. That [method of tracking vitals] is far more likely to be sustainable for users than if they’ve got to not only separately track [vitals] but record them in their computer and go through a whole additional process to make sense of them.

I think we’ve got to look at ways it becomes a much easier thing to do, a byproduct, something I don’t have to take a separate specific action in my life. Then we start to see the real benefits coming though.  That’s when we are going to get real traction--when we can make not just the data, but the information that the data tells us--a byproduct of daily living.  Recently a 58-year-old diabetic talked to me.  He was a master at using tracking to manage his condition, and he had a blood glucose monitor that made it easy to upload his data.  However, he noted, his insurer wouldn’t pay for the glucose testing strips that monitor used because they cost a few cents more.  When we consider tactics to make engagement easier, we need to incorporate rewards for those who track, not extra costs.

When I was at Kaiser the most used digital function was looking at your lab results. The most active pathway on the site was the path between reading the lab results and the explanation of what that meant.  That tells you there is something magical about that teachable moment. This is about me, what does it mean? But we have to figure out how to convert that teachable moment to action. It’s not just about reading, although that is an important step, but the next layer is what can I do? Is there a program I can do? Maybe it’s a class I could take, whether it’s on high blood pressure, managing weight, or something else. What actions can I take right there when I’m trying to make a difference for my health? Part of the systems problem we have is thinking about how we can engineer teachable moments that help people convert into action. It’s doable, but it’s not “falling off the log” easy.

Part of the systems problem we have is the need to think about how we can engineer teachable moments that help people convert into action.

What about mobile technology, certainly it plays a role in reaching out, specifically to underserved patients?

Mobile has huge promise because it’s ubiquitous and it’s a habit. It is absolutely something we can capitalize on. What we still have to figure out is how to make it a sustained experience. How to keep people engaged over time. I don’t think mobile devices will fix the whole problem, but in the context of community and other reinforcements, it will have a huge impact.

Let’s think about adding to mobile, other ways community can help reinforce better behavior. What are the other ways we can use mobile in conjunction with family and community support to keep people moving in the right direction? How can we use them as part of our orchestration of teachable moments? We’ve got that person, device, and moment; let’s combine it into a full system.

Research shows that text messages have been shown to help people get refills on time, help them take medications, and it’s been useful to get people to show up to appointments. It’s a simple technology that’s been shown to have significant impact on the right kinds of engagement around health. We do have to be sensitive to use them in ways that don’t create alert fatigue, which is what we’re seeing with physicians and EMRs. But it’s one of the most promising things on the horizon.

Mobile has huge promise because it’s ubiquitous and it’s a habit.

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