The world is growing more and more digital everyday—both the world in general and the healthcare world in particular. So, as we move further into the digital realm, we need to find out how to effectively reach patients in a digital world.
We are surrounded by smartphone health apps, cloud-connected medical devices, and software-driven therapies. Even our health records are now electronic. Each and every one of these digital innovations is redefining the very nature of healthcare and, along with it, how we can effectively reach patients.
In the Digital World, Care Clinics Can Be Virtual
The digital world promises many healthcare benefits: personalized care, remote health monitoring, and cost controls among them. Now that smartphones and Internet access are everywhere, we are beginning to experience the continuously accessible, on-demand form of healthcare that the USC Center for Body Computing has modeled in its Virtual Care Clinic.
Healthcare delivery in the digital world is envisioned as a virtual care clinic by the USC Center for Body Computing – Source
With the Virtual Care Clinic, the patient and healthcare provider don’t need to be in the same place at the same time to interact. They can interact remotely using teleconferencing, text messaging, or email. And, their interactions can happen either in-real-time or asynchronously.
Because of the always-on nature of the Internet, healthcare information and records can be accessed at any time, fostering an on-demand environment that more closely mimics a consumer-serving environment. Add advanced digital technologies like artificial intelligence (AI) and machine learning (ML) that can identify and anticipate the specific patient’s condition and this virtual clinic can provide individualized medicine.
One example of this could be a heart failure rehab program delivered as an app and configured specifically for the patient receiving it. With both the patient and provider having easy access to the patient’s health records via the Internet, a more comprehensive picture of the patient’s condition is available. For the engaged and informed patient, this puts their discussions with their provider on a more even footing.
Hurdles to Patient Engagement Must Be Addressed
But hurdles remain between the world we currently live in and the digital world we are moving toward. Three key hurdles to engaging patients in digital healthcare world have been identified by the USC Center for Body Computing. They are:
- Trust and security
- Cost and accessibility
Trust and security
Patients will only engage with digital health if they feel that they can trust it and that their data is secure. Based on recent news stories, patients have reason to be concerned.
Patients have varying levels of trust in healthcare organizations – Source
Poor administration of a highly-effective healthcare initiative undermines patient trust.
The State of California stores the DNA of children born in the state since 1983 in a state-run biobank. Despite legal protections, parents have found that their child’s DNA data can be purchased by outside researchers without their expressed consent. Understandably, parents are upset.
There is widespread support for the Newborn Genetic Screening program that collects and analyzes the infant blood samples for congenital disorders. Thousands of infants have received timely treatments and avoided serious health complications because of this program. What most people don’t realize is that the extra blood drawn from the infants becomes the property of the state.
The process for informing parents of their right to have their child’s blood sample destroyed has proven ineffective. Parents were informed of their rights with a statement on page 13 of a pamphlet. And to exercise this right, parents need to specifically opt-out. The state doesn’t take any action to confirm that parents are informed of their rights or understand what they need to do to exercise them.
While this process may be within the legal requirements of the law, it doesn’t satisfy the spirit of the law and undermines parents’ trust in the state and its biobank.
Data breaches happen and when they do, patients take action.
In its report, Digital Trust: Are You One Breach Away from Losing a Healthcare Consumer?, Accenture Consulting reports that 91% of consumers take action to protect their data after a data breach.
Patients take action in response to healthcare data breaches – Source
A significant percentage of patients go so far as to change their healthcare provider (25%) or healthcare insurance company (21%) after experiencing a healthcare data breach. There are only so many times that they will go through this before their trust in digital health is completely shattered.
For patients and providers to operate effectively in the digital healthcare world, they will need to learn new skills and educate themselves on the latest information.
The smartphone is an instrument that can be used for a variety of tasks.
The smartphone is ubiquitous. By one estimation, more people in the world have access to smartphones than have easy access to toilets. But being able to surf the Internet or make calls using a smartphone and being able to rely on it for healthcare are two different things.
Both patients and providers need to learn how to use new applications that gather, store, analyze, and communicate health data. Beyond just being users, they need to understand the advantages and vulnerabilities that come with participating in digital healthcare.
Digital communication differs from in-person conversations.
When communicating face-to-face, patients and providers have a myriad of non-verbal cues and physical body language that they can rely on to convey meaning. These are not readily apparent with teleconferencing, text, and email. For example, people need to learn that ALL CAPS in a text or email is the equivalent to shouting in real life.
Technical language and medical vocabulary can get in the way of effectively reaching patients.
Healthcare professionals are used to using highly technical language in their written communication. Not all patients will readily understand medical vocabulary or scientific explanations. However, this may be changing for highly-engaged e-patients. Communication must meet the participants where they are and take the time to clearly explain any new or unfamiliar concepts and ideas.
New laws will affect how to reach and engage patients in the digital healthcare world.
Everyone needs to understand how their rights and responsibilities are changed in the digital
world. Most importantly, they need to understand how to effectively exercise their rights, as the controversy surrounding California’s Newborn Genetic Screening program shows.
Cost and accessibility
Patients won’t be able to engage with the digital healthcare world if they can’t afford the cost or find the technology too difficult to use.
Digital health assumes uninterrupted and stable access to the Internet.
This means that the patient always has access to sufficient data plans and networks, regardless of economic or educational status. Recent events in the US call these assumptions into question.
Pew Research, in measuring broadband and smartphone access by income, found significant disparities between low- and high-income users.
Overall, Pew found that people at every income level are shifting to smartphones for accessing the Internet. Those earning the least were more reliant on smartphones for their Internet access as they were less likely to have broadband Internet access at home, along with smartphone access.
Those earning $30,000 per year or less rely more on smartphones for Internet access and are less likely to have broadband at home as well – Source
Additionally, in the US about 12.5 million low-income people rely on the federal Lifeline Program to subsidize the cost of phone service and Internet access. Recently, the FCC voted to scale back this program. And rule changes under consideration by the FCC would no longer allow telecommunications resellers to receive Lifeline Program subsidies, driving low income consumers to telecommunications providers who have their own physical telecommunications networks. These providers are often more expensive than resellers, so the net effect will be to increase the cost for those receiving the Lifeline Program subsidy. People living on tribal lands will be disproportionately affected because this rule change will create a de facto telecommunications market with a single provider.
Collectively these shifts in government policy are likely to create a barrier for low income people to accessing digital healthcare. As Jessica Gonzalez, deputy director and senior counsel at Free Press, has said, “Lack of reliable Internet tracks closely with other disparities across the country, including disparities in healthcare and education.”
Digital health needs to pay close attention when building interfaces that are accessible to the elderly and disabled.
In order to build digital healthcare apps that will reach patients, the designers and developers must take patient accessibility in to account.
By their very definition, patients who are elderly or who have a disability will have special accessibility needs. Text will need to be displayed in high contrast against a plain background for those with visual impairments. Button size will matter. The ability to switch to a voice-driven mode will be needed by some.
These accessibility requirements might be at odds with current design standards, but without them the app can’t be used by some patients. If the designer and developer ignore patient accessibility, a sizable group of patients will, in effect, be excluded from being reached in the digital healthcare world.
Reaching Patients in the Digital Healthcare World
Developing this new digital healthcare world is dependent on the policies and practices of a digital infrastructure that didn’t even exist when our healthcare systems were originally established. The result will be a healthcare system that is interdependent with digital communications, devices, and infrastructure.
Every stakeholder has a role to play in building a digital healthcare world that is accessible to all. Inclusiveness and trustworthiness need to be the hallmarks of the digital world or else the promised benefits of digital health will only be realized by the affluent and able-bodied.
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