Using Health Information
Technology to Engage
and Empower Patients
Steven Wilson 2015
0
Contents

Acknowledgements
2

Personal Profile
3

Executive Summary
4

Introduction
6

Aims and Approach
7

Health Information Technology
8
o Telemedicine
o Electronic Health Records
o Patient Portals
o Mobile Health
o Wearable Technologies
o Social Media

Case studies
13
o Veterans Administration
o Kaiser Permanente
o Mayo Clinic
o National Partnership for Women & Families
o Centre for Digital Health Innovation
o Apple

Discussion and Key Learning Points
35

Appendix
41
o List of organisations visited
1
Acknowledgements
I would like to take this opportunity to sincerely thank the Winston Churchill
Memorial Trust for funding my Travel Fellowship to the United States. It has been an
honour to represent the Trust and to meet with so many wonderful people on my
travels. The Churchill name is much revered in the USA and sparks a great reminder
of Anglo–US cooperation and friendship.
In every single case I found those that I met with to be welcoming, interested and
keen to share his or her experiences. In my travels across the country from
Washington DC to San Francisco I have heard about some great areas of innovation,
good practice and new ways of working. I made some fantastic contacts,
opportunities for future collaborative work and many, many new friends.
I would also like to acknowledge the huge support and encouragement I have
received from Healthcare Improvement Scotland. It was great to have the time out
to immerse myself in the Fellowship experience and have the extended "space to
think".
“Success always demands a greater effort”
Winston Churchill
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Personal Profile
I am a Senior Programme Manager with Healthcare Improvement Scotland, leading
the planning, management and delivery of national quality improvement
programmes across the health sector in Scotland. As an Accreditation Team Leader
with International Society for Quality in Healthcare (ISQua), I also work with survey
teams across the world to evaluate international healthcare organisations, ensuring
they meet the highest standards and best practice. I have a Master’s degree in
Leadership for Health Quality Improvement from Birmingham University and an
honorary research fellowship with Dundee University. I am qualified as a green belt
in Lean Six Sigma and a Member of the Chartered Management Institute.
“The best way to predict the future is to create it”
Peter Drucker
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Executive Summary
Health information technology (HIT) is a broad concept that encompasses an array of
technologies to store, share, and analyse health information. If implemented
effectively HIT has the potential to improve the quality of health care, prevent
medical errors, reduce health care costs, increase administrative efficiencies and
decrease paperwork.
From my interviews, demonstrations and discussions with experts in the field I have
identified a number common critical success factors for the implementation of
health information technology:

Leadership
The vision and ongoing support of senior clinical leaders is critical to the successful
implementation of health information technology. Without this committed clinical
leadership in place, HIT implementation is likely to fail.

Innovation
Healthcare organisations must create the right environment and culture where
innovation and creativity thrives in every corner. Experience shows that people will
be most creative when they feel motivated by interest, enjoyment, satisfaction and
challenge of the job. Leaders must use the skills of networking, coaching and
facilitation for creativity and innovation that are both empowering and inspirational.

Co-design
Enabling person-centred care through health information technology needs a
different approach. We must engage and involve patients throughout the
development process from identifying needs through to final testing. Lets design
around the needs of the user, not the demands of the technology.

Collaboration
For health information technology to become widespread, healthcare organisations,
government and industry must work together to clear the roadblocks. The ability of
all these parties to collaborate in more productive ways is essential to speed
translation of ideas and observations into benefits for patients.

Regulation
Innovation and regulation have a tenuous relationship. While the base goal of
regulation is to keep a level playing field, the base goal of innovation is to disrupt the
status quo. It is essential that we adopt a balanced and risk based approach to HIT
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regulation that both supports continued innovation and assures appropriate patient
protections.

Education
With the widespread use of health information technologies, there is a growing need
to educate healthcare providers on the use of technological innovations.
Appropriate health information technology education is critical to ensure quality
documentation, patient privacy, and safe healthcare.

Balance
Face-to-face communication has been and will continue to be the foundation of the
clinician-patient relationship - there is no app for empathy and compassion.
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Introduction
Although the healthcare delivery and funding systems are very different, the
endeavour to better engage and empower patients in their healthcare is a high
priority for both the UK and US. Successful patient engagement is equal parts
innovation and empathy. A growing body of evidence demonstrates that the
foundation of the “triple aim” of improved health outcomes, better care and lower
costs is built upon engaged patients who are actively involved in their healthcare
experience. As a result, many healthcare organisations are focusing on improving
patient engagement by providing better education about conditions and
encouraging greater involvement in care decisions. When a patient and clinician
work together to consider the patient’s condition, treatment options, medical
evidence, benefits versus risks, as well as patient preferences, they can craft an
achievable and effective treatment plan.
A range of innovations, from wearable tech and mobile apps to patient portals and
electronic health records, appear poised to improve the patient experience by
streamlining administrative tasks and providing clinicians with data to enhance the
care process. For such technology to have an impact, though, patients must use it,
clinicians must accept it and healthcare organisations must integrate it — as well as
the basic principles of patient engagement — into their strategic plans.
We are in the 3rd age of digital technology: the 1st age was about automation and
efficiency; the 2nd about information; and the 3rd is about social collaboration. Digital
is about engaging, involving and empowering people. As Eric Topol of Scripps Health
put it, “the digitisation of human beings will make a parody out of ‘doctor knows
best.’”
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Aims & Objectives
Aim
To identify the opportunities available and the challenges to be overcome in using
health information technology to engage patients in activities that improves
understanding of health and disease, and links them to health providers and
resources.
Objectives

To identify low cost/high impact health information technology solutions for
healthcare organisations to build relationships, share knowledge and provide
better access to experts

To identify best practices and leading edge work in the use of health information
technology for patient engagement

Work with clinicians, managers, patient groups and policy colleagues to translate
the findings from this research into solutions for the NHS Scotland context and
culture

