StayWell is a health engagement company that helps its clients engage and educate people to improve health and business results. Nicole Latimer joined StayWell in 2016 as president and became CEO in 2017.
How do you maximize the best possible outcomes when it matters most?
A few years back, one of our clients — a large academic medical center (AMC) — invited my colleagues and me to attend its patient and family council. This AMC would regularly bring in patients and family members to provide the organization with feedback and advice on how to better provide their services and improve the patient and family experience.
At this forum, we heard from patients who spoke passionately about the need for consistent and accessible education. One was a terminal cancer patient who described how she had to become her own researcher. She had to go and find out what the appropriate next steps and treatment actions were. At the time, she had only been provided with one sheet of paper that described one option, and she was pretty sure that it wasn’t comprehensive. She researched on the internet to find information relevant to her condition, and she came back to her physicians to show them what she had found.
What this patient expressed to us was that she was incredibly motivated to do her own research because she had a terminal illness. “This is how I had to spend my last few months, making sure that I got the right treatment, making sure that I got the treatments that were relative to what I wanted out of life,” she said.
That really brought the need for patient education home for me. I started to wonder: What happens to the patients and the families who aren't that motivated to do their own research or lack the skills to do so? Might they be given a limited amount of information and routed through the system without ever knowing that they have other options?
Patient education isn't just pamphlets and leaflets. Today's patients are sophisticated technology users, and they have the opportunity to interact with and understand any data or information that pertains to their health.
The evolution of patient education
In the not-so-distant past, patients had only one source for health care expertise: their personal physicians. They relied on doctors or nurses to monitor their symptoms, track changes in their health, manage their diseases and personalize their care. Today’s patients are more financially responsible for their health care, and they are also becoming more engaged in coordinating their own care or proactively managing their health. More than ever before, care activities are being administered in the home by the patients themselves or by caregivers. It’s no surprise that our industry requires a greater level of comprehension and education to empower patients and caregivers to follow instructions, deliver those care activities themselves and keep on track with a care plan.
For example, when we think of some of the care activities that are being delivered in the home, I look at patients who have had a prostatectomy. Often, the patient will be self-catheterizing or a caregiver will be catheterizing that patient multiple times per day. There's a tremendous amount of patient instruction and caregiver instruction that goes with that activity. Another example is that post-surgical hospitalization has dramatically shortened in the last decade, and that means the wound care that used to be performed at an inpatient facility is performed at home by the patient or the caregiver.
Training for the patients and caregivers in these circumstances — instructional videos, checklists or other materials — needs to be clear and understandable to make adherence easy.
High expectations of health IT for patient education
We’re all used to consuming content. We learn things via our smartphones or through portals that we access. We use sophisticated search engines that procure the exact type of information we’re looking for, often within seconds of searching. We’re so accustomed to easy and quick navigation that we expect the same experience from health IT (HIT).
Patients bring those types of expectations to us in our testing of patient education materials. They expect an interface that's as easy to use as YouTube so that they can find videos around health education topics they're interested in and quickly get to the topics that are relative to their health and well-being.
One of the interesting barriers that we see is how health systems approach information sharing. We see health systems running the entire gamut from those who want to be very open and transparent and share as much information with patients and caregivers as possible, to those who truly believe the most effective method of sharing is in an individual setting with a trained clinician who uses a teach-back methodology to ensure the patient and caregivers understand the information.
In other words, the health systems’ needs relative to the sharing of information haven’t been homogenous, and therefore, it hasn't been as easy for HIT providers to create one product or one service to meet client needs.
But informative, inspiring and technologically integrated patient education is making progress, led by innovations in HIT. For example, emergent solutions like Fast Healthcare Interoperability Resources (FHIR®) are offering hospitals, physician offices and health systems flexible new technology that is integrated into electronic medical records to deliver patient education at the point of care.
FHIR stands to offer significant efficiencies, including:
- Serving up relevant, pinpointed content to meet a patient’s immediate needs
- Reducing steps for physicians who are prescribing education to patients
- Increasing patients’ access to engaging, interactive information that helps them better understand their health care issues
- Providing high-quality digital and print content that engages patients to become more active in their health
We see FHIR as a significant step forward for the industry, offering a much more seamless and on-demand information exchange and improving the quality of service to patients.
