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Patient Engagement, Devices, and Health IT

November 5, 2011
by Mark Hagland
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A recent report offers insights on paths forward for healthcare IT leaders

This summer, the New York-based Deloitte released an issue brief entitled “The Public View of Health Care Reform,” which this spring surveyed 4,000 healthcare consumers nationwide on important issues in healthcare, using a web-based questionnaire. Among other broad findings, the survey found that U.S. consumers perceive the American healthcare system as being complex, wasteful, and lacking in value for the costs incurred; consumers have a mixed view of the healthcare reform legislation passed in March 2010; and their views of healthcare reform are tempered by concerns about the privacy and security of personal health information.

More specifically within the area of mobile health (mHealth) and health information technology, Deloitte researchers found significant interest on the part of consumers in potential engagement through mobile devices and health IT. Recently, Harry Greenspun, M.D., the Washington, D.C.-based senior advisor, health care transformation and technology, in the Washington, D.C.-based Deloitte Center for Health Solutions, spoke with HCI Editor-in-Chief Mark Hagland regarding some of the findings of the survey on which the issue brief was based, and their implications for the leaders of patient care organizations. Below are excerpts from that interview.

What were the broad findings regarding healthcare consumers and their perceptions of the healthcare system?

What we found was that consumers did not have a really clear sense of how their healthcare system worked, but they had strong opinions; there was widespread dissatisfaction, and that was true internationally as well [the U.S. survey was one component of an international survey of healthcare consumers]. And one of the things that we found was that everyone is using their healthcare systems, and most people both in the U.S. and internationally believe that they’re in good health; but in fact, many have chronic diseases, and most are not exercising.

But there is a hunger for information and engagement from consumers; because consumers really evaluate the personal experiences they’ve had with the healthcare system, primarily around their service experience—what it was like to be treated. And along those lines, consumers were very interested in and gave the highest marks for technologies that helped them manage their own health.

And in the U.S., 61 percent of healthcare consumers expressed interest in having a medical device that would help them check their health and interact with their doctors. And 66 percent said that they would like to use a smart phone to monitor their own conditions. And it’s not surprising, because if you think of everything consumers access on their mobile devices—financial information, retail, travel, and so on—it’s not surprising that they’d want to access medical information as well.

There’s significant concern, though, over privacy and security. We asked them how concerned they were with data being transferred electronically. In the U.S., 38 percent of people said they were highly concerned.

Harry Greenspun, M.D.

What do you think the implications are of those statistics for healthcare IT leaders?

There are important implications around how IT can help create engagement with consumer audiences. But it’s important to remember that healthcare consumers have strong opinions, even without a lot of knowledge. Still, they’re seeking engagement and technology; they really want technological innovation. Now, when you look at whom they trust, interestingly, from our survey results, people’s trust of Internet sites is actually quite low; it’s only about 15 percent, versus 47 percent trust in academic medical centers and teaching hospitals. At the bottom are insurance companies, employers, pharma, and biotech and device manufacturers—they’re down at about 10 percent, and Internet sites are down at around 15 percent. So providers have the ability to utilize their technologies to provide information, stress service, and improve satisfaction.

As a doctor, I can’t ignore the issue of patient care quality. At the same time, I firmly believe that by stressing service and engagement, you actually enable all sorts of improvements in patients’ care. They’re more engaged, and so you’re more attuned; their providers are more likely to catch things early on and prevent repeat interventions, and overall, promote better health.

So that engagement through mobile technology can really catch issues when they come up, right, per readmissions reduction, for example?

Right, and it’s no different from your bank informing you that your bank balance is in trouble. And if you have CHF [congestive heart failure], and you gain a few pounds, and we can monitor that and communicate with you—now, there’s real money at stake in this, to make this work.

What should CIOs and CMIOs be thinking about as they strategize forward in this area?

Well, we do our own surveys of CIOs and others, and there’s a lot of variability out there in terms of how people are prioritizing around healthcare reform, meaningful use, ICD-10, and other issues. And I think a lot of them are potentially ignoring some of these rising consumer demands. For example, looking at the number of seniors who would like to use a personal health record—the desire for these is actually quite high. For example, interest among seniors in personal health records (PHRs)—61 percent of seniors are interested in transferring information back and forth with their physicians—that’s higher than people might expect.

Meanwhile, when it comes to self-monitoring through a smart phone—72 percent of Gen Yers, 62 percent of Gen Xers, 42 percent of Baby Boomers, and 26 percent of seniors, are interested in doing that. But looking at the rapid growth anticipated in demand among Boomers for care, that will be growing. And 66 percent overall would consider switching physicians over the issue of access to electronic records and information; and that number has stayed consistent now for a few years.

And what’s driving this is that more and more people are using technology for other types of communications in their lives. It’s in this context that people start asking, if I can track a package across the country or make a restaurant reservation online, why do I have to wait two weeks to hear the results of my lab test? And I’m not saying that people are standing outside holding pitchforks and torches, but the demand is going to rise.

The next area really is around analytics, because providers are going to have to profile populations, analyze physician performance, and figure out how best to provide healthcare services. And it’s going to be a very data-driven healthcare system. And how do you know as a consumer that you’re receiving high-quality care? That will evolve forward quickly as well.

And I think the final area has to do with the fact that the out-of-pocket costs for consumers is going to continue to rise. And right now, unfortunately, most consumers are simply skipping care. But over time, they’ll see more affordable options. And if they can find excellent service at a lower price, they’re likely to seek alternatives, particularly as their own costs continue to go up. And that opens up the opportunity for all sorts of services, such as retail clinics and specialty services, where they’ll carve out a particular piece of the healthcare delivery pie, and will do it very well. And those entities will provide a high level of quality of care and a high level of quality of service, and will provide services at lower cost and at high quality.

So traditional hospital and physician group organization leaders really need to look at that issue?

Yes, and they’ll have to look at the IT infrastructure they have to provide quality services in an era when individual healthcare consumers’ costs are going up.

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