To build and maintain strong collaborative relationships between US and UK
rural healthcare providers
Approach
During July and August 2015 I visited a range of healthcare providers, information
technology companies, academic bodies and patient advocacy organisations across
the United States to explore the use of information technology to better engage
patients in their healthcare.
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Health Information Technology
Digital health comprises the technologies supporting an essential shift in methods,
attitudes and actions regarding health and wellness in our society today. It’s also
helping to reduce inefficiencies in healthcare delivery, improve access, reduce costs,
increase quality, and make medicine more personalised and precise. The underlying
lexicon of Digital Health is extensive and includes all or elements of mHealth (aka
Mobile Health), Wireless Health, Health 2.0, eHealth, Health IT, Big Data, Health
Data, e-Patients, Wearable Computing, Gamification, Telehealth & Telemedicine,
Precision Medicine, plus Connected Health.
“Digital health is a check engine light for your body”
The rate of digital health adoption amongst clinicians and healthcare organisations is
growing rapidly in the United States. Over the last few years, two major pieces of
legislation have been passed, the Health Information Technology for Clinical and
Economic Health provision of the American Recovery and Reinvestment Act and the
Affordable Care Act, which have provided unprecedented levels of financial support
for health information technology adoption and implementation, primarily in the
form of financial incentives for providers, and emphasised the importance of this
technology in delivery system reform.
The focus has now begun to shift from simply turning on the technology to using it in
a way that improves the quality and efficiency of care. Social technologies are
becoming common tools in the business of US healthcare. Use of these technologies
has gone beyond marketing, public relations and branding functions and they are
now being used for education, support, collaboration, communication and
engagement. More recent uses also include surveillance, gaming, care coordination,
research and intelligence.
The list of those who may benefit from these social tools is multifaceted. Patients
and carers are supporting each other on public social media channels; clinicians are
collaborating, communicating and accomplishing the work to be done on a daily
basis; and most importantly, healthcare leaders are engaging their communities and
increasing transparency as patient expectations shift.
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Telemedicine
Telemedicine seeks to improve a patient's health by permitting two-way, real time
interactive communication between the patient, and the clinician at the distant site.
Telemedicine may be as simple as two health professionals discussing a case over
the telephone, or as complex as using satellite technology and video-conferencing
equipment to conduct a real-time consultation between medical specialists in two
different countries.
There are three main categories of telemedicine:

Remote patient monitoring - allows patients with chronic diseases to be
monitored in their homes through the use of devices that collect data about
blood sugar levels, blood pressure or other vital signs. The data can be reviewed
instantly by remote clinicians.

Store and forward technology - stores clinical data, as well as X-rays and other
images, and forwards the data to other locations for evaluation.

Interactive telemedicine - allows clinicians and patients to communicate in real
time. Such sessions can be conducted in the patient's home or in a nearby
healthcare facility.
Research by the American Medical Association shows that roughly 1 billion doctor
visits occur each year in the United States, and of those, 70 percent are unnecessary
and could be avoided by consulting with a clinician by phone, email or text. Deloitte
has estimated that within the next few years, one of every six patients will be seen
virtually.
Electronic Health Record (EHR)
An EHR is an electronic version of a patient’s medical history. The EHR can include
demographics, progress notes, medications, vital signs, past medical history,
laboratory data and radiology reports. The EHR automates access to information and
has the potential to streamline the clinician's workflow. The EHR also has the ability
to support other care-related activities directly or indirectly through various
interfaces, including evidence-based decision support, quality management and
outcomes reporting.
Meaningful Use is a Medicare and Medicaid program in the US that awards
incentives for using certified electronic health records to improve patient care. To
achieve Meaningful Use and avoid penalties, providers must follow a set of criteria
that serve as a roadmap for effectively using an EHR.
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Patient Portals
A Patient Portal is a secure and private web-based portal. It enables patients and
healthcare professionals to exchange documents, images, results and messages.
Patient Portals help patients become more involved in their care by helping to
provide a clear understanding of what they need to do, which in turn can result in a
better patient experience and improved health outcomes.
A Patient Portal can empower and engage patients by:




Providing secure access to their health information
Improving communication with their care providers
Helping them to take responsibility for their own health
Providing easy access to relevant and current reference information
As part of the Meaningful Use Stage 2 requirements, healthcare providers in the US
must have at least five percent of their patients using an online patient portal to get
incentive payments.
Mobile Health
Mobile health, or mHealth, is defined as the delivery of healthcare services via
mobile communication devices. It has the potential to address one of the most
pressing global challenges: making healthcare more accessible, faster, better and
cheaper. Unlike many other forms of communication mHealth will likely have a
greater effect on how care is delivered for three reasons:



Mobile devices are ubiquitous and personal
Competition will continue to drive lower pricing and increase functionality
Mobility by its very nature implies that users are always part of a network,
which radically increases the variety, velocity, volume and value of
information they send and receive
Despite clear consensus from most stakeholders that mHealth has significant
potential to support patient self-care and reduce the demand on healthcare systems,
its use has yet to be mainstreamed – 80% of apps are abandoned in two weeks. The
EU’s Green Paper on mHealth [Summary report on the public consultation on the
Green Paper on mobile health, published 12 January 2015] identified seven major
areas of concern with mobile health apps that need to be addressed before the
technology can go mainstream. These were: (i) the need for clarity on levels of data
security to protect public and patients, (ii) lack of appropriate governance of lifestyle
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(non-medical) health apps, (iii) possible threats to patient safety, (iv) lack of
transparency about who lies behind an app, (v) lack of clinical input and integration
with healthcare systems, (vi) lack of clarity about whether health apps produce
positive outcomes, and (vii) the ill-funded nature of the entire enterprise that
surrounds app development. Reflecting on my Fellowship experience, there is one
key reason missing from the EU list. We haven’t yet seen the full potential of
mHealth because more often than not health apps are developed in isolation from
their intended users: patients and the public.
We need devices that are easy to use and that promote on-going customer
engagement. Developers must take the time to explore and understand the EHR
vendor's API. Mobile health tools and technologies must integrate into the existing
healthcare environment in a cost-effective and timely manner.
Wearable Technologies
The terms ‘wearable technology’, ‘wearable devices’, and ‘wearables’ all refer to
electronic technologies or computers that are incorporated into items of clothing
and accessories which can be worn on the body. These wearable devices can
perform many of the same computing tasks as mobile phones and laptop computers
With wearable technology, learning more about yourself has not only become hightech but also real-time. From devices and apps that help you track heart rate and
food consumption details to gadgets that monitor your mood and even surrounding
air, the "quantified self" is a reality for the everyday person.
What’s exciting about wearables and wireless monitoring devices is their potential to
empower consumers to make meaningful changes and improvements to their
health, on their own. What’s more, the current generation of wearables can
empower those with chronic conditions to better monitor and manage their
conditions. It has been estimated the wearable technology industry will see a fivefold increase over the next ten years, from over $14 billion to over $70 billion
Social Media
Social media allows healthcare providers to connect and engage directly with
thousands of people and organisations, be seen to understand and take on board
their viewpoints and involve them in local solutions. It also allows them to reply to
questions and comments and, in some cases, challenge misinformation. This creates
a much more transparent and healthy environment for debate and discussion.
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Social media in healthcare changes the traditional one-to-one patient-doctor
dialogue to one-to-many and many-to-many dialogues between doctors-patients,
patients-patients and doctors-doctors at a phenomenal speed. This fundamental
change in how people in the healthcare ecosystem interact with each other opens
up the possibilities for many novel applications of social media in healthcare such as:






