Tag Archives: patient engagement

Engaging Patients with an Apple and Health Apps: Watches Are No Longer Just for Telling Time

Today patients are increasingly connected.  The fastest growing demographic on Twitter is actually those that are between 45 and 65 years old.  Our patients are becoming better informed and are flocking to the internet and to social media to discuss and learn more about disease.  Prevention of disease is becoming more of a priority in our healthcare system as we begin to adjust to the mandates provided for in the Affordable Care Act and physicians are now expecting patients to take a more active role in their healthcare.  In the last 5 years, the concept of the electronic patient has emerged and is becoming more and more prevalent among mainstream patient populations.  These patients often come to office visits armed with information and data collected on the internet and are very technologically savvy.  They embrace new devices and are eager to track health indicators such as blood sugar, blood pressure and heart rate through easy to use phone applications.

This week, Apple intends to announce a new smartwatch and a group of associated health applications.  These innovations will further allow the electronic patient to become more of a mainstream phenomenon.  However, in order to be effective, physicians and other healthcare providers must embrace these technologies and begin to better understand their utility in all patient populations.  According to the Wall Street Journal, the announcement of the new smartwatch is expected to introduce no less than ten new sensors for monitoring health indicators.  Apple has created a data repository that will allow health related information to be stored (with the user’s permission) and directed to healthcare providers if so desired.  This assimilation and collection of massive amounts of health indicator data may be a significant game changer in the fight against chronic disease.  With many patients, compliance with medication or lifestyle modification plans is a challenge.  Many diseases such as hypertension do not produce immediate ill health effects–rather they accumulate over time.  However, if we can clearly demonstrate to patients the positive responses to interventions on a daily (or even hourly basis) they may be much more likely to comply with prescribed treatment plans.  Glancing at a smartwatch and noting a response to exercise or to a completed dose of medication can be a powerful motivational tool.

What if all of the data is collected simply by wearing a watch?

If we make collection and organization of information simple and user friendly, then important information can be transmitted to a physician who can review the data prior to the next face to face office encounter.  Real time feedback can then be provided to the patient and this may ultimately result in increased engagement and may actually spur change in habits or behaviors that are detrimental to a particular patient’s health.  Moreover, according to the WSJ, the new Apple operating system will include a Health icon that will allow for the development of a dashboard with many health indicators that are easily accessible in one place–lab results, heart rate, blood pressure, weight–even calories consumed and burned in a given time period.  The engaged patient can see what they are doing right, what they are doing wrong and can track improvements in habits rather quickly.  Having the data all in one place will likely increase compliance and improve overall health of the adopters of this technology.

What about security of sensitive personal healthcare data?

As with most new advances in medicine, there are significant concerns about data breaches and compliance with the federal Health Insurance Portability and Accountability Act (HIPAA) regulations.  According to a story in the New York Times, Apple is working with application developers as well as the federal government in order to ensure that any stored or tracked healthcare data will remain secure.  Partnerships with application designers, insurance companies, healthcare systems and physicians will be critical to the success of the new Apple smartwatch.  As these new technologies are rolled out and continue to develop, efforts to secure data will continue to evolve.

The development of new and exciting healthcare technologies and applications will continue to bolster the development and of the growing number of electronic patients.  Ultimately, the Apple smartwatch and other soon to be developed health indicator monitors, trackers and data repositories will only serve to further engage both patients and doctors and, in my opinion, significantly improve our ability to intervene EARLY and prevent the terrible consequences of chronic disease.



Managing Risk and Modifying Lifestyle: The Role of Mobile Applications (Can an App a Day Keep the Doctor Away?)

Applications for mobile devices are commonplace.  These small but often sophisticated programs are quite varied and allow for anything from vehicle GPS navigation (Google Maps), taxicab or car pickups in New York City (Uber)  or rating wines and restaurants (Zagat).  As with most new gadgets and technologies, medicine and healthcare provide many opportunities for expansion and use. When we examine the available applications found at the Apple App Store, it is evident that medical mobile applications continue to be developed at a remarkable pace.  In response, the FDA is actively involved in developing strategies for evaluation and approval of new medical related applications as the market continues to rapidly grow and evolve. (And that in itself is a whole separate issue blog about!)

As the medical application industry grows, more disease specific programs have been created.  There are already several advanced apps that allow for tracking medications, daily weights, blood pressure and blood sugars–However, some of the more popular applications focus on more basic strategies for improving overall health status.  Many of these newly developed general health and fitness applications focus on self help, diet and exercise.  As we all know, diet and exercise are key components to making wholesale lifestyle changes and these changes can significantly reduce risk for chronic disease.  It stands to reason that many of the new medically relevant applications have focused on tracking dietary habits–calorie counts, food dairies, etc.  In particular, dietary applications can make a huge difference in our behaviors.  For instance, an application that tracks everything you eat can be quite eye opening.  In general, we have no idea as to the calories we take in on a daily basis–combine this with an app that can also track calorie expenditure and you have real time data that can be the impetus for change.  Data empowers us all–both doctor and patient.

