Patient engagement is about giving patients communication channels they want as well as the ones they need, according to Chanin Wendling, Director of eHealth at Geisinger Health System. And from her experience, patients are still more interested in useful web-based patient portals than they are in apps.
"We did a study this past summer on women's health where we were trying to figure out if we could do a mobile app in that space, around lots of issues in women's health and taking care of the family members," she said in a presentation at HIMSS in Orlando, Florida. "And the feedback we got was 'No, I'd really just like you to use the stuff in the portal, and text messaging would be great, but we're not so interested in the mobile app space.' We do have a mobile [version of the portal] for the iPhone and Android, but the adoption has been low."
Wendling said the most important thing about engaging patients was giving them a voice and a chance to interact with their own care.
"Patient engagement is one of those catchphrases everyone's talking about -- patient engagement this, patient engagement that. In reality, though I think we've done a lot of cool stuff in this space, but I think we've barely scratched the surface. ... We tend to think in a paternalistic way: this is what the patient needs, versus thinking 'What will work best for the patient?' and 'How will the patient relate to whatever we're prescribing?'. And that's extremely important because at the end of the day, if you can't get the patient to help, if they don't take their meds, if they don't lose the weight, if they don't do their exercises, there's nothing you as a clinician can do. You need the patient to help you."
She shared a few examples of successes Geisinger has had with this approach. Using the portal and tablet applications in the waiting room, Geisinger was able to screen all adult primary care patients for depression, something that Wendling said would have been impossible without digital engagement tools. In another example, they used the patient portal to follow-up with patients and make sure the medication information on file for them was accurate.
"We found out that 50 percent of our patients aren't taking a medication we think they are taking. Twenty-one percent are taking a med differently than we think they are, and 25 percent are taking a medication we didn't even know about. This is a way, again, that doing something interactive with the patient can help you get information you're struggling to get and help you get a better clinical outcome."
Geisinger has also found success with text messages. They found that using motivational text messaging for patients trying to lose weight reduced BMI about half a pound on average, and they have 73,000 patients signed up for text message appointment reminders.
Wendling also shared some stories of mobile initiatives tried and failed by her department in the last year. One project, a game designed to increase engagement in under-40 men, failed because of internal logistics -- making a game was more complicated than she anticipated and she missed her pilot deadline. Another project was a mobile app meant to supplement cardiac rehab. Though promising, this one failed because Wendling couldn't get a physician to sponsor it.
"For them, they couldn't figure out how to introduce this change," she said. "They had a very set program, they were used to the program, and it was very hard for them to fathom how to set this up with their patients. And they put up a lot of resistance and barriers. I tried to get an executive sponsor to help and I couldn't get one, so ultimately I pulled the plug. ... I don't treat patients. I need the people who treat patients to work with me."
Tension between clinicians and the innovation department is not uncommon, according to Wendling. She also said she meets resistance when she tries to make additional patient data viewable in the patient portal.
"If I want to make my clinical teams crazy, I try to add additional data into the portal," she said. "I usually get 'Chanin, the patient won't understand that' or 'The patient's just going to call us, it's going to create more work.' That's all bunk. ... This past May, we made a decision to display Open Notes, the provider's process notes. ... We have about 1400 providers displaying their notes to patients now. In our March 10th release I'll have over 85 percent of the outpatient providers on board. I have not gotten a single complaint. Not a single comment from a patient or provider that says 'You've ruined my life'."
Wendling shared a lot of general advice for innovators. She said to be selective in dealing with vendors, and to be aware of your own health system's size, strengths, and limitations. She extolled the virtues of having a dedicated innovation staff, saying she doubted the efficacy of putting innovation responsibilities on the shoulders of people with full time operations jobs. Finally, she re-iterated that not every project will succeed.
"When you innovate, you mess up sometimes," she said. "You've just got to learn, discard what didn't work, move on."