Patients and doctors interact via social media to promote awareness about
diseases, precautions and other health-related information with each other
Patients use social media to meet their health-related wants, needs and
preferences
Online applications like WebMD offer platforms for both consumer and clinician
moderated health related conversations
Clinical investigators and research organisations use online communities to
recruit volunteers for clinical trials
Public health and regulatory agencies use social media tools for public health
campaigns and announcements
Web applications are used for treatment, clinician and hospital selection
comparisons
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Case Studies
Veterans Administration
The first visit on my Churchill Fellowship travels to the US was to the Veterans Health
Administration in Washington DC. The Connected Health Team at VA gave me an
excellent insight into how the application of health information technologies are
transforming VA’s delivery of health care and its effect on patients’ health outcomes.
These technologies are used to maximise patient-provider encounters by effectively
managing information to ensure patients and clinicians have the information needed
to customise patient care to meet the unique requirements and preferences of each
Veteran.
Connected Health Programme
VA defines Connected Health 'as extending the reach of healthcare, empowering
patients, and supporting healthcare teams through virtual systems of
care'. Connected Health is powered by consumer health technologies that engage
patients and connect them to their health care teams, enabling the extension of the
health care relationship beyond the traditional in-person encounters that for so long
have been the centerpiece of patient/provider interactions.
The VA is a leader in virtual access for patients. Here are the stats for 2014
▪ 1 million+ prescriptions refilled online per month
▪ 1 million patients used VA secure email with providers
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▪
▪
▪
▪
▪
▪
More than 2 million Telehealth visits were made
150,000 patients were case-managed by home telehealth
250,000 patients used clinical video telehealth between VA clinics
4,000+ received Clinical Video Telehealth visits directly into their homes
380,000 used store and forward telehealth technology
1 million patients used Blue Button to download Electronic Health Record data
The VA Vision for Health Information Technology
Patient Focused
▪
▪
▪
▪
▪
▪
Makes the home or local community the preferred site of care
Provides the right care - in the right place - at the right time
Helps coordinate care across the continuum
Accessible as part of patient-facing virtual services
Offers just-in-time care
Supports both patients and caregivers
Forward Looking
▪ Functions across platforms and devices to be accessible across a wide range of
patient-centered electronic systems and devices
▪ Flexibly incorporates new modalities of care
▪ Moves beyond simple transfer of data and communication to include knowledge
management
▪ Identifies VA as the national leader in the use of innovative technologies to
promote patient-centered care
Results Oriented
▪ Demonstrates reduced utilization of health care resources
▪ Promotes VHA as health care provider of choice
▪ Focuses on patient self-management and shared decision-making and improved
outcomes
▪ Uses patient-facing technologies to capture routine activity and outcomes data
What are the lessons learned?
▪ Patients must be able to connect to their healthcare provider easily through the
internet to receive both synchronous and asynchronous care, via a web browser
or mobile device
▪ Healthcare providers must move away from a focus on devices and hardware and
towards a focus on the patient experience of care, independent of device
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▪ Self-service tools on personal devices should be prioritised
▪ While security, privacy, performance and usability remain paramount; policies
and processes must mirror industry-standard development practices
Virtual Access must:
▪ Be fully integrated into the electronic health record
▪ Focus on empowering the patient with the tools, data, and access they need to
self-manage their health and wellness
▪ Take advantage of present and future communication technologies
▪ Be sustainable from a cost perspective
▪ Include connections with other providers and health systems
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Kaiser Permanente is the USA's largest nonprofit health plan with 9.6 million
members. They employ 17,400 physicians, 48,000 nurses and operate 38 hospitals
serving 8 states and the District of Columbia. Kaiser has invested over $9 billion in
developing their electronic health records system (KP HealthConnect) that stretches
across every department and every Kaiser patient.
Kaiser Permanente’s patient portal, My Health Manager, is directly connected to KP
HealthConnect. By providing members with 24/7 online access to their health
information and critical, time-saving tools, including online appointment scheduling,
prescription refill and secure email messaging with doctors, Kaiser empowers
members to manage their health care and the health care of their family members.
Currently more than 4.4 million members in Kaiser Permanente’s 9.1 millionmember network are using Kaiser’s online health management platform.
Use of the EHR and online portal to support care management and new modes of
patient encounters appears to be having positive effects on utilisation of services
and patient engagement. For example, three-quarters or more of online users
surveyed agreed that the portal enables them to manage their health care
effectively and that it makes interacting with the health care team more convenient.
Researchers at the UCSF and Kaiser Permanente followed nearly 18,000 Kaiser
patients with diabetes for five years and found those who requested statin refills
exclusively via the patient portal decreased medication non-adherence by 6 percent.
Patients who used the Kaiser portal also decreased their risk of high cholesterol
levels by 6 percent. Interestingly the average age of the research population was 62,
and 40 percent were non-white minorities.
Unfortunately many patient portals still pivot around the material relevant to the
healthcare system (the medical record) rather than those activities that are closer to
people’s health needs. Patients want a relevant individualised experience and
information from their portal rather than a one-way interface to the EHR. They
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should be able to provide structured data back to their care team, in a way that
complemented the evaluation of their progress.
What are the big challenges to introducing patient portals?
▪
▪
▪
▪
▪
▪
▪
Outspoken resisters
Inadequate budget and resources
Variable support from sponsors
Lack of skills in implementers and champions
Multiple major initiatives deployed concurrently
Adoption of paradigm shift
Impact to daily operations
What are the Kaiser key success factors?
▪ Change management strategy
▪ Effective communication
▪ Sponsorship and champions
▪ Decision making at right levels
▪ Input from patients, families and carers
What does Kaiser see as the future for online healthcare?
▪ Designing Experiences
▪ Data-Driven Personalisation
▪ Emotional Engagement
▪ Access care anywhere, anytime
▪ Seamless Transactions
▪ Social Integration
▪ Synched Devices
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Kaiser Permanente Garfield Innovation Center
For a tech geek like myself, the Kaiser Permanente Garfield Innovation Center is a
real Aladdin's cave. Situated in San Leandro, this sprawling warehouse is the largest
healthcare innovation centre in the country. Simulated spaces include an entire
medical-surgical unit complete with nurse stations, various patient rooms, critical
care room, labor and delivery room, operating room, emergency bay, family waiting
room, interventional radiology suite, and more. Here, the entire care process can be
