What is patient engagement? How do we create it? This talk proposes that focusing on human qualities and applying user experience design processes can help health information technology professionals with this key goal.

1. Understanding
Patient Engagement
Elizabeth Bacon
HIMSS Usability Task Force
Jan 21, 2014

2. Agenda
•
Introduction
•
Quest for patient engagement
Strategy for digital health engagement
Case study: Find Wellness
Last note, Q&A
•
•
•
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

3. Introduction
Liz Bacon
1999-2002 Cooper
2002-2007 St. Jude Medical
2007-2010 IxDA Director/Vice-President
2007-now Devise
2012
2012-now
Elizabeth Bacon
Providence Health & Services
Find Wellness
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

4. UX Sundial model
“UX” is an umbrella term for a range of disciplines
UX specialties operate
on a spectrum of
“soft” skills:
• Understanding
• Definition
• Communication
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

5. Agenda
•
•
•
•
•
Elizabeth Bacon
Introduction
Quest for patient engagement
Strategy for digital health engagement
Case study: Find Wellness
Last note
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

6. Healthcare is broken (sorry!)
“Healthcare is broken. ... We have set
up a delivery system that is fragmented,
unsafe, not patient-centered, full of
waste, and unreliable. Despite the best
efforts of the workforce, we built it
wrong. It isn't built for modern times." *
* Dr. Donald Berwick (who oversaw Medicare & Medicaid) as quoted by Richard Anderson at
http://riander.blogspot.com/
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

7. “Behavior change”
•
We can’t “motivate behavior change”
•
•
Paternalistic view that removes individual agency
Instead, we facilitate behavior change
**
“Teachable moments”
Where we usually reside
** from Dr BJ Fogg, Director of Persuasive Tech Lab at Stanford University, as presented at Healthcare
Experience Design conference on March 27, 2012
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

8. Healthcare’s new goal
• Quest for patient engagement
• One way to assess engagement is the “Patient
Activation Measure” (PAM) model
**
* diagram from Insignia Health Solutions http://www.insigniahealth.com/solutions/patient-activationmeasure
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

9. Improving behavior
• Results suggest that improved behaviors follow
on increased activation*
* from Health Services Research publications by Judith Hibbard, et al. such as http://www.ncbi.nlm.nih.gov/
pmc/articles/PMC1955271/
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

10. To increase activation
We need to:
• build patients’ confidence
• build patients’ understanding
• grow their skills
• facilitate healthy behaviors
• address inevitable back-sliding
Is that all?
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

11. Engage personally
• We have to understand individuals, first and
foremost
• Healthcare system needs to treat the whole
person, across all our life contexts
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

12. Connected world
•
We have to reach and activate people wherever
they are, whenever they act
•
Digital channels are key cost-effective, modern
way to extend the reach of care delivery system
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

13. Problem: it’s all transactions
Each encounter for a patient with the healthcare
system is a distinct, separate transaction.
!
•
•
Elizabeth Bacon
It’s rare for any transaction to be related to
earlier transactions.
It’s not yet happening that today’s transactions
are related to FUTURE transactions…
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

14. From transactions to
engagement
21st century
business models
must evolve from
systems of records
and transactions to
systems of
engagement
*
Elizabeth Bacon
http://www.dachisgroup.com/2011/06/movingbeyond-systems-of-record-to-systems-ofengagement/
*
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

15. How it looks today
• Kind of ecommerce model — but applied to the
vital business of health
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

16. Must consider context
Arguably healthcare’s greatest IT problem is the
plethora of disconnected, 3rd party systems that
ostensibly support care delivery
!
• Must always consider the bigger picture:
the patient’s perspective
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

17. Alternative care models
We do have to explore and embrace alternatives
•
•
Accountable Care Services: new business
model being explored by delivery systems and
encouraged by government regulation
Moving from fee-for-(face-to-face)-service to
fee-for-quality-outcomes demands greater
efficiency at scale
!
•
Elizabeth Bacon
Question remains, how will quality be
measured?
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

18. What can we do in our work?
If HIT systems of record can’t even manage
related transactions well, or be proactive, then
how can we expect to build patient
engagement and facilitate behavior change?
!
Let’s keep in mind a few things, focusing on
positively-oriented, real human traits…
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

19. People are emotional
Decision making is compromised when
negative emotions hold sway.
!
!
!
“Emotion may interfere with patients'
understanding of the risks and tradeoffs of
treatment options and with their ability to
make good decisions. … Group Health
Cooperative in Washington state saw a
26% and 38% drop in hip and knee surgery
rates, respectively, after the HMO adopted
video and written patient decision aids.”
* Research as discussed in Modern Health Care article published 2013-12-07
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

20. Not all are health literate
“Health literacy and health numeracy are
something that is a problem for everyone, even
college-educated folks and doctors.”*
!
When we receive upsetting health news, we’re
often in one of the worst positions to absorb
information and act rationally.
* Quote from Catharine Clay, director of shared decision making education and outreach for the
Dartmouth Institute of Health Policy and Clinical Practice, in Modern Health Care article ibid
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

21. Can’t we just ask people?
The most satisfied patients have a 26% higher
mortality rate, AND
Had 9% higher medical costs;
Spent more on drugs; and
Were more likely to be admitted as inpatients.*
!
So, no, we can’t just ask people whether they’re
satisfied and be done…
* Researchers at University of California-Davis analyzed responses from 51,946 adults between 2000
and 2007 for the national Medical Expenditure Panel Survey, as covered by Advisory.com
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

