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August 20, 2017 Guest articles No Comments

The Promise (and Pitfalls) of Greater Consumer Expectations
By Anne Weiler

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Consumer expectations are finally hitting healthcare. We’ve long become accustomed to having anything we want delivered to our homes at any time, in minutes. This level of 24/7 convenience is driving an expectation that all service delivery should be that good. And healthcare is no exception in the eyes of increasingly cost-conscious consumers. After all, rising deductibles, premiums, and copays are causing people to examine where they spend their healthcare dollars, leading them to evaluate care based on outcomes, convenience, and overall experience. We first saw indications of this on highway billboards advertising emergency room wait-times. It’s now spilling over into other areas of healthcare, like concierge medicine and direct primary care, both business models that give patients almost unlimited access to their care team. Healthcare technology is certainly aiding and abetting these expectations, with telemedicine perhaps offering the most promise in meeting expectations around convenience and up-front costs.

Virtual assistants and interactive mobile treatment plans also show huge promise. But for these burgeoning healthcare concepts to take off, their popularity with patients and physicians alike hinges on some basic tenets. First, patients need to feel supported and confident. Once they do, they can start to self-manage outside the clinic. The old way of delivering care instruction – be it verbally or on paper – is seriously lacking in providing this support and confidence. Patients forget between 40 and 80 percent of what is said to them in a face-to-face visit, while paper instructions are often lost. Virtual assistants and apps are always available, and can deliver tailored information when and how patients need it. They can alert both the patient and care team when something requires greater attention. This ability to provide actionable, personalized, and real-time care shows great promise in improving patient experience and outcomes.

However, the challenge in creating this always-connected world of healthcare – whether that’s through consumer health apps, wearables, or even those apps prescribed by healthcare organizations – is that they generate more data than physicians know what to do with. Though this data can provide extremely valuable insights to manage populations, there’s often no place for it in the medical record, which is not designed for patient-generated data.

Data without context is meaningless, which is why physicians initially balked about having device data in the EHR. While understanding how much a healthy person is active is interesting, you don’t need Fitbit data for that when there are other clinical indicators like BMI and resting heart rate. Understanding how much someone recovering from knee surgery is walking is interesting, but only if you understand other things about that person’s situation and care, such as how much they walked before surgery, pain levels, and side effects.

However, if you ignore the patient experience outside the clinic, decisions are being made with only some of the data. In Kleiner-Perkin’s State of the Internet Report, Mary Meeker estimates that the EHR collects a mere 26 data points per year on each patient. That’s not enough to make decisions about a single patient, let alone expect that AI will auto-magically find insights from aggregated information.

How do you marry this patient-generated data with current healthcare IT systems? The value of patient engagement and self-management through virtual assistants and applications is real. Current systems, however, aren’t designed for this data. To the patient, every single one of those Fitbit steps or recorded symptoms is interesting. To the physician, it’s noise. To make sense of these two worlds, we need a few things. First, we need to leverage machine-learning and big data tools to make sense of the terabytes being collected directly from patients. Next, we need to identify indicators of adverse events or negative trends. Then, we need to be able to react to and act on those indicators for patients, either with alerts and instructions delivered by an app, or by direct outreach from a clinician.

Finally, this data needs to make its way back into the patient’s medical record – but not all of it. Scores from patient-reported outcome surveys, important recorded symptoms, and trend data should be attached to the EHR. The rest should be available directly to the patient, and to clinicians and analysts to work with in BI and other tools. To make this new world a reality, patient engagement systems must be interoperable and open, and sit side-by-side with the EHR. There’s a whole world of data and learning out there to improve patient experiences and outcomes, but to capitalize on it, we need openness and interoperability.

Consumer expectations are indeed hitting healthcare – hard. Patients are no longer shy about telling physicians and payers what they want and how much they’re willing to pay for it. While these expectations can seem overwhelming to those insiders who have long become accustomed to healthcare’s glacial pace, we shouldn’t be discouraged. These greater expectations can indeed be met, provided we take the time to develop and offer physicians and patients tools that meet their needs and fit their workflows.

Anne Weiler is co-founder and CEO of Wellpepper in Seattle.


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