analysed, role-played, questioned, tested, and refined under one roof.
Healthcare teams from Kaiser start the process by making sure they are solving the
right problem. To do this they conduct field research, observe system and user
needs, and assess current and emerging technologies. Once the problem and
opportunities for change have been identified, Garfield Innovation Center is the ideal
space to try out new ideas. This is where clinical teams come to explore the
possibilities while participating in hands-on activities such as simulations, technology
testing, prototyping, and product evaluations. After thorough testing in a safe
environment, successful initiatives undergo final refinement at Kaiser Permanente
medical centers, offices, and clinics across the US.
Kaiser Permanente has recently rolled out three high-tech hospitals in Northern
California to provide patient-centered healthcare. These hospitals incorporate a
variety of innovations - from way-finding applications to state-of-the-art MRI
equipment - but two technologies, in particular, have been critical to their efforts to
improve the patient experience. These include Interactive Patient Care (IPC) and Real
Time Location Services (RTLS). IPC is a hospital room technology hub where patients
can view a Care Board to see their schedule, care plan, care team and health
education videos. Patients can also order food from a customised menu, control the
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lights, blinds, temperature and music in their hospital room. They can access the
Internet for email, social media and on-demand free movies. RTLS cuts down on nonclinical nurse activities by tracking, mapping and reporting the location and status of
moveable devices or machines.
Here are another couple of the fantastic innovations I was privileged to see when I
was with the team in San Leandro.
The futuristic looking HealthSpot Care4 Station is a fully enclosed kiosk used by
Kaiser to deliver primary and specialty care in a private setting in neighborhood
pharmacies, supermarkets or the workplace. The sound proof, private 8-foot x 5-foot
kiosk houses a chair and desktop with a touch screen interface and video screen. The
kiosk is equipped with diagnostic equipment including blood pressure cuff,
thermometer and otoscope. There’s also a camera to capture your height and a scale
captures your weight when you step on the floor. The hands-on virtual visit with a
doctor takes 15 minutes on average and includes diagnosis and sending a
prescription to your pharmacist, if necessary. A medical record of the visit is saved
and accessible to the consumer via a website. A medical assistant is on-site to
answer any questions, disinfect and keep the diagnostic equipment in hygienic
working order. The kiosk is also equipped with a UV light that sanitises the
equipment. This marriage of medicine and technology allows Kaiser to care for
patients in regular everyday settings without the requirement to travel long
distances.
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Roving about the Innovation Center on wheels, I met the InTouch Health robot that
lets doctors see and talk with patients, families, and staff in the intensive care unit in
the middle of the night. From their home computers, doctors guide the robot,
connected via secure video, to virtually respond to urgent needs in a matter of
minutes. During a three-month pilot of the InTouch robot, doctors at the Kaiser
Permanente Medical Center in Fremont, CA, reported fewer night emergencies
because ICU physicians virtually were able to catch issues before they became big
problems. Doctors formed stronger relationships with the late-night shift nurses,
enhancing nurses’ ability to detect issues early. Family members visiting in the
evenings also valued the chance to talk to doctors.
Innovation @kpinnovation
Kaiser Permanente is widely recognised for its leadership in harnessing health IT to
improve quality and care delivery. The Kaiser Permanente Innovation team was
established in 2010 as a first-of-its-kind experiment to explore the value of human
centered design in health care. Through a combination of innovation and the science
of improvement, the process is grounded in ethnography, creative thinking, rapid
prototyping, and iterative testing.
What they do is watch people, take notes, snap pictures, and make sketches. Some
of what matters will be physical or logistical: Who stands where, does what,
communicates most or least or best? What tools are used? Are they used easily,
effectively, gracefully? How are they carried? If they’re not carried, are they
conveniently positioned? What about the subjective evidence? They'll ask nurses
how they feel about what they’re doing and patients how they feel about what’s
being done. They will try to get some sense of the atmosphere—colour, light,
energy, mood. Information that may at first seem unimportant can later mean a
lot. The goal is to find hidden clues to the nature of the problem at hand and some
line of inquiry for progressing toward possible solutions - in this context the
innovation at Kaiser flourishes!
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The Mayo Clinic
The Mayo Clinic is unlike any other hospital I’ve visited across the world. It is located
in the small city of Rochester (pop. 111,000), about a two-hour drive from
Minneapolis, Minnesota. The Clinic was founded in 1887 and grew out of a
partnership between providers and administrators. That commitment to
interdisciplinary collaboration, along with the team approach adopted by clinic
founder William Mayo and his sons Will and Charles, continues to define the
institution’s culture. Early medical innovations attributable to Mayo, such as the
common medical record and the tumor-grading index, exemplify its highly pragmatic
ethos.
Every year more than 500,000 patients come to the Mayo Clinic from across all 50
US states and nearly 150 different countries. The Dalai Lama has visited the Mayo
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Clinic for check-ups, Middle Eastern royalty come to the Mayo Clinic for long-term
treatment, and politicians and wealthy captains of industry are not unusual sights in
Rochester. Each Mayo clinic patient benefits from the expertise of more than 3700
doctors and scientists working together to understand and meet the needs of their
patients.
Doctors in the United States are usually paid fees for each service they provide. The
more procedures and tests they order, the more money they pocket. There is
widespread agreement among health policy analysts that many of these procedures
are unnecessary, raising costs in ways that often do nothing to improve patient
health. By contrast, the Mayo Clinic pays salaries to all of its doctors. No matter how
many tests or procedures are performed, they take home the same amount of
money.
Myself and Lee Aase, Director of the Mayo Clinic Center for Social Media
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The Mayo Clinic Center for Social Media was set up in 2010 to coordinate and focus
the Clinic’s various social media initiatives and programs. Lee Aase and his small
team of 6 use social media tools and technologies to help patients become better
advocates for their own care. The Center’s philosophy is based around the firmly
held belief that individuals have the right and responsibility to advocate for their
own health, and it is the team's responsibility to help them use social media tools to
get the best information, connect with providers and with each other, and inspire
healthy choices. The Mayo Clinic is putting this philosophy into practice across all of
the big social media platforms - Twitter, Facebook, YouTube, Google+, Pinterest, and
Flickr.
So why do they excel?
1. Senior leadership support
Use of social media for engagement and experience management, can be a hit or
miss proposition without the right strategy, support and resourcing. Executive
commitment is essential when it comes to launching and growing your social media
strategy. CEO of the Mayo Clinic John Noseworthy understands the power of social
