A survey of patients who've been prescribed wearables finds some issues with the technology and design, but also a lack of education on how to use the mHealth devices and how they'll improve care management.

A survey of hundreds of patients who’ve been prescribed wearables finds that problems with adoption and engagement are tied not only to technical issues, but also to how providers are prescribing them.

Conducted by Software Advice, the survey of more than 450 patients found that while 86% said the mHealth devices did improve clinical outcomes and their quality of life, even more – 87% – said the devices had given them inaccurate information, and 85% blamed those mistakes on usability issues.

Specifically, of those were reported getting inaccurate data from their wearable, 54% said it wasn’t clear how they were supposed to upload data from the devices to their care provider, while 31% said the interface was confusing and 15% said the device malfunctioned. In addition, 65 percent said they had to contact their doctor’s office to correct the mistakes, adding tasks to the care process that wearables are designed to eliminate.

“User experience is such a massive element of developing these devices, and patients need to be able to easily understand how to engage with these tools in order to get the most out of them,” the article points out.

The problem is more than just technical. When asked to list the biggest drawbacks to using wearables, 39% cited security vulnerabilities with protected health data and 17% cited IT issues. But 31% said the devices lead to less frequent office visits, thus negatively affecting their relationship with their care provider, while 8% cited reduced quality of care and 5% said wearables complicate care management.

Those three concerns point not as much to the technology, but to how care providers may or may not be preparing their patients to use wearables. Providers need to not only research mHealth devices and choose those that would best help their patients, but work with those patients on how to collect and send data.

More importantly, they should be able to explain why wearables are important to care management, and how these devices can improve collaboration and clinical outcomes while reducing unnecessary tasks and costs.

The healthcare industry has long looked at the consumer-facing wearables market with both envy and skepticism, longing for the popularity of Apple and Fitbit while saying the data coming from those devices isn’t reliable or accurate enough for clinical care. That gap was seen in the survey as well, with only 9 percent saying their prescribed device performs better than a commercial device and 43 percent liking commercial devices over prescribed devices.

That said, while developers of medical grade wearables may have a ways to go to be considered stylish, those devices are usually more appropriate for clinical care. And it’s up to providers to make that point and help patients adjust to using wearables.

“It stands to reason that patients who are dealing with confusing interfaces or who don’t understand how to interact with their devices won’t get the most out of them,” the article notes. “Prescribers need to be fully aware of their patients’ comfort levels with technology in order to offer user training and support that is tailored to individual patients’ abilities and knowledge base.”

That, too, can be an issue. When asked to rate their “technological literacy,” 20% said its excellent and 58% said it was good, but the remaining 22% said they were either average, poor or very poor in their knowledge to technical issues. Providers need to know when their patients aren’t comfortable with technology (and not just assume someone is tech-savvy) and find ways to help them.

To that end, when asked how they would like to be taught, 67% asked for a help desk or support team that could be contacted for assistance, while 57 percent wanted in-person training on how to use the device and 28 percent asked for “a library of resources and references to help troubleshoot and resolve device issues on my own.”

Finally, despite all the challenges to musing wearables, patients are seeing value to them.

According to the survey, roughly half of those patients surveyed say wearables contribute to “a better understanding of my health,” a key component to patient engagement and the idea that patients should be in more control of managing their health and wellness. Some 27% percent, meanwhile, said the device improve quality of care, 15% said they allow one to receive remote care (such as in the home or office), 5% cited improved collaboration with providers and 4% said the devices “simplified management of my condition.”

Those numbers are low, but that may be because the idea of using wearables for care management is still in its infancy, and the barriers to adoption and sustainability need to be addressed. 

Health systems are learning that they need to plan carefully to give consumers access to services on a mobile platform.

Healthcare organizations are finding that an effective patient engagement strategy involves more than just opening a patient portal. A good platform not only gives consumers access to health system services and resources, but allows them to access those services on the device and at the time and place of their choosing—all without overwhelming either the consumer or the provider with unnecessary steps or tasks.

