Health Literacy and Consumer-Facing Technology Workshop Summary (2015) / Chapter Skim
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3 Health Literate Digital Design and Strategies
3 Health Literate Digital Design and Strategies
Pages 15-42
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From page 15... ...
Alex Krist, associate professor of family medicine and population health at Virginia Commonwealth University, spoke about patient portals as an example of a consumer-facing health technology. The three experts who commented on these presentations were Dean Hovey, an experienced entrepreneur and currently president and chief executive officer of Digifit; Catina O'Leary, president and chief executive officer of Health Literacy Missouri; and Lana Moriarty, director of the Office of the National Coordinator for Health Information Technology's (ONC's)
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This population continues to experience an increase in the number of new HIV infections, particularly in young Latino and African American men, despite the fact that the number of new cases in the American population in general has remained constant over the past few years. "We need something to target this population," said Schnall, and given the age of the target population, mobile health technology in the form of an app should be an appropriate venue for delivering health information.
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A thematic analysis of the focus group sessions revealed five broad categories of what the participants wanted in an app: • Information management, or the ability to manage their own health information, such as the time of their most recent HIV test or physical; • How to stay healthy, including information on diet and exercise; • HIV testing information; • Chat or other communication functions that would enable them to stay in contact with peers, health counselors, and health care providers; and • Access to resources. With the relevance cycle complete, Schnall's team conducted activities related to the rigor cycle, which included an environmental scan of the existing literature related to both mobile health interventions and electronic health interventions that had been used with high-risk men who have sex
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The final cycle, the design cycle, had two components: the develop/ build and evaluation phases, with activities centered on creating a highly usable app that incorporated the five categories of what users wanted in an app. As part of the design phase, Schnall and her colleagues conducted two 90-minute design sessions with the same group of 6 participants, ages 20 to 25, who were asked to tell the developers what the app should look like given the 5 broad categories.
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Location Rating Cost Waiting Time Testing Log Picture of Test Results Last Date Tested Chat/Communication Medical Providers Contact for PrEP Link to Emergency Contact/Resources Live Hotline Social/Peer Forums for Social Support Social Media Links Resources Support Group Locations Voice Activated "Siri" GPS Mapping Condom Distribution GPS Mapping and Locations Information on Condom Distribution Sites Latest HIV News Newsfeeds SOURCE: Schnall presentation, March 24, 2015.
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. She also noted that the sexually transmitted disease report screen underwent the most remarkable changes, both in terms of the overall look of the page and the use of colors to denote the difference between a positive and a negative test result.
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SOURCE: Schnall presentation, March 24, 2015. THE FEDERAL DIGITAL STRATEGY AND HEALTH LITERACY2 Read Holman began his presentation by explaining that part of his role at HHS is to bring what he called "entrepreneurial methodologies" of the sort that are often associated with Silicon Valley into HHS.
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Instead, the strategy was aimed at the larger world of digital government and the direction of the information technology industry and its impact on society. The document that lays out the federal digital strategy (The White House, 2012)
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One challenge, for example, was to create an attractive patient record that an individual can download using the Blue Button. More than 230 developers responded, producing what Holman characterized as a number of beautiful and inspiring examples of apps and websites for displaying patient records.
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He noted that government websites are increasingly being built using this approach to responsive design to produce websites, mobile apps, and tablet apps that are consistent in the way they present information. In what he called a quick note about a data-driven future, Holman quoted President Obama, who said, "We want every American ultimately to be able to securely access and analyze their own health data so that they can make the best decisions for themselves and for their families." Meeting this goal will be difficult without health literate, consumer-facing technologies, for most Americans are not going to download their entire patient record, create macros in Excel, and analyze their data.
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When thinking about patient portals, one fact to keep in mind is that two-thirds of primary care practices now use EHRs and 60 percent are participating in meaningful use, which means that they need patient portals. What this means for patients, explained Krist, is that they might have distinct portals with their primary care doctor, their specialists, the radiologist, the insurance company, and the laboratory company.
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This design is based on the Health Literate Care model, Krist explained, and takes a universal precautions approach that assumes that everyone is at risk for not understanding the information. Even with taking a universal precautions approach, he noted, patients can take away different meanings than what health care professionals intend.
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HEALTH LITERATE DIGITAL DESIGN AND STRATEGIES 27 FIGURE 3-4 An example of the MyPreventiveCare user-friendly patient portal and the page detailing the preventive care a particular female patient needs. SOURCE: Krist presentation, March 24, 2015.