media and is a strong advocate for the potential it offers to engage patients in their
healthcare.
2. A focus on great content
The Mayo Clinic use a range of social platforms to explain what they do,
answer questions, and allay concerns. They regularly share educational materials
and other resources, establishing themselves as the clinical experts and helping to
connect with and engage patients. They introduce Mayo Clinic staff and the work
they do, giving patients a chance to 'meet' their doctor before they attend the clinic
in person.
It's a great way to share patient and staff stories to demonstrate expertise and
personalise the healthcare process - this can help reduce the fear factor, something
that often keeps our patients from making or keeping appointments.
3. Innovation and creativity
The Mayo Clinic are constantly looking at new and innovative ways of interacting
with their patients through social media - and encouraging patients to communicate
with each other through social media.
Redefining how we obtain health information online, the Mayo clinic has partnered
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with Google to present search results in a clearer and more accurate format. Health
consumers will see a box alongside their search results filled with enhanced
information culled from throughout the web, verified by multiple clinicians and,
finally, signed off by doctors from Mayo Clinic. This is just one example of the
innovative work going on all the time at the Mayo Clinic Centre for Social Media.
Where next?
Through social media tools & technologies the value of engaging in clear, open, twoway communication at every point of care has become abundantly clear. Active
engagement between healthcare organisations, patients, families and carers has a
demonstrably profound impact on experience, compliance, and clinical outcomes. At
the Mayo Clinic social media plays a key role in facilitating this constructive
engagement. It's through these 'real-time' tools patients are now able to comment,
participate and engage at every point along their own care pathway. Social media
provides the tools for patients and clinicians alike to join the healthcare conversation
beyond constraints of time or geography.
“In the very near future, social media will be
considered part of routine healthcare operations and
our day-to-day lives.”
Mobile Health at the Mayo Clinic
Today's healthcare landscape is shifting dramatically, driven by changing healthcare
policy, advancements in technology, and a continuing quest to deliver high-quality
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care in the most cost-efficient manner. mHealth – also known as mobile health – is
the practice of medicine and public health supported by mobile devices such as
mobile phones, tablets and the wireless infrastructure. Data from mHealth can
inform, assess, anticipate, and aid in interventions while monitoring and
coordinating patient health status and care.
Mayo Clinic's flagship mobile app was created in collaboration with Apple and in
consultation with Mayo Clinic patients. App users have full control of their personal
health information, and can decide what, if any, data is stored in the Apple Health
app. The app allows users to:
▪
▪
▪
▪
View Mayo Clinic health data through the Apple Health dashboard
Contact their care team directly through secure messaging
View and manage details of their appointment schedule
View Mayo Clinic videos on their iPhone, iPod, and iPad
Mayo’s flagship mobile app has recently been updated to include access to radiology
images and Touch ID, as well as compatibility with Apple’s Passbook.
Touch ID
Apple users can easily and securely authenticate access to the Mayo Clinic app on
the go. The patient’s fingerprint is the password and with a touch of the home
button on the device, the Touch ID sensor quickly reads the fingerprint and
automatically logs into the Mayo Clinic app.
Passbook
Upcoming appointments appear as a pass within the Passbook app. Patients can see
their appointment details from the lock screen of their Apple device with a simple
swipe of the appointment pass.
Radiology images
Unique to the Mayo Clinic, patients now have anywhere, anytime access to their
radiology images and reports within the Mayo Clinic app. This gives patients
flexibility and greater access to their health information. These images are for a
patient’s information only, and not meant to be used for diagnostic purposes.
Whilst it's still early days for mobile technology in the delivery of health care,
evidence supporting the huge potential to impact the delivery of better health care,
lower costs and improve patient outcomes is apparent. mHealth can empower
clinicians to more effectively engage patients and provide secure information on
demand, anytime and anywhere.
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Innovation at the Mayo Clinic
The Mayo Clinic Centre for Innovation is transforming the delivery and experience
of healthcare. By applying a creative, problem-solving design thinking approach
they're aim is to revolutionise the experience for Mayo Clinic patients and staff.
The Center for Innovation fuses design principles with the scientific method to
uncover human needs in the health care environment, which include empathy,
creativity, systems thinking and a human-centered focus. Design methods include
ethnographic and observational techniques, visualization, prototyping, sketching,
storytelling, brainstorming and more. The complement of design allows the center to
think beyond what it normally does and serve as a translator for ideas and
possibilities.
The innovation team takes a 3-prong approach to all of their work
▪ Connect
▪ Design
▪ Enable
Bring people together in new ways inside and outside of Mayo Clinic
Identify opportunities and realise solutions that transform care delivery
and experience
Facilitate and accelerate innovation across Mayo Clinic
The Center for Innovation works with a "Think big. Start small. Move fast.™"
philosophy - something I think we can all aspire to!
▪ Think Big
▪ Start Small
▪ Move Fast
First, by thinking big and tackling important problems, the team at
Mayo Clinic is able to help insure broad organisational support for its
projects
Then, by starting small, complex challenges are reduced to
manageable size, allowing the team to get immediate traction and
tangible results
Finally, by committing to moving fast, hypotheses can be tested
quickly and interest in particular innovation projects remains high.
The goal is to implement a major prototype of the concept within six
months of launch
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The team has an undivided focus on the customer and customer experience, and
constantly asks 'will our actions have the potential to profoundly impact the
experience and delivery of health and health care?'
All of us are caught in a situation where the current system doesn't work and this
brings tremendous frustration - innovation in healthcare has never been more
important.
Here are a few pictures of the wonderful glass-enclosed, reconfigurable space they
have at Mayo Clinic Center for Innovation
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The National Partnership for Women & Families promote fairness in the workplace,
reproductive health and rights, access to quality, affordable healthcare, and policies
that help women and men meet the dual demands of work and family. The National
Partnership recognise that Health IT alone will not solve the problems facing health
systems, but its implementation and effective use can provide a foundation for
improvement. Information technology can empower individuals with the
information and electronic tools necessary to be active partners in their own care.
Health IT can help patients and carers make more informed decisions; be better
connected; generate and share important health information; and set, track and
achieve personal health goals.
In order to meet patients wherever they are along a continuum of engagement and
health, we must leverage a variety of health IT solutions and tools capable of