"It has to separate the signal from the noise," says John Lock, chief transformation officer for MedStar Health, which launched a new patient experience platform designed by b.well Connected Health this past January. The Maryland-based health system, he says, has a strategy in place to "get you to the right care at the right time and on the right modality."

That's not as easy as it seems.

"I wish it were as easy as Uber," he jokes.

John Lock, chief transformation officer at MedStar Health. Photo courtesy MedStar Health.

The patient engagement—or patient experience—landscape has changed dramatically over the past few years, in part due to the challenges imposed by the pandemic but also because of the shift to patient-centered healthcare, a philosophy that's been around for about a decade. The advance of mHealth devices and telehealth platforms has created new channels for accessing care and given the consumer more power to choose how and where to get that care. Healthcare executives are finding that they can no longer sit back and wait for the consumer to come to them; they must be proactive, reaching out to the consumer, or that consumer will go somewhere else.

"You need to create a boundary-less experience for the consumer," says Lock, in which MedStar Health has been working on its own technologies and strategies for the past decade through the MedStar Institute for Innovation. "For us, it's part of … being on the path of becoming digital rather than just doing digital."

The challenges posed by being digital, rather than doing digital, lie in the culture shift that this creates within the health system. At healthcare organizations, new ideas and technology aren't always readily and easily embraced. Health systems need support throughout the institution to adopt new services and adapt to new ideas, and those in charge of leading that change need to make sure doctors and nurses are on board.

"Digital transformation is significant," says Lock. "The work that goes into this, when you've been doing something the same way for a long time," is extensive.

Easy to Visualize, But Difficult to Implement

Patient engagement is a tricky term, and one that might mean different things to the consumer and provider. Surveys done by different sources over recent years indicate more than half of all consumers prefer digital tools for such tasks as appointment reminders and follow ups, and about 60% want to share their health data virtually with providers. About half want to communicate with a doctor via digital channels, and 70% say they'd choose providers based on digital access.

Mobile might seem like a cool term that can be added to any service to make it more popular, but the journey from a portal to portability isn't easy.

At Atlantic General Hospital in Berlin, Maryland, Vice President and CIO Jonathan Bauer, CHCIO, said patient engagement through the portal was a top priority at the hospital when he came on board in 2017. But adding mobility to the mix took a lot of time and resources, and in 2019 hospital leadership felt the cost was too much.

Jonathan Bauer, vice president and CIO, Atlantic General Hospital. Photo courtesy Atlantic General Hospital.

COVID-19 changed that strategy. Suddenly mobility was a necessity, as the hospital needed to stay in touch with patients who were staying home. Atlantic General contracted with Allscripts to roll out the FollowMyHealth portal, along with its telehealth platform, and made use of federal grants to expand the service.

Bauer said the pandemic forced the health system to act quickly, but they knew the numbers were there to support mobility.

"Ninety-seven percent of all Americans have a cell phone and 85% have smartphones," he said in an e-mail.  "We knew if we could start relying on sending text messages to patients' cellphones, we would have a better chance to reach them."

"The fact that patients no longer have to sign up or into a portal account to receive reminders, messages, and protected health information [PHI] is a huge win," Bauer added. "We are reaching more patients with less involvement from our staff.  We are able to prioritize those patients who require contact and to make sure we are completing the circle of care."

Like so many other health systems, Atlantic General saw rapid support for messaging and telehealth, but ran into problems when they considered expanding into scheduling.

"The staff was very receptive to most of the deployment until campaigns like online scheduling and waitlist notification started altering their schedules," Bauer said. "This was not well received, and we are still struggling with these two campaigns as of today. We are trying to find that happy medium where the technology lets the user schedule an appointment but does not disrupt the office flow. Our deployment strategy was based on bringing the easier campaigns live first and easing into the more difficult ones."

The challenges underscore an overlooked aspect of being mobile. What's great for consumers might not be that good for providers.