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"They were more likely to go and get recommended care including screening and immunizations, and we saw increases of 12 to 16 percent for breast and colon cancer screening," said Krist. In some practices, breast cancer screening rates were already high, yet this type of information increased those rates to what may be a ceiling, which Krist called encouraging.
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One of the challenges he and his colleagues encountered was getting information to patients at the right time, so the research team tried to engage people by sending them alerts before visits to have them review information and prepare themselves to be partners in making decisions about cancer screening, for example. This worked to some extent, but Krist said that further work is needed in the area of culture change to better inte grate this process into the normal workflow.
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"Most providers have never been in a place where they had 24/7 data and have been able to get into a person's home, so I 4 Thissection is based on the comments of Dean Hovey, an experienced entrepreneur and currently president and chief executive officer of Digifit; Catina O'Leary, president and chief executive officer of Health Literacy Missouri; and Lana Moriarty, director of the ONC's Office of Consumer eHealth.
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The final reactor, Lana Moriarty, said that Holman's comment about looking to the private sector for innovations sums up the way ONC approaches much of its work in the field of health literacy. "We try to find the best practices, try to bring those to the table, make sure the right people
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In fact, her team has been looking at an architecture that wraps data around a person instead of having it spread across disparate places, so she is eager to talk more about how to make that happen. DISCUSSION To start the discussion session, Suzanne Bakken asked the panelists and reactors if they had ideas on how to create a story arc for the use of consumer-facing technologies that takes health literacy into consideration, and if so, what some of the key targets for that story should be.
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"We've been trying to shift who is doing activities within practices as part of our strategy," said Krist, who added that he believes "there are many untapped opportunities where promoting health literacy, building teams, sharing information, and creating partnerships can really change what we can do." Wendy Nickel, director of the ACP's Center for Patient Partnership in Healthcare, commented that 30 percent of ACP members are still in solo practice even with the move toward patient- entered medical homes and c care teams. "These practitioners who are in solo practice don't have the time to sit down with their patient and go through their apps." Hovey added that smartphones may not be the answer for all patients -- the means to deliver this technology could be television and a remote con
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She added that her team has been studying how patients contribute to and manage their health care, what their goals are, and how they account for those life goals. If the whole point of being healthy is for a person to be able to do what he or she wants for as long as possible, asked Moriarty, at what point is it possible to create a story arc that enables an individual to use one of these technologies to help plan what to do to meet that goal and to become a partner with the entire care team?
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, which was created as a one-stop shop for consumers to understand their legal rights to their electronic health information and to better prepare themselves for conversations on the topic with their health care team. The site was launched in September 2014 and already has 600 members who have committed to open data and giving consumers access to their data.
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Hovey said that can certainly help, but that smartphones and computers are not going to work with everyone. Today, he noted, a significant percentage of the population that most needs health information grew up in an era of radio and analog technology, and that group of people is likely to be more comfortable with a different type of user interface.
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He reminded the workshop that the Starbucks logo has undergone changes over time to reflect the fact that they needed to first introduce the lady on the logo and get people to associate that the lady equals Starbucks. "There's a mental translation between icon or brand and plain language, and I think where we the experts get stuck is in that middle layer, where we try to use words, but we're actually using jargon.
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If Digifit can design an app that allows more of these individuals to receive less expensive in-home care and involve family members to provide part of the care, there may be an opportunity for the company to carve out some of the resulting savings. Laurie Myers, lead for health care disparities and health literacy strategy at Merck, asked if the change in payment models that is occurring is creating opportunities to finance the need to put these technologies into the hands of those who need them most.
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Krist added that changing reimbursement policies are creating an opportunity for technology to help shift the cost curve as accountable care organizations take root and the demand for care coordinators, case managers, and patient navigators, many of whom have health literacy issues themselves, grows. Myers agreed and said that technology aimed at these new members of the health care team can help address these health literacy issues.
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Doctors cannot be gatekeepers preventing use and if patients chose not to use technology then practices may suffer on some performance measures. Erin Kent, program director in the Outcomes Research Branch of the Healthcare Delivery Research Program at NCI, noted that recent research (LeBlanc et al., 2014)
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The result was that the two of them engaged in a conversation on things that Hovey found important, but this episode illustrates the point that most doctors need training when they are also using a computer in the examination room, on how to engage their patients in a way that is most meaningful. In closing the discussion, Rosof said that what he heard is that one of the most valuable attributes in the doctor–patient relationship or the health care team–patient relationship is trust.
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