supporting different phases of health, consistent with shifting needs and priorities.
The National Partnership have outlined 7 strategies to engage patients and families
in their health and care using information technology:
▪
▪
▪
▪
▪
▪
▪
Continue to adopt and use Electronic Health Records to improve patient care,
experience, access and use
Integrate more convenience features as standard features of patient portals
Strengthen and expand electronic access to and use clinical health
information throughout new models of care delivery
Enhance functionalities for patients to communicate with and share
information with health care providers and others
Build robust functionality to support patients and families in health and care
planning
Foster trust with patients by showing how their health information is stored,
exchanged, used and protected
Build tools and systems that recognise demographic diversity, with particular
attention to language and cultural competency issues
Here are a couple of six word memoirs from US patients about health information
technology?
"Help me help you help me"
"My whole team on the same page"
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University of California Centre for Digital Health Innovation
The Center for Digital Health Innovation (CDHI) at University of California San
Francisco use their expertise, connections and scientific rigour to better innovate the
future of healthcare. CDHI collaborates with innovators from UCSF and beyond to
envision, realise and evaluate new digital health technologies. Similar to the Digital
Health Institute (@DHIScotland) in Scotland, CDHI works with a range of startups
and companies looking for consultation or looking to evaluate their product in a
clinical environment, bringing together innovators, thought leaders, and other
partners from the digital health community to foster new connections and ideas.
Andy Auerbach and the team have four key areas of focus at CDHI, to:
Innovate: bringing ideas to life through a range of development services. CDHI
support includes online resources, consultation, funding support, or full incubation
opportunities.
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Validate: evaluating the usability, adoptability, and impact of technology solutions
on clinical and educational outcomes, as well as healthcare value.
Integrate: focusing on the interoperability of technologies, data storage and
analytics, device and data interface standardisation, security/privacy services, and
electronic health record integration opportunities.
Educate: learning from others and helping to create the next generation of digital
health and healthcare leaders. CDHI host events to engender collaboration between
the UCSF community, startups, industry, and capital partners.
Here are a couple of examples of the great collaborative work I heard about on my
visit to the UCSF Center for Digital Health Innovation
Health eHeart
Working with the American Heart Association, CDHI has supported the development
of Health eHeart. This is a clinical trials platform using social media, mobile
technology & novel realtime sensors to revolutionise heart disease. Through this
study the team hope to
▪
Develop new and more accurate ways to predict heart disease based on
measurements, behaviour patterns, genetics, and family and medical history
▪
Understand the causes of heart disease (including heart attack, stroke, heart
failure, atrial fibrillation, and diabetes) and find new ways to prevent it
▪
Create personalised tools the public can use to forecast when they might
develop heart disease or, if they have it already, when they might be getting
worse
Blip
People with diabetes need to be able to see their data in order to learn from it. That
means being able to easily collect it and see it in context of our day-to-day lives. Blip
is a simple, visual hub for diabetes data, where everything shows up, where all of the
insulin pumps, monitors, tests, meals, exercise and sleep information start to make
sense. It makes it easier for patients to get data from their devices, even if they are
from different manufacturers. Blip is useful for people who want to dive into their
data. It’s a communication tool for patients and clinicians to talk about and learn
from the device data. Using messaging tools, Blip lets school nurses, teachers,
families and doctors see the same thing at the same time and adjust treatment
accordingly.
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University of California Mission Bay Hospital
Myself and Seth Bosker (UCSF's Associate Chief Medical Officer)
Seth showed me around the new UCSF Mission Bay Hospital. The 878,000-squarefoot facility is actually three hospitals in one: the 183-bed UCSF Benioff Children's
Hospital San Francisco, the 70-bed UCSF Bakar Cancer Center and the 36-bed UCSF
Betty Irene Moore Women's Hospital, along with the UCSF Ron Conway Family
Gateway Medical Building.
Through some fantastic patient-facing interactive technology UCSF is moving the
culture towards shrinking the health literacy gap. Most patient rooms in the medical
center come equipped with a tablet and a large screen monitor that allow the
patients to connect and keep up to date with friends, family, coworkers and
classmates outside the hospital, reducing stress and anxiety for the patient.
The implementation of information technology at Mission Bay reflects the
uniqueness of UCSF and the fantastic building they have built. In addition to
empowering patients with information, education, and entertainment, they are
using technology to promote a very broad definition of health that includes
emotional wellness, opportunity for reflection, and human connection. The in-room
platform enables personalisation by theme, language, and age; connection through
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social media; and access to patients’ own cloud-based entertainment. Patients can
upload photos of their key support network onto their in-room system to give them
warmth and strength.
In addition to the full electronic health record and automated medication delivery
system at Mission Bay, Seth and the team have introduced the Voalte nextgeneration communication system, through which voice call, text messages,
traditional “pages,” and alarms are transmitted to mobile smartphones. Another
area, which is closely related to patient engagement, is telehealth. Patients at
Mission Bay have full access to all the expertise throughout UCSF Health System —
no matter where the patient or doctor is located. They also have the largest
deployment of transport robots, which roam the halls delivering supplies and patient
meals - all very space age!
Patients and families in the San Francisco Bay Area use, and in many cases create,
technology applications to empower people in banking, travel, retail, and many
other areas of their life. These same people desperately want to use technology to
empower themselves in healthcare. This transition from “you’re a patient in my
hospital” to “I’m a doctor in your room” is not an easy one. Clinicians are slowly
learning to function in a world where their patients can use UCSF apps to access a
critical lab result before they have an opportunity to see it. We are slowly pulling
back the curtain and using technology to democratise medical information for
patients and families - with sometimes conflicting evidence and uncertainty.
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Apple
Apple's HealthKit is being tested by more than half of major US Hospitals in a pilot
scheme of the service, as doctors use it to collate data and monitor patients
remotely.
HealthKit is a framework designed to house healthcare and fitness apps, allow them
to work together and collate their data under the Health app. For example, a heart
monitoring app and blood pressure tracking app could send information to each
other from within HealthKit to develop a more comprehensive picture of a patient’s
health. This customised data can then be sent to the patient’s cardiologist via an app
such as Mayo Clinic, which allows remote monitoring. Apple is also working with a