Strong patient education is critical outside the clinical setting
The greatest educational risk occurs when the patient is outside of direct contact with the health system. While they're in front of a nurse or a physician in the office, in an inpatient setting or at a clinic, they can ask questions and receive information. It's when they go home and their spouse or caretaker asks them the second level of questions that the patient may realize they have forgotten details or need clarification, but they don't have ready access to information. That’s where HIT can help reduce the risk and improve the patient experience by making education much more accessible.
When patients can access that information in their patient portal or smartphone, and then email or text it to their caretaker, they become more engaged. This can potentially reduce their anxiety relative to the condition or procedure and truly provide the opportunity for discussion, reflection and empowerment. This is where choice comes in: Patients can think through the treatment options available, make decisions about what they can tolerate and what outcomes they seek. Ultimately, the treatment they pick is one that works for them as individuals.
Things like shared decision-making applications can help with preference-sensitive conditions, which allow a patient to understand the treatment options available and evaluate the advantages and disadvantages. This can guide them through a series of questions that they should be asking themselves and their doctors so that they can achieve the best outcomes. For example, someone with lower back pain might ask questions like, “Am I eager to get back to work? Do I want to resume an active sports-oriented lifestyle? Do I anticipate that I have comorbidities or other conditions that might impact the choice of treatment I'm going to take on?” This way, patients are guided toward the outcomes they want to achieve so that they're happier with the final results.
Likewise, programs that include guided journeys through chronic conditions can help increase patient engagement and health outcomes. In most chronic conditions, there are usually a handful of critical daily activities. For example, for diabetics, critical daily activities include checking blood glucose levels, blood pressure and weight. Programs should not only remind and reinforce those daily activities, but also provide greater education around the condition through fun, motivating pieces that help patients stay engaged in taking care of their health.
The future of patient education
Today, it’s most important for patient education materials to be interactive. Whether the content is video, audio or digital, it must engage patients. Online quizzes, puzzles and video vignettes are all good ideas, but unless they’re interactive, they won’t truly capture the patient’s attention and improve information comprehension.
The future of patient education belongs to augmented and virtual reality. It's about in-the-moment reminders through augmented reality: things that steer patients to make the right behavior changes or choices relative to their overall health.
Additionally, virtual reality will offer up the opportunity to visualize what it would be like if someone doesn’t maintain their health. Most of us can't imagine who we're going to be 20 or 30 years from now, and virtual reality will show us different versions of ourselves in the future based on the kind of behavior choices we're making today. That can be a powerful tool to help people understand why it's important to make small behavior changes today rather than waiting for an impending chronic condition.
Finally, patient education materials must remain relevant in the ever-evolving world that is health care discovery. Content that reflects the latest studies or findings lets patients feel confident in their decision-making.
Taking lessons from consumer behavior patterns
Patients are consumers for more of their lives than they are patients. They're walking into a health system and they're working with clinicians or a health care team with the same set of expectations they would have for a consumer experience. More and more, consumer experiences are becoming incredibly individualized and personalized. Retailers and other companies can observe purchase patterns and suggest the most appropriate next purchase or set of services that could be helpful.
That's exactly what patients expect from their health care team, and that's where interoperability and common IT systems help with communication — not only from clinician to clinician across the continuum, but also within the individual care team in a particular setting. It's important for clinicians to know what information has been provided to the patient, what education they did or did not understand and how that care team — regardless of where a patient is in the continuum —- can reinforce critical messages to ensure the patient sticks to their care plan.
Patient education has always played an important part in improving satisfaction, quality and cost. HIT-integrated patient education encourages patients to be active participants in their own health, lets patients understand and adhere to their care plans and improves efficiency through more informed patient-clinician discussions. Greater adoption of interoperability, digital health apps and other HIT innovations will only enhance these triple-aim outcomes by facilitating easily accessible, personalized education for each patient.