When I saw the full agenda of the upcoming Stanford Medicine X conference, the name of one of the panels – “The ‘No Smartphone’ Patient” – jumped out at me. The conference is focused on the ways new technology intersects with health care, and it’s heavily attended by researchers, health-care innovators, and patients who strike me as likely to never leave the house without their smartphone or tablet. The topic seemed a curious thing for the organizers to offer.
Once I read the full description of the Sept. 5 talk, though, it made complete sense. Part of Medicine X’s aim has always been to empower patients to be proactive in their care and to contribute to the discussion on how technology can be used to improve human health. So if a significant chunk of the population is low-income and/or has limited access to health-enhancing technologies, it would be prudent for stakeholders to determine how to improve that access and how, exactly, to give those so-called “no smartphone” patients a voice.
Intrigued by the topic and wanting a preview of the discussion, I reached out to panelist Veenu Aulakh, executive director of the Center for Care Innovation (CCI), which develops patient-engagement innovations and provides support to the state’s safety-net providers (community health centers, public hospitals, and public health clinics). After noting that almost one-third of California’s population is considered underserved and vulnerable, Aulakh talked with me about what’s been done for underserved populations in recent years, how she believes the digital divide among various populations is shrinking, and what those attending “The ‘No Smartphone’ Patient” panel can expect to learn.
At Medicine X, you’ll be discussing some of the cultural, social, and economic barriers that prevent certain patients from fully engaging with health-enhancing technologies. Can you provide a hint of what those things might be?
There are a number of barriers for patients to fully engage with health-enhancing technologies. The solutions that are created today are often not built for low-literacy, non-English speaking patients. Having solutions in Spanish and written at less than a 4th grade reading level are critical for getting solutions adopted. In addition, many of these technologies are often introduced to patients via their health-care providers, and the solutions are not created at a price point that either safety net health systems or patients can afford. Also, the solutions need to be more reflective of the realities of patients lives – folks are extremely busy and don’t have a lot of time to hand-enter data or engage with technologies that don’t provide immediate value. If we’re going to get patients (and their providers) to use effective technologies, we need to make sure that they can see immediate benefits if they are to use these technologies regularly. Lastly, the smartphone penetration rate in low-income populations still isn’t at a level where it would be useful for most safety net providers to broadly offer smartphone solutions to their patients. As this changes, the adoption rate of health apps and similar technologies may rise as well.
Do you foresee a time when patients who currently face such barriers can become part of the e-patient movement?
I think there are already many vulnerable and underserved people who would consider themselves part of the e-patient movement. Health centers are now beginning to e-mail with patients, inviting them to participate in texting programs and starting to roll out other e-offerings. However, for more patients to join the e-patient movement, we need to reduce the barriers. As more patients move to smartphones, I believe we’ll see a shrinking of the digital divide. According to Pew Research Center, as of January 2014, 47 percent of low-income people had smartphones. As this number continues to increase, this will help low-income patients be active e-patients (assuming language, literacy and cost issues are addressed).
CCI works to bring various health-enhancing technologies to California’s low-income patients. What are some of the patient-engagement techniques you’ve seen delivered in recent years?
We’ve seen everything from building strong patient and family advisory groups who give input to clinics on how to better design care systems that are truly patient-centered, to launching efforts to hear from the patients about their needs through surveys, focus groups and ethnographic research. Many clinics are also starting to implement texting programs to follow up with patients between visits with appointment reminders, or send education reminders for patients with chronic diseases. They’re also starting to use remote monitoring devices like home blood pressure and blood glucose monitoring. The funding environment (and the limited resources of both clinics and patients) have hampered wide-spread adoption of these types of solutions, but clinics definitely see the value in engaging patients – with both high- and low-tech solutions.
How have your group and other safety-net providers involved patients in developing these techniques?
Many health centers have developed patient and family advisory groups to provide feedback to design these programs. Other clinics are beginning to use the principles of design thinking to better understand the needs of their patients and going beyond the traditional patient experience surveys to hear the real voice of their patients. However, much more work needs to be done to make this the standard of care.
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