number of partners on the fitness side of HealthKit, through which users can set
goals and track their own progress through a single dashboard.
A large platform collecting billions of data points about hundreds of aspects of our
health on a daily basis will create a powerful information resource for health care
providers and researchers. But in order for that to happen, the data will have to find
a way into clinical systems, like the electronic health record (EHR). To this end, Apple
is collaborating with Epic Systems to aggregate patients' health data from myriad
health applications into the EHR. This allows clinicians to monitor patients at home,
adjust their medication via phone, and ultimately avoid preventable hospital
admissions. In the past, clinicians have relied on patients to log information, bring it
to the clinic where data would be manually input to the system and a course of
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action decided. Using HealthKit we can share information seamlessly between
patient and clinicians to allow real-time, accurate analysis of a patient's health
status.
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Discussion & Key Learning Points
Both the US and the UK are struggling with the difficult dance of improving quality,
while increasing access, and doing so in a cost effective manner. Fortunately, digital
health is offering increasingly effective solutions to do so. According to a 2012 report
by the Digital Innovation in Healthcare Working Group, digital is the new “Fourth
Space” in healthcare - a blending of digital and social media use within the
traditional healthcare system, patient empowerment toward self-care, and social
movements focused on preventative health. The result is a significant impact on
quality, access and cost.
However, some of the most important innovations of the coming decades will not be
new healthcare tools & technologies, but the new ways of working together that are
made possible by these new technologies. We must create a culture that encourages
and rewards collaborative working and makes best use of all these new
technologies. Welcomed or not, it is the inevitable future and is becoming the
present in many US healthcare organisations at an amazing pace. At the same time,
there is a choice about whether to deny and react to these cultural and economic
shifts or instead acknowledge and embrace them. And there is a choice as well—for
both organisations and individuals—about whether and to what extent to cultivate
the culture, mind-sets, skills, and knowledge that make it possible to leverage the
enormous potential of HiT, mHealth and social media tools to better realise their
purposes.
Unless patients and carers in the UK are empowered and informed, it will be difficult
to realise the potential of a learning healthcare system. We need new tools to create
a new system, and mobile health and consumer facing apps are a critical piece of the
puzzle. Creating healthy individuals necessitates true patient engagement and
accountability, which means this new system must be easy to use and accessible.
With patients in control of their health using digital tools and the creation of a
system that invests in wellness and the management of chronic illnesses, not only
can we eliminate much of the waste in healthcare today, we will also create more
cost-effective care and healthier, more productive individuals. Information is power,
and by empowering patients with data we can not only improve the patient
experience and clinical outcomes, but also ultimately lower costs.
So how will the patient consultation change in the near future? Well, to be honest, I
don't think it will look wildly different! I'm sure we'll see a lot more online
interaction, and I sincerely hope the power gradient between patient and doctor will
be reduced. No doubt the information generated from mobile tools and wearable
technologies will improve the knowledge both parties bring to the consultation, but
will it change the conversation itself? Digital healthcare is about building the service
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around the patient, not the structures. Doctors will still have to be compassionate
and caring, and patients will still have to be engaged partners in their health, and
both will have to contend with emotions, psychology, and uncertainty.
Health technology solutions to date have typically digitized existing processes rather
than giving expression to carefully considered new models of care, decision support
and patient engagement strategies. To break through the plateau in adoption and
benefit realisation, clinicians must lead a service-design approach for the
development of solutions that truly empower people in health and care delivery
across the whole system.
Key Learning Points
Leadership
During my fellowship travels I was constantly reminded of the importance of
clinicians and managers working together to lead change. In all of the healthcare
organisations I visited there was a visible commitment of clinical leaders and a clear
passion for quality improvement. Many of those in senior leadership roles in US
healthcare organisations are physicians – certainly more than is the case in the UK.
This is in part due to the investment made in the development of clinical leaders,
and a culture that values leadership roles and sees them as attractive career
opportunities.
Kaiser Permanente and Mayo Clinic are great examples of the benefits of joint
working between physicians and managers. KP has built an organisational culture
that transcends the traditional conflicts between “medicine” and “management.”
There is a mutual commitment to partnership working between physicians and
management that is deeply ingrained in the organisation. A number of factors are
responsible for this success, but three stand out.
Joint leadership
Physicians and management within KP and Mayo have acknowledged their mutual
dependency. Having this propensity for partnership explicitly modeled at the highest
levels of the organisation has guided behaviour at all levels, including frontline staff
and their counterparts in management.
Alignment
Many of the healthcare organisations in the US are highly fragmented, disaggregated
healthcare structures with conflicting incentives and goals among clinicians, insurers,
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and administrators. At KP there is an explicit alignment of mission and strategy,
bringing both sides into a mutually interdependent relationship. The success of
physicians and managers is in the hands of the other, creating a powerful alignment
of interests that transcends professional or cultural differences.
Management training for physicians
At Kaiser Permanente there are a range of leadership development programmes that
ensure physician leaders understand both the bedside and the boardroom and make
competent partners for similarly well-trained managers.
Chief Medical Information Officer
The many health care reform initiatives underway in the US are forcing hospital
information technology and information management departments to evolve and
titles to change. The new names are more than cosmetic, heralding a shift in
leadership roles to meet new realities and priorities.
Chief Medical Information Officers (CMIO), sometimes called directors of medical or
health informatics, are a fairly new addition to the US healthcare sector, but they are
already in high demand, as the healthcare industry transitions to electronic health
records (EHRs).
As the field of health informatics is still developing, the CMIO role will vary from one
organisation to the next. However, most CMIO’s are practicing clinicians and their
responsibilities reflect their dual areas of expertise. On a regular basis, the average
CMIO may evaluate an organisation’s IT systems; design and apply EHR software and
applications; convert and analyze medical and health data; ensure quality of care
across multiple information systems; leverage medical and health data to improve
services and daily operations; and train doctors and other medical professionals in IT
