understanding patient engagement

Understanding Patient Engagement

Elizabeth Bacon HIMSS Usability Task Force

Jan 21, 2014

Understanding Patient Engagement HIMSS Task Force - Jan 2014Elizabeth Bacon

Agenda

• Introduction

• Quest for patient engagement

• Strategy for digital health engagement

• Case study: Find Wellness

• Last note, Q&A


IntroductionLiz Bacon 1999-2002 Cooper 2002-2007 St. Jude Medical 2007-2010 IxDA Director/Vice-President

2007-now Devise 2012 Providence Health & Services 2012-now Find Wellness


UX Sundial model

UX specialties operate on a spectrum of “soft” skills:

• Understanding • Definition • Communication

“UX” is an umbrella term for a range of disciplines


Agenda

• Introduction • Quest for patient engagement • Strategy for digital health engagement

• Case study: Find Wellness

• Last note


Healthcare is broken (sorry!)

“Healthcare is broken. ... We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable. Despite the best efforts of the workforce, we built it wrong. It isn't built for modern times." *

* Dr. Donald Berwick (who oversaw Medicare & Medicaid) as quoted by Richard Anderson at http://riander.blogspot.com/


“Behavior change”• We can’t “motivate behavior change”

• Paternalistic view that removes individual agency

• Instead, we facilitate behavior change

** from Dr BJ Fogg, Director of Persuasive Tech Lab at Stanford University, as presented at Healthcare Experience Design conference on March 27, 2012

**

Where we usually reside

“Teachable moments”


Healthcare’s new goal• Quest for patient engagement • One way to assess engagement is the “Patient

Activation Measure” (PAM) model

* diagram from Insignia Health Solutions http://www.insigniahealth.com/solutions/patient-activation-measure

**

http://www.insigniahealth.com/solutions/patient-activation-measure


Improving behavior

• Results suggest that improved behaviors follow on increased activation*

* from Health Services Research publications by Judith Hibbard, et al. such as http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955271/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955271/


To increase activation

We need to: • build patients’ confidence • build patients’ understanding • grow their skills • facilitate healthy behaviors • address inevitable back-sliding

Is that all?


Engage personally

• We have to understand individuals, first and foremost

• Healthcare system needs to treat the whole person, across all our life contexts


Connected world

• We have to reach and activate people wherever they are, whenever they act

• Digital channels are key cost-effective, modern way to extend the reach of care delivery system


Problem: it’s all transactionsEach encounter for a patient with the healthcare system is a distinct, separate transaction. !

• It’s rare for any transaction to be related to earlier transactions.

• It’s not yet happening that today’s transactions are related to FUTURE transactions…


From transactions to engagement

21st century business models must evolve from systems of records and transactions to systems of engagement

*http://www.dachisgroup.com/2011/06/moving-beyond-systems-of-record-to-systems-of-

engagement/

*


How it looks today

• Kind of ecommerce model — but applied to the vital business of health


Must consider context

Arguably healthcare’s greatest IT problem is the plethora of disconnected, 3rd party systems that ostensibly support care delivery

!

• Must always consider the bigger picture: the patient’s perspective


Alternative care models We do have to explore and embrace alternatives • Accountable Care Services: new business

model being explored by delivery systems and encouraged by government regulation

• Moving from fee-for-(face-to-face)-service to fee-for-quality-outcomes demands greater efficiency at scale

!

• Question remains, how will quality be measured?


What can we do in our work?

If HIT systems of record can’t even manage related transactions well, or be proactive, then how can we expect to build patient engagement and facilitate behavior change?

!

Let’s keep in mind a few things, focusing on positively-oriented, real human traits…


People are emotionalDecision making is compromised when negative emotions hold sway. !

!

* Research as discussed in Modern Health Care article published 2013-12-07

!

“Emotion may interfere with patients' understanding of the risks and tradeoffs of treatment options and with their ability to make good decisions. … Group Health Cooperative in Washington state saw a 26% and 38% drop in hip and knee surgery rates, respectively, after the HMO adopted video and written patient decision aids.”

http://www.modernhealthcare.com/article/20131207/MAGAZINE/312079983/1135?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGFWdjBHRWxYOU9qTENvK25lK0g4UUxyeW1lMDVubEF4SXN6ekM=


Not all are health literate

“Health literacy and health numeracy are something that is a problem for everyone, even college-educated folks and doctors.”*

!

When we receive upsetting health news, we’re often in one of the worst positions to absorb information and act rationally.

* Quote from Catharine Clay, director of shared decision making education and outreach for the Dartmouth Institute of Health Policy and Clinical Practice, in Modern Health Care article ibid

http://www.modernhealthcare.com/article/20131207/MAGAZINE/312079983/1135?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGFWdjBHRWxYOU9qTENvK25lK0g4UUxyeW1lMDVubEF4SXN6ekM=


Can’t we just ask people?

The most satisfied patients have a 26% higher mortality rate, AND

Had 9% higher medical costs;

Spent more on drugs; and

Were more likely to be admitted as inpatients.*

!

