A successful connected health program, in which patients use information, technology, and other tools to engage in their own care and self-manage conditions such as heart disease and diabetes, involves a lot of preparation. In fact, the planning for a connected health program begins well before you even launch a pilot program.
Any kind of change will be resisted by an equal, opposing force, observes Susan Lane, RN, corporate manager of technology and operations for the Partners Center for Connected Health (PCCH), which hosted its annual symposium in Boston last week. To create a program that can grow, you must have a clear focus and put measurements in place that will translate to a final scaled program if the pilot is successful, she said.
Connected health programs use technology to deliver care outside of the provider setting. For example, a program might connect patients and physicians via remote monitoring and e-visits and allow patients to upload their own data and track it online. The technologies and tools track medication adherence, weight, blood pressure, and other vital signs.
The goal of these programs is not only to get patients more involved in their own health, but also to give physicians and caregivers early warnings and a chance to intervene when a patient's health is declining, in order to avoid readmissions and trips to the emergency room.
Lane and four other members of the PCCH team outlined six steps taao creating a successful connected health program:
1. Create objectives and a justification
A connected health program typically starts off with a pilot, says Khinlei Myint-U, corporate manager for product development and communications at PCCH. But one step that's sometimes overlooked is setting a focus and a goal for the pilot. For example, a feasibility pilot would look at the impact on workflow and how the program affects the patient, while a research pilot would examine outcomes and utilization. Whatever type of pilot you're considering, be mindful of what you want to learn from the outset, she says, and create specific learning objectives that are defined in the very first stages of the project.
Another piece of advice from Myint-U: Even if leaders don't ask, include a financial ROI measurement. Identify the drivers of costs and benefits not only for the pilot, but also for the final scaled program. Of course, as payment models change so will the value equation, so be prepared to revise your numbers.
One of the reasons to create objectives and build a justification for your project is to get stakeholders on board. Be very clear about those objectives, Myint-U advises.
In designing a program there are several questions to ask: Who will the program target, and how will you find and enroll patients? How do you relay the expectations to the patients? What is the role of clinicians? What data will you collect and who will monitor it?
3. Choose technologies and operational processes
A big challenge in choosing a vendor to help build the connected health program is that the concept—and the technology to support it—is so new, says Rob Havasy, project specialist and operations manager at PCCH. Investments in new technologies and adapting existing technology to support your connected health program is not inexpensive. Further, you must test your capabilities with an eye toward the final scaled project in mind. "We don't want to just run pilots," he says. "We want to change healthcare."
One of the biggest operational challenges is physicians who are reluctant to turn patients over to the IT department or an outside vendor. Doctors want to protect their relationships with their patients. Be prepared to offer above-average support to both physicians and their patients. Help desk staff should be well-educated, highly compassionate, and well-paid, Havasy says.
4. Build adoption and engagement
Lane notes that organizations need two people, in particular, to overcome resistance and ensure success of a connected health program. The first is an executive champion—the highest-level person who can override "no" and authorize resources, money, and time as well as approve the pilot. The second, and equally important, person is an administrative champion, the "feet-on-the-street and make-it-happen" person. He or she will make sure the program has the right staff and technology and ensure successful project management.
In a connected health model, there are lots of end-users, including patients, caregivers, doctors, nurses, and social workers, says Alex Pelletier, PCCH's corporate team leader. Each of these groups has different needs and will require different adoption and engagement strategies.
The newness of connected health can make it tricky for end-users, especially patients. In a typical connected health program, 60% of patients might engage—sending in their reading daily, for example. So how do you reach the other 40%. "I don't think we have all the answers to all of this," Pelletier says.
Nudges and incentives can help improve patient engagement. Those might include automated reminders, such as text messages or emails and reminders and outreach from family members and providers. But none of these tactics will work all of the time for every patient, Pelletier says.
For providers, the key is to make life as easy as possible, he says. Recruit champions and influencers first—those who are willing to try something new, share what they learned with their larger circle of peers, and convince others that connected health is the right thing to do.
Maintaining engagement is another challenge. Clearly communicating program goals and what each user must do to accomplish them can help, Pelletier says. Define what a healthy program looks like and watch the data to ensure you're on the right track.
5. Evaluate your efforts
If you evaluate your program when the pilot is complete, you're too late, says Kamal Jethwani, MD, lead research scientist at PCCH. You must build in evaluation during the program design phase. For example, if you determine during program design that you will focus on patients who are most at-risk for readmission, later on you can measure whether you reached the appropriate audience. And if you decided your pilot would focus on improving outcomes for patients, you can measure readmissions and utilization throughout the program pilot and figure out if you asked "too much or too little," he says.
You should also be measuring the effectiveness of individual program components, such as the impact of nudges and incentives on adoption. When assessing patient engagement, look not only at the number of patients who signed up for the program and reported in at least once, but also how many patients continued to participate.
Armed with that data, Jethwani says, you can figure out the difference between engaged patients and practices and those who were not engaged, with an eye toward future improvements. Other questions to ask: How did patient and practice engagement correlate and how did the program affect patient and provider satisfaction?
6. Start all over again.
Answering these kinds of evaluation questions is not the end of the process for connected health programs, Jethwani says. You will make more changes based on your evaluations, perhaps even changing your goals and objectives. "Be open to that," he says, and to the cycle of connected health.