systems and applications. CMIOs, depending on their individual areas of expertise
and training, may also conduct data analytics for research purposes and report
findings to senior management, government, or academic organisations.
The role of the CMIO has been, and continues to evolve to meet changing
organisational, clinical and population health-related demands with increasingly
capable and innovative technology.
When America sneezes Britain catches a cold - I see the CMIO role as one of the
more exciting evolutions going on within the world of healthcare and something that
healthcare organisations in the UK need to seriously consider.
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Innovation
Healthcare delivery systems in the US and UK are under increasing pressure due to
rising costs and increasing patient expectations. These pressures and the inherent
nature of the industry itself make innovation in healthcare more complicated than in
the consumer products sector. Success requires a range of inter-related technical,
social and organisational factors.
The health service can learn a lot from Apple when it comes to innovation
▪ Empower employees
Apple is run by ideas and not by hierarchy. Putting Apple employees first and
empowering them to understand their own value has helped the company to
produce one groundbreaking product after another. Healthcare providers must
give employees the power to problem-solve and innovate by creating an
atmosphere in which they feel comfortable taking risks and have resources
available to them.
 Embrace Failure
Apple is the most valuable brand in the world right now but it has still had its
share of failures. Failure is the foundation of innovation. It’s crucial that the
Healthcare Providers foster a culture that celebrates productive mistakes, the kind
that can stimulate thoughts and generate new paths.
▪ Take calculated risks
Provide tools allowing employees to explore possible scenarios and develop plans
with confidence.
▪ Look outside the healthcare sector for ideas
Innovation can come from without as well as within. This approach, known as
network innovation, has been embraced by companies such as Procter & Gamble,
BT and several drugs giants, all of which have realised the power of admitting that
not all good ideas start at home. Making network innovation work involves
cultivating contacts with start-ups and academic researchers, constantly scouting
for new ideas and ensuring that we do not fall prey to “not invented here”
syndrome, which always values in-house ideas over those from outside.
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Co-design with Patients
The big promise of mHealth is support on demand to help with greater self-care.
Unfortunately patients end up frustrated, with an obvious disconnect between what
they really need and what developers or clinicians think they need. If we don’t put
patients in the driving seat then technology will continue to drive and define
mHealth development.
It is essential that we engage and involve patients throughout the development
process from identifying needs through to final testing – making this the norm,
rather than an unaffordable luxury. IT developers need to spend time and resources
on understanding and measuring user experience with technology mediated
healthcare delivery. Experience shows that engaging patients in this way will help
build a higher level of end-user trust and acceptance. Lets design around the needs
of the user, not the demands of the technology.
Collaborate with Industry
With unprecedented challenges such as the ageing population and increasing
prevalence of lifestyle related disease facing our healthcare system, technology
offers the best platform for creating sustainable health and care services that will
encourage people to take ownership of their health. We need to learn from other
industries and apply this to healthcare so we can provide affordable and effective
services that will become valuable additions to people’s lives. The ability of
healthcare organisations, universities and industry to collaborate in more productive
ways is essential to speed translation of ideas and observations into benefits for
patients. UK healthcare providers should continue to forge innovation networks and
link with young information technology firms and universities to incorporate their
diverse skills and knowledge to innovate or incorporate new technologies in the way
they do things.
In Scotland, the Digital Health Institute is leading new energised methods of
collaboration amongst all parties – manufacturers, developers, clinicians and patient
advocates. Creating a platform where these organisations can collaborate is key to
making digital healthcare technology affordable, accessible and successful in the
future.
Reduce Regulation
Beth Israel Deaconess Hospital Chief Information Officer John Halamka describes the
burden of health technology regulation in the US as “crushing”. The plethora of
Federal regulations has replaced innovation and has become the all-consuming
majority of the CIO’s daily work. This level of regulation only succeeds in protecting
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the status quo and hindering or preventing innovation.
New technology often comes from unexpected places and from people that had
previously not been major players in the market. However, this is only possible when
the cost of regulation is low. Having a well defined, risk-based regulatory framework
is essential to the continued success of health IT in both the US and UK.
Upskilling staff in the use of IT
It is vital that healthcare leaders are seen to champion information and digital
capability as core enablers of effective decision-making, service quality, safety,
effectiveness and efficiency. In future all members of the healthcare workforce must
have the knowledge, skills and characteristics that are necessary to embrace
information, date and technology, appropriate to their role.
Beware the Silver Bullet
Health information technology is often held up as the panacea for all that ails the
healthcare system, with the argument that it will free up clinicians from various
computational tasks so that he/she can concentrate fully on their patient.
Unfortunately HIT has yet to deliver on its huge potential. Design flaws, poor
execution and inadequate orientation/education all contribute. The field of health
information technology shows real promise but it is still in its infancy.
Even as a huge supporter of health information technology I know it cannot replace
the human elements in medical care, which are so effective in producing the
therapeutic effect – there is no smartphone app for empathy and compassion!
HIT has huge potential to augment healthcare renovation by providing powerful
tools, data and solutions, but patients will always need emotional attention and
empathy from their care team.
We will know that ‘digital healthcare’ has truly reached its
potential when it becomes just ‘healthcare’
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Appendix
Organisations Visited
Veterans Administration
50 Irving St NW
Washington, DC
United States
Boston Children’s Hospital
300 Longwood Avenue
Boston, MA 02115
Kaiser Permanente Center for Total Health
The Permanente Federation, LLC
700 2nd Street NE
Washington, DC USA 20002
Mayo Clinic Hospital
201 W. Center St.
Rochester, MN 55902
National Partnership for Women & Families
1875 Connecticut Avenue NW,
Suite 650
Washington DC 20009
Apple Campus
1 Infinite Loop
Cupertino
CA 95014
Mobile Health World Conference
Seaport Hotel
1 Seaport Lane
Boston, MA 02210
University California San Francisco
Center for Digital Health Innovation
San Francisco
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
Garfield Health Care Innovation Center
590 Whitney Street
San Leandro, CA 94577-1114
Massachusetts General Hospital
Main Campus
55 Fruit Street
Boston, MA 02114
University California San Francisco
Mission Bay Benioff Children’s Hospital
1975 Fourth Street
San Francisco
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