Archives March 7, 2014

WhatsApp Lessons to Engage Patients

by Barry P Chaiken, MD

Information technology has achieved some amazing changes in consumer behavior. Over the last 20 years, companies have decreased their costs simply by transferring the work previously done by employees to consumers. For example, think about the last time you took an airline trip. You probably bought your ticket online through an airline or travel website. You printed your boarding pass at home, at the airport kiosk, or pulled it up on your smartphone.

If you checked a bag, you entered the data into the airport kiosk while the agent simply checked your government ID and placed the tracking tag on your bag before tossing it onto the luggage belt. Does anyone miss the paper folder we used to hold our boarding passes and itinerary?

If you reviewed the typical airport counter a decade ago, you saw more than a dozen agents working quickly to assist travelers. Today, just two or three agents hold court at the counter. Instead, you see busy travelers doing much of the work formerly done by those agents.

Numerous other industries present a similar story. Many of us do our banking using ATM machines and online portals. We deposit checks and transfer money using our smartphones. Do you remember the last time you visited a bank and interacted with a teller?

Similarly, we often stroll to the check-out counter in our supermarket, pharmacy, or hardware store to scan each of our chosen store items. We then swipe our credit card or deposit cash into a slot to pay for our goods rather than watching a clerk do this all for us.

Rather than think this consumer engagement only benefits the companies deploying the technology, consumers embrace these new processes because they also obtain benefits from doing so. Wait times at the airport are shortened, while trips to the bank become rare occasions. Convenience and control trump the additional effort required of the consumer.

HIT lags other industries

While information technology assists other industries to reduce costs and improve processes by transferring some of the work to engaged consumers, healthcare lags in its use of information technology to similarly engage patients. And this is not only about decreasing costs. Engaged patients are more likely to remain healthy by taking responsibility for their care, following prescribed therapies, and utilizing care appropriately. The lessons from other industries have not to date significantly impacted the use of patient focused information technology to change processes and accompanied outcomes.

Although many vendors offer patient portals as part of their electronic medical record (EMR) offering, these applications provide limited functionality and usefulness to patients. Allowing patients to use portals to obtain test results, seek patient education documents, or communicate with a physician, offers some value but does not engage the patient in a compelling manner. In addition, the IT structure of these portals limits the information available to patients from a single source due to their lack of interoperability and comprehensive functionality.

Comprehensive solution only

Lessons learned from our experience with smartphone applications shows that only applications that provide a comprehensive solution successfully engage consumers. For example, WhatsApp, with just 55 employees, recently sold to Facebook for $19 billion. In five years its founders built a communication service that now supports more than 450 million monthly active users worldwide and more than 320 million daily active users. WhatsApp charges a nominal fee of $1 per year after the first year of use.  What fueled the tremendous growth of WhatsApp in such a short time? Perhaps this description of the application taken from sheds some light:

WhatsApp Messenger is a cross-platform mobile messaging app which allows you to exchange messages without having to pay for SMS. WhatsApp Messenger is available for iPhone, BlackBerry, Android, Windows Phone and Nokia and yes, those phones can all message each other! Because WhatsApp Messenger uses the same internet data plan that you use for email and web browsing, there is no cost to message and stay in touch with your friends.

The key words above include “cross-platform”—think interoperability—and “uses the same data plan,” meaning it leverages existing ongoing costs to consumers while eliminating the need to pay for SMS text messages. In addition, WhatsApp provides a single comprehensive solution for consumers who want to communicate with others using text messaging. WhatsApp is independent of mobile network and smartphone operating systems, allowing consumers to connect with anyone, anywhere, at anytime for a nominal cost. What would a similarly designed application that helps consumers manage their health look like?

Consumer-grade health portal

A patient portal fails to provide a broad solution to engage patients. Its narrow view of a patient’s condition focuses on segmented, siloed care delivery rather than a comprehensive, independent point-of-service view. Therefore, patients are forced to access multiple patient portals to obtain a complete view of their health, thereby making it very difficult for them to understand and actively participate in their own care.

Applying a WhatsApp approach to patient portals morphs these portals into a health portal—a solution that provides consumers with a complete, easily accessible view of their health while offering consumers the ability to act upon and enhance their health record and maintain their health. Rather than limited to segmented and non-interoperable patient data sources, a consumer-grade health portal applies the best approaches to consumer engagement, as learned from other consumer-focused industries, to help consumers manage all facets of their health.

The health portal capabilities expand beyond information that is collected within provider organizations and includes data created by patients themselves. Examples include data collected by popular apps such as MapMyRun and self-generated sensor data created by Internet-of-things devices such as FitBit.

In addition, a health portal helps consumers manage their own care costs by translating explanation of benefits (EOB) and other cost correspondence to make them meaningful. The portal processes such communications through covered benefits rules that report and track individual healthcare costs including out-of-pocket deductibles, copayments, and deductions from health savings accounts (HSA), and flexible spending plans (FSA). Lastly, the health portal integrates with provider applications allowing for online appointment scheduling, telemedicine, patient-physician communication, and access to patient education. Although offering all this functionality within one application appears difficult, it offers the only solution that can provide meaningful consumer engagement and impact population health.

Following the lead of other industries by engaging consumers presents a tremendous opportunity for organizations to reduce their labor costs by transferring activities currently completed by staff to consumers willing to engage due to the convenience and value offered by their active participation. It is WhatsApp time for patient engagement.

Excerpts from “WhatsApp Lessons to Engage Patients” published in Patient Safety and Quality Healthcare

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