"The first piece of advice would be to make sure [the providers] understand how each office is manipulating its existing schedule," Bauer says. "One of the main reasons online scheduling was not well received is the fact each office was manually manipulating its schedules to meet the provider's preference. Sitting down with each office and documenting their workflow would help understand how online scheduling and waitlists will affect them."

"The next step we are looking to take is to start using the data we are collecting. MPE [mobile patient engagement] collects a tremendous amount of data that can be used to guide decisions about care. One change we are looking at in the short term is expanding the questions that are asked after an appointment. Currently, we are getting a 6% response rate but we are only asking two questions. We want to expand that to four questions to capture more detail about the patient's encounter."

Adding Scheduling to the Patient Portal

MedStar Health has integrated scheduling into its mHealth portal, but the process wasn't easy. One of the bigger challenges, Lock says, was moving from legacy health IT platforms to more nimble tools that have mobility baked into the back end.

Many health systems are facing that challenge now. The newest generation of digital health tools and platforms no longer sits outside the electronic health platform but integrates with existing platforms to create a seamless experience. For hospitals that have used the same platforms for a decade or two, that transition might have a few more seams than expected.

"We are moving toward interoperability," Lock says. "You're lifting data from legacy systems that you need, and you're getting data from all these new [platforms], and you're trying to make them work together."

With scheduling, Lock says the platform MedStar Health is using incorporates AI technology that can match a consumer's healthcare needs to the most appropriate care provider. This ensures not only that the consumer is being matched with the right provider, but that the provider is seeing patients that he or she should be seeing.

The process includes input and buy-in from clinicians, he said, as well as from other departments whose services will be affected. The health system even spent a year talking to patients and consumers about what should be included. Sometimes it takes a while, and a few changes and test runs to make sure the end result meets everyone's expectations.

"The business transformation that goes along with the digital transformation is significant," he says.

MedStar's portal now boasts several features, including access to records and test results, online registration, check-in and appointment scheduling, and medication reminders. It's a step-by-step process, Lock says, and the next step is to integrate specialty care.

"It's more complicated than just creating an entry point," he notes.

The future, Lock says, will lead to a more personalized platform, with itineraries tailored to the specific patient and access to more health and wellness resources. Consumers will be able to pay their bills online, and manage data from wearables and other smart devices. On the other end, clinicians will be able to use the platform to not only communicate, but collaborate with patients on care, rather than waiting for them to pick up the phone or come into the office or hospital.

The whole idea behind using digital technology, Lock says, is to reduce repetitive steps and redundant actions that push people away from healthcare until they show up in a clinic or ER with a critical health issue that needs to be addressed. The technology should be intuitive, guiding consumers directly to the care provider who can best address the issue at hand.

"We wanted to be able to [create a platform] that doesn't just say, 'Call us,' " he says.

The Health Data Use and Privacy Commission Act, introduced earlier this month in the Senate, would create a commission to study how HIPAA can be updated to take into account new technologies, including digital health and telemedicine.

A bill introduced earlier this month in Congress would update the Health Insurance Portability and Accountability Act (HIPAA) to account for new technology.

The Health Data Use and Privacy Commission Act, sponsored by US Senators Bill Cassidy (R-LA) and Tammy Baldwin (D-WI), would cerate a new health and privacy commission to advise Congress on “how to modernize the use of health data and privacy laws to ensure patient privacy and trust while balancing the need of doctors to have information at their fingertips to provide care.”

The proposed legislation takes aim at a 25-year-old law that was instrumental in creating guidelines for the dissemination of personal health data, but has since come under attack for being outdated. The proliferation of online resources, telemedicine and digital health platforms has given healthcare organizations new avenues for accessing, collecting and analyzing information – and opened the door to new ways that such data can be misused.

“As a doctor, the potential of new technology to improve patient care seems limitless. But Americans must be able to trust that their personal health data is protected if this technology can meet its full potential,” Cassidy said in a Feb. 9 press release. “HIPAA must be updated for the modern day. This legislation starts this process on a pathway to make sure it is done right.”

