The Informed Patient

Author: Charles Lee, MD

Patients and caregivers are seeking smartphone health apps that are adaptable to their needs.
Mobile health technology holds great promise to improve our health care system, especially to engage consumers. In 2012, 46% of all US adults owned a smart phone. In 2013, smart phone ownership had risen to 56% and 85% of all adults over age 18 had access to the Internet.1 Yet there appears to be a continuing disconnect between apps created by developers and apps that effectively engage consumers.

A recent review of Google Play and Apple AppStore found more than 200 mobile health care applications that were co-branded with health care organizations and targeted for patient engagement.2 Yet many health apps have failed to have an impact. There are apps that provide access to health records, allow appointment scheduling, prescription refills, and medication reminders—features that are often driven by what health care organizations believe patients need. However, according to data from the Pew Internet & American Life Project, the number of Americans using technology to track their health or fitness didn’t change between 2010 and early 2013.3 Even Google Health failed to find the right approach to engage consumers and discontinued its service in early 2012.

But there is a bright side to this story. Patients and caregivers really do want to use their mobile devices more to connect with their health care providers. But they want the developers to listen to their needs—not develop tools that annoy them with constant reminders (encouraging many to shut it off or remove the app completely) or only focus on things they would do just once a year (they forget how to use the app or can’t remember the password). So, if we are really interested in engaging patients—not just to check off a box to say “we have mobile technology”—we should start by better understanding the patient and listening to their needs. Here are 4 things to keep in mind:

Personal & Adaptable—The technology should be personal and adapt to the needs of each patient. All people are the not the same and technology shouldn’t treat them as if they were.

Illness: Healthy peoples’ needs are very different from patients with multiple chronic illnesses. We need to understand how patients vary based on their conditions. Identify repetitious tasks that lend themselves to time-saving technology.

Accessibility: Accommodate elderly and visually-impaired patients by enabling larger display fonts or content in alternate audiovisual media formats.

Health literacy: One of every 3 adults in the US has low health literacy, which is defined as the ability to 1) gather, 2) understand, and 3) act on appropriate health information. Because those with low health literacy are at the highest risk for preventable negative health outcomes, they are the ones who can most benefit from technology support. We can’t expect patients to become engaged if they can’t find or understand health information.

Language: Similarly, about 8% of adults have difficulty with the English language and really struggle understanding and navigating the health care system. They represent one of the most vulnerable populations and are at high risk for medication errors. And language doesn’t mean just Spanish. There are many other languages spoken in the United States.

So, one of the first goals for app developers should be to build tools that can adapt to the needs of each individual patient. In order to do this, we need to be better listeners and not assume that we know better than our patients about what they need. And don’t give in to the temptation to focus on the more highly educated, early adopters of technology— they may be easy targets but they don’t represent the patients who can benefit the most.

Routine vs Infrequent—Consumers should want to use the technology routinely. The challenge for developers here is finding the right balance of motivation and encouragement without annoying them with constant reminders. Again, find out what’s important for each patient or caregiver. Is it communication? Quality of life? Difficulty remembering? Repetitive tasks? Remote caring? Patents and caregivers (caregivers are usually very motivated and one of the earliest adopters of technology) should want to use the features frequently. Tasks that are performed once or twice a year are not engaging and the burden of relearning how to perform infrequent tasks makes them inconvenient for most users. Forgotten user IDs and passwords are common barriers to use in these cases.

Simple & Quick—Keep the app design simple, clean, relevant, and obvious. Remove unnecessary clutter by adapting the content to each user. Access to features and information should be quick and obvious, not buried several layers down. Test your interface with people off the street and just observe what they do. See where they get stuck. Keep repeating until your design becomes obvious. An attractive, clean design will encourage users to come back and promote your tool to others.

Rewarding—This is the part that most developers forget—the reward. Does the app make users feel good or provide an incentive for being engaged? Apps should also appreciate the effort of users for using it. For example, if users are able to access their personal health record, does the system recognize and encourage their input to keep the records updated? Or does it cause frustration because it is uneditable, even if they find errors? Examples of some other types of rewards include convenience (appointment scheduling), cost saving (discount on services), time saving (wait time monitoring), tracking (lab updates of relatives by caregivers, peak flow readings), and remote communication (access to nurses for questions).

Consider these 4 issues during your app development, and you’ll soon be on a solid foundation to create active and informed customers.


Charles Lee, MD, is the founder and president of Polyglot Systems, Inc. He received his Doctor of Medicine degree from Northeastern Ohio Universities College of Medicine and is board certified in internal medicine. He was a National Library of Medicine Fellow at the Duke/ University of North Carolina medical informatics program.

References:
  1. Smith A. Smartphone ownership 2013 [published online June 5, 2013]. Pew Internet and American Life Project. http://pewinternet.org/Reports/2013/Smartphone-Ownership-2013/Findings.aspx.
  2. Conn J. More than 200 available apps co-branded with healthcare organizations [published online September 19, 2013]. Modern Healthcare. www.modernhealthcare.com/article/20130919/BLOG/309199996#.
  3. Fox S, Duggan M. Tracking for health [published online January 28, 2013]. Pew Internet and American Life Project. www.pewinternet.org/Reports/2013/Tracking-for-Health.aspx.