Viewing patient engagement through the lens of pathology

By Jonah Comstock
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Jonah Comstock - Babyforyou.net.ua Writer and Associate EditorThe key to cracking patient engagement isn't better kinds of technology, it's understanding patients better. That was the theme that emerged from a panel discussion at the Partners Healthcare Connected Health Symposium, where a doctor, a consultant, and two healthcare executives spoke about their own experiences working with patients in the healthcare system, especially patients with behavior health concerns like depression.

"Medicine at large is a people business in need of technology, it is not a technology business looking for people," Dr. Jordan Shlain, founder of HealthLoop, said. "There’s a lot of homesteaders, data gold diggers, people trying to take big data and make a business out of it while there are people hurting on the other side. And people don’t scale. Technology does, but people don’t."

Shlain argued that although many patient engagement programs make it easier for patients to reach out to their doctor, they still place the burden on the patient, who isn't always thinking clearly when they're anxious about their health. Instead, doctors should reach out to their patients.

"I think engagement needs to be viewed through the lens of pathology, meaning [establish] what doesn’t work," he said. "If people aren’t engaging, we should treat it like a disease, as opposed to this weird buzzword in the world of technology. And we need to acknowledge that when people are sick, they aren’t thinking clearly. And when you aren’t thinking clearly, you’re not a [rational] consumer."

Philip Graves, a consumer behavior expert at Shift Consultancy, argued that technology could proactively reach out to patients if it makes use of the smartphone and of natural language processing. 

"One of the biggest challenges we have in healthcare is extending the good work done into the context of the healthcare system into the context of people’s daily lives and daily life choices," he said. "As everyone who’s tried to drink a bit less or eat a bit less will attest, that’s quite hard to do in practice."

A smart app that can dialogue with patients about those daily life situations, and bring in the doctor if necessary, can help extend their treatments and therapies into parts of their lives their doctors can't possibly participate in. And if that device also tracks the patient or allows them to record their experiences, it could also provide new learnings about how well different longterm interventions work.

"As well intentioned as our interventions are with patients, when we throw them back into the world there are a whole series of contextual influences that will pull on them in ways that are incredibly hard to predict, we can’t predict," he said. "But if we build a relationship with them, and we can be there throughout the process to support them. And the further we can take that, the better it will be for patients’ lives and the better the outcome will be. The important thing is that the technology exists. What we’re looking for is the imagination and the right healthcare players to recognize that opportunity and embrace it."

Laura Adams, President and CEO of the Rhode Island Quality Institute, cautioned that apps that send data back to doctors can be an overload for the doctors themselves. But she believes that the right technology can mediate that data into smart alerts that only bring in the doctor when necessary.

The point the panel fixated on at the end, however, was once again about listening to patients; in particular, listening to their goals for treatment. Adams told a story of a friend with breast cancer whose first oncologist immediately jumped into a speech about how they were going to fight the cancer with chemotherapy or whatever it took. But the patient didn't want to fight the cancer at the expense of her quality of life; she wanted to live comfortably as long as she could and then end it quickly. She had to switch to a second oncologist to have that goal heard.

Shlain added that listening to patients' goals for care isn't just a one-time conversation, but also involves recognition that a patient's goal for treatment might change over time. Susan Edgman-Levitan, an executive at Massachusetts General Hospital, said it best in the closing words of the panel.

"I spend a lot of time thinking about how to engage patients in their care, which is very very complicated because you don’t know what your preferences are or your values are until you know what you’re faced with ...," she said. "One of the ways we’re trying to change that paradigm is to change the way our clinicians are thinking about this from 'What’s the matter with you?' to 'What matters to you?'"

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