So, no, we can’t just ask people whether they’re satisfied and be done…

* Researchers at University of California-Davis analyzed responses from 51,946 adults between 2000 and 2007 for the national Medical Expenditure Panel Survey, as covered by Advisory.com

http://www.advisory.com/Daily-Briefing/2012/02/15/patient-satisfaction


Focus on quality of life

* Noreen Clark, director of the Center for Managing Chronic Disease at the University of Michigan, as quoted in “The Simple Idea That Is Transforming Health Care” http://online.wsj.com/article/SB10001424052702304450004577275911370551798.html

"Quality of life happens to be the element that is most important in motivating people to deal with an illness.”*

This may sound obvious, but it speaks to how people want to feel in their engagement with the healthcare system.

http://online.wsj.com/article/SB10001424052702304450004577275911370551798.html


People exist in context

Patients have families whose feelings weigh on their decisions !

Patients may also be caretakers — or have caretakers !

Individuals operate according to their own goals and values (albeit within broad behavioral categories that we can identify through research)


Agenda

• Introduction

• Quest for patient engagement • Strategy for digital health engagement • Case study: Find Wellness

• Last note


Strategic interaction framework for healthcare• Interaction framework for healthcare is a blended

model: – Transactions ≈ ecommerce – Engagement ≈ social media


Back to the peopleWe have to understand what people value, what their behaviors are today, and what their goals are

!

• We can create more engaged patients and facilitate preventative health behaviors when we truly know them…


Strategy for engagement

A digital health engagement strategy boils down to three elements: !

1. Know the people you want to serve

2. Facilitate behavior change

3. Create systems of engagement

!

!

UX processes give us the roadmap


UX Process


Know the peopleDo user research & create persona models — understand your specific domain !

“It depends” — you must focus on your actual contexts of use !

Prioritize IT development by using persona classification to manage different users


Facilitate behavior changeCapitalize on existing healthy behaviors that you now understand !

Ride the motivation wave by becoming embedded into their daily lives !

Serve people’s goals, as articulated by personas !


Create engaging systemsMove beyond viable and feasible — build desirable experiences !

FeasibleViable

Desirable


Agenda

• Introduction


• Strategy for digital health engagement • Case study: Find Wellness • Last note


Origins of Find WellnessPositive preventative care behaviors include seeking care from practitioners of acupuncture; massage; chiropractic; coaches; counselors; meditation teachers…

• CAM is 1% of total healthcare spending: ~$23 Billion in 2013


Problem identificationIt’s hard to use the web to find qualified providers Practitioners are passed around through word-of-mouth !

Providers aren’t very tech savvy or marketing savvy, and they need help running their businesses !

America is still fairly ignorant of the efficacy of many ancient healing modalities


Spark of wellnessHypothesis: healthy behaviors can be contagious! !

• Facilitate connections and foster a quality source of “help care”

• Use PROMs to measure quality and feed that data back into health tracking tools & provider recommendations

• Creates longitudinal engagement that benefits all participants


User researchWe conducted research to understand people and their real-life situations !

Generative research tool to discover today’s obstacles and opportunities (“unmet needs”) !

Best practice: ethnographic-style research involving interviews and observation in the user’s context


FW research

Met users in context, discussed their current habits and experiences with CAM, identified today’s successes and issues, considered future states…

!

• Consumers

• Practitioners

• HR Directors


Created personas

Archetypal user models based on behavior patterns discovered among target demographic !

• Keeps us focused on specific needs (while representing the needs of many)

• Builds a shared understanding of users for team

• Reduces self-referential design

• Supports feature prioritization among a set of personas


FW persona set


Classification & focus

Focused on primary personas Janelle & Alexa


Ideate and model

Created paper prototypes of key interactions • Conducted guerrilla usability testing with people

like Alexa and Janelle


Built marketing website

Beta sign-ups and build social media connections


Interactive prototype

Created digital prototypes of system • Conducted guerrilla usability testing with people

like Alexa and Janelle


Launched alpha in Oct

Focus on acquiring practitioners & building presence


Engaging search

Natural language searches lead to list of qualified providers who serve that health condition


Engaging health tracking


Engaging onboarding


Engaging networking

At our launch party in November, practitioners expressed need for a place to network and develop referrals… !

so we created a private LinkedIn group and are scoping referral functionality into our product roadmap.


Iterate and keep iterating

Keep doing it over and over again…

!

Add fidelity

!

Add learnings from previous iterations

!


Agenda

• Introduction


• Strategy for digital health engagement

• Case study: Find Wellness • Last note


Points of light• Healthcare Experience Design /

Healthcare Refactored: conferences that help disseminate design thinking to healthcare decision makers

!

• We need a multi-disciplinary effort to get our heads around how to facilitate behavior change and create systems of engagement


Let’s get more UX designers involved in healthcare!

• Reach out to and engage with user experience designers for key initiatives

• Bring UX speakers and trainers into your organization

• Hook them with your passion for solving wicked problems

• Collaborate, collaborate, collaborate!


Find the right practitioners for your needs

• Remember that not every “UX Designer” is equally strong in the skills of UNDERSTANDING, DEFINITION and COMMUNICATION

• Match your needs to the right set of UX capabilities


Thank you — let’s keep talking!

Email: [email protected]

Slideshare: Elizabeth Bacon

Twitter: @ebacon

mailto:[email protected]

http://www.slideshare.net/ebacon

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