This week in the New York Times, personal tech author Kit Eaton explores several new applications for iOS and Android that are specifically devoted to diet.  These applications provide the user the ability to create a food log and to actually scan labels to obtain exact nutrition information and calorie counts.  These applications then can track your exercise habits and estimate your calorie expenditures–some are even able to make suggestions for healthy food choices based on your pattern of intake and output.  Most start with the input of basic data such as height, weight and age.  Particularly in our current era of cost containment and as we stand in the shadow of the albatross that is Affordable Care Act, we must spend more time on prevention.  Preventative care is the single most important thing physicians can do for their patients during this time of reform.  We have long known that chronic conditions such as heart disease, type 2 diabetes and hypertension are directly related to obesity.  Obesity and obesity related illnesses account for nearly 150$ billion dollars of healthcare costs each year in the US alone.  Applications that provide assistance in lifestyle modification and risk factor reduction can have an enormous impact on our ability to successfully change negative habits. As we move forward as physicians, it will be important for us to engage patients and assist them in taking individual responsibility for their own health.  Applications are an important way for us to directly involve patients and promote change.

Based in California, an application known as Lift is working to make an impact now.  The motto on the Lift home page says it all:  “Unlock your potential..change your life”.  Working with researchers at UC Berkeley, Lift’s designers are now studying the effectiveness of individual diet plans on overall health and wellness.  Previous studies have compared the effectiveness of one or two diets against each other or a control–however, no one has ever evaluated several diets at one time via a mobile application.  The quantified diet project as it is known is likely to provide us with important information about the effectiveness of mobile technology and mobile “coaching” and its role in patient compliance and success.  Moreover, it will provide the opportunity to directly compare several popular diet plans all in one large study group.

Mobile applications have the potential to revolutionize preventative care.  As we continue to work to engage our patients and motivate them take individual responsibility for their health status, we must take advantage of emerging technologies.  Simple applications may result in significant changes.  Embrace change.  Embrace technology.  Advocate for your patients and prescribe an app today! (An APP a day make keep the doctor away!)


Considering A Divorce From Your Doctor? Here’s What You Need to Know

Just As in marriage, the ability to communicate is essential to any successful doctor-patient relationship.  In fact, the most successful doctor-patient relationships are a lot like a marriage.  Both parties must be willing to listen, to negotiate and to support each other’s decisions.  As I have stated in many previous blogs, outcomes improve significantly when patients are engaged in their own healthcare.  Engagement only occurs when doctors and patients are able to effectively work together to solve health problems.  The days of the paternalistic physician dictating lifestyle changes and treatment plans are long over.  Today, patients are better informed and armed with information as they enter the office for consultation.

Unfortunately, just as in marriage, not all doctor-patient relationships work out.  Sometimes changes have to be made in the spirit of moving forward with effective healthcare. This week in the Wall Street Journal, author Kristen Gerencher addressed the issue of “When to fire your Doctor”.  In this piece Ms Gerencher provides sound advice on how to determine when it is time for a change.  She mentions 5 warning signs that may indicate that a divorce and remarriage to another provider is important.  In particular, if you feel worse when you leave your physician’s office than when you arrived, it may be time to consider a change.

Here’s my take on the warning signs that the WSJ mentions:  (the warning signs listed are directly from the WSJ article, the commentary below each one is mine)

1. You leave with more questions than answers.  

It is critical that physicians take the time to communicate clearly to patients.  Essential to this communication is allowing time for questions AND clarifying any misunderstandings or addressing concerns about a treatment plan.  This can be challenging for doctors in the current healthcare environment where federally mandated documentation requirements and pressures to see more patients in less time are limiting the time once dedicated to patient discussion.  However, it is essential to the health of the doctor patient relationship that physicians do not allow these conversations to be pushed aside.  Remember, patient engagement is key.  An informed patient is much more likely to be engaged.

2. Your doctor dismisses your input.

In the age of the internet, patients often come armed with lots of information (lots of which is unreliable and shady at best) that is obtained from online searches.  Rather than simply dismiss the information as junk, it is important to guide our patients to more reliable and more accurate sources of internet information such as MedPage Today and other good patient friendly information sites.

3. Your doctor has misdiagnosed you.

Medicine is not a perfect science.  It is important that you work with your doctor every step of the way along your path to diagnosis.  Mistakes in diagnosis happen–however, these mistakes are not always negligence.  Consider if your physician has carefully considered your problem and has provided a well thought out differential diagnosis before leaving due to a misdiagnosis.  It is important that communication continues during the process of misdiagnosis.  If there is no good communication at this stage, it may be time to choose another provider.

4. Your doctor balks at a second opinion

A good physician is never afraid of a second opinion.  In fact, I often welcome a second opinion in cases where there are multiple choices of a plan of action.  It is essential that patients feel comfortable with their treatment plan–a feeling of comfort breeds engagement and engagement is key for success.  As physicians, we must be willing to put our egos aside in order to provide the best possible care for our patients.

5. Your doctor isn’t board certified.

When choosing a physician, it is vital that you examine his or her background and training.  Typically, doctors must complete a course of training in residency and fellowship in order to be boarded in a particular specialty.  Board exams (some written and some oral) must be passed and competency must be proven.  Once certified, physicians must maintain competency through continuing medical education and re-certification every 10 years.  If your doctor is not board certified, it is not necessarily the end–ask why.  There are several reasons that they may not be including overseas training that is not recognized in the US by the US societies responsible for board certification.

Choosing a doctor is a lot like choosing a spouse.  Decisions should be made in cooperation with one another and both sides must contribute to planning and execution of the chosen course of action.  Patients must weigh options, consider pros and cons and discuss issues with their provider and the provider’s staff when unhappy with a particular physician or physician group.  IF communication is not productive and there is no engagement, patients must make a change.  Good healthcare is a two way street.  Doctor and patient must work in concert in order to achieve optimal outcomes.