22. Focus on quality of life
"Quality of life happens to be the
element that is most important in
motivating people to deal with an
illness.”*
This may sound obvious, but it speaks to how
people want to feel in their engagement with the
healthcare system.
* Noreen Clark, director of the Center for Managing Chronic Disease at the University of Michigan, as
quoted in “The Simple Idea That Is Transforming Health Care”
http://online.wsj.com/article/SB10001424052702304450004577275911370551798.html
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

23. People exist in context
Patients have families whose feelings weigh on
their decisions
!
Patients may also be caretakers — or have
caretakers
!
Individuals operate according to their own goals
and values (albeit within broad behavioral
categories that we can identify through research)
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

24. Agenda
•
•
•
•
•
Elizabeth Bacon
Introduction
Quest for patient engagement
Strategy for digital health engagement
Case study: Find Wellness
Last note
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

25. Strategic interaction
framework for healthcare
• Interaction framework for healthcare is a blended
model:
– Transactions ≈ ecommerce
– Engagement ≈ social media
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

26. Back to the people
We have to understand what people value, what
their behaviors are today, and what their goals are
!
• We can create more engaged patients and
facilitate preventative health behaviors when we
truly know them…
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

27. Strategy for engagement
A digital health engagement strategy boils down
to three elements:
!
1. Know the people you want to serve
2. Facilitate behavior change
3. Create systems of engagement
!
!
UX processes give us the roadmap
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

28. UX Process
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

29. Know the people
Do user research & create persona models —
understand your specific domain
!
“It depends” — you must focus on your actual
contexts of use
!
Prioritize IT development by using persona
classification to manage different users
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

30. Facilitate behavior change
Capitalize on existing healthy behaviors that you
now understand
!
Ride the motivation wave by becoming embedded
into their daily lives
!
Serve people’s goals, as articulated by personas
!
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

31. Create engaging systems
Move beyond viable and feasible — build
desirable experiences
!
Desirable
Viable
Elizabeth Bacon
Feasible
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

32. Agenda
•
Introduction
Quest for patient engagement
Strategy for digital health engagement
Case study: Find Wellness
•
Last note
•
•
•
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

33. Origins of Find Wellness
Positive preventative care behaviors include
seeking care from practitioners of acupuncture;
massage; chiropractic; coaches; counselors;
meditation teachers…
• CAM is 1% of total healthcare spending:
~$23 Billion in 2013
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

34. Problem identification
It’s hard to use the web to find qualified providers
Practitioners are passed around through word-ofmouth
!
Providers aren’t very tech savvy or marketing savvy,
and they need help running their businesses
!
America is still fairly ignorant of the efficacy of
many ancient healing modalities
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

35. Spark of wellness
Hypothesis: healthy behaviors can be contagious!
!
• Facilitate connections and foster a quality source
of “help care”
• Use PROMs to measure quality and feed that data
back into health tracking tools & provider
recommendations
• Creates longitudinal engagement that benefits all
participants
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

36. User research
We conducted research to understand people
and their real-life situations
!
Generative research tool to discover today’s
obstacles and opportunities (“unmet needs”)
!
Best practice: ethnographic-style research
involving interviews and observation in the
user’s context
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

37. FW research
Met users in context, discussed their current habits
and experiences with CAM, identified today’s
successes and issues, considered future states…
!
• Consumers
• Practitioners
• HR Directors
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

38. Created personas
Archetypal user models based on behavior
patterns discovered among target demographic
!
•
•
•
•
Elizabeth Bacon
Keeps us focused on specific needs (while
representing the needs of many)
Builds a shared understanding of users for
team
Reduces self-referential design
Supports feature prioritization among a set of
personas
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

39. FW persona set
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

40. Classification & focus
Focused on primary personas Janelle & Alexa
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

41. Ideate and model
Created paper prototypes of key interactions
• Conducted guerrilla usability testing with people
like Alexa and Janelle
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

42. Built marketing website
Beta sign-ups and build social media connections
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

43. Interactive prototype
Created digital prototypes of system
• Conducted guerrilla usability testing with people
like Alexa and Janelle
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

44. Launched alpha in Oct
Focus on acquiring practitioners & building presence
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

45. Engaging search
Natural language
searches lead to list
of qualified providers
who serve that health
condition
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

46. Engaging health tracking
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

47. Engaging onboarding
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

48. Engaging networking
At our launch party in November, practitioners
expressed need for a place to network and develop
referrals…
!
so we created a private LinkedIn group and are
scoping referral functionality into our product
roadmap.
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

49. Iterate and keep iterating
Keep doing it over
and over again…
!
Add fidelity
!
Add learnings from
previous iterations
!
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

50. Agenda
•
•
•
•
•
Elizabeth Bacon
Introduction
Quest for patient engagement
Strategy for digital health engagement
Case study: Find Wellness
Last note
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

51. Points of light
• Healthcare Experience Design /
Healthcare Refactored: conferences
that help disseminate design thinking to
healthcare decision makers
!
• We need a multi-disciplinary effort to
get our heads around how to facilitate
behavior change and create systems
of engagement
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

52. Let’s get more UX designers
involved in healthcare!
• Reach out to and engage with
user experience designers for
key initiatives
• Bring UX speakers and trainers
into your organization
• Hook them with your passion
for solving wicked problems
• Collaborate, collaborate,
collaborate!
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

53. Find the right practitioners
for your needs
• Remember that not every “UX
Designer” is equally strong in
the skills of UNDERSTANDING,
DEFINITION and
COMMUNICATION
• Match your needs to the right
set of UX capabilities
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014

54. Thank you —
let’s keep talking!
Email: liz@deviseconsulting.com
Slideshare: Elizabeth Bacon
Twitter: @ebacon
Elizabeth Bacon
Understanding Patient Engagement
HIMSS Task Force - Jan 2014