The commission would consist of 17 members, to be appointed by the Comptroller General, and would report back to Congress and the President six months after all members are appointed. That report would offer recommendations on:

• The potential threats posed to individual health privacy and legitimate business and policy interests;
• The purposes for which sharing health information is appropriate and beneficial to consumers and the threat to health outcomes and costs if privacy rules are too stringent;
• The effectiveness of existing statutes, regulations, private sector self-regulatory efforts, technology advances, and market forces in protecting individual health privacy;
• Recommendations on whether federal legislation is necessary, and if so, specific suggestions on proposals to reform, streamline, harmonize, unify, or augment current laws and regulations relating to individual health privacy, including reforms or additions to existing law related to enforcement, preemption, consent, penalties for misuse, transparency, and notice of privacy practices;
• An analysis of whether additional regulations may impose costs or burdens, or cause unintended consequences in other policy areas, such as security, law enforcement, medical research, health care cost containment, improved patient outcomes, public health or critical infrastructure protection, and whether such costs or burdens are justified by the additional regulations or benefits to privacy, including whether such benefits may be achieved through less onerous means;
• The cost analysis of legislative or regulatory changes proposed in the report;
• Recommendations on non-legislative solutions to individual health privacy concerns, including education, market-based measures, industry best practices, and new technologies; and
• A review of the effectiveness and utility of third-party statements of privacy principles and private sector self-regulatory efforts, as well as third-party certification or accreditation programs meant to ensure compliance with privacy requirements.

The bill is supported by a number of organizations, including the American College of Cardiology, Association for Behavioral Health and Wellness, Association of Clinical Research Organizations, Executives for Health Innovation, Federation of American Hospitals, Heath Innovation Alliance, National Multiple Sclerosis Society and United Spinal Association. Also supporting the bill are Teladoc, Epic, IBM and athenahealth.

In a blog posted this week, Sydney Swanson, an associate with the Morgan Lewis law firm, and W. Reece Hirsch, a partner with the firm, said HIPAA doesn’t regulate digital health companies that collect data from consumers or reference new technologies like mHealth apps and wearables. The bill, they said, “seeks to close the gap between existing protections and risk to personal health information (PHI) created by new healthcare technology that extends beyond the scope of HIPAA.”

“Recommendations based on the above studies could involve updates to HIPAA to cover a broader range of entities using PHI or new federal legislation covering health data, as the commission would be instructed to assess ‘any gaps in the privacy protections [under HIPAA] resulting from data collection and use by non-covered entities,’” they wrote.  “Any such legislation might alter the Federal Trade Commission’s current authority to regulate many direct-to-consumer digital health products that are not subject to HIPAA pursuant to Section 5 of the FTC Act.”

“Proposed legislation stemming from the studies may be based on state law, such as the California Consumer Privacy Act of 2018 (CCPA), as the commission would be instructed to evaluate relevant proposed state legislation and existing state law,” Swanson and Hirsch added. “New legislation may also be inspired by General Data Protection Regulation (GDPR), as the commission would be instructed to evaluate privacy protections undertaken by foreign governments and international governing bodies.”

The University of Alabama at Huntsville is studying how drones can be used to ferry medications and other medical supplies to rural healthcare sites and facilitate critical tests.

Researchers at the University of Alabama in Huntsville (UAH) say a recent simulation test has proven the value of drones in delivering critical medications and other supplies to rural residents.

The UAH team, comprised of members from the College of Nursing and the UAH Rotorcraft Systems Engineering and Simulation Center (RSESC) Unmanned Aircraft Systems (UAS) Program, created a scenario in which a rural hospital receives a pregnant woman at risk for preterm labor. Nurses at the hospital perform a focused preterm labor assessment and receive a prescription for fetal fibronectine (fFN) and betamethasone – but neither are available at the hospital or anyplace nearby.

This is where a drone comes in handy. An urban clinic or hospital uses the drone to send the medicine and an fFN testing kit (fFN is a protein produced during pregnancy that’s used to predict risk for preterm delivery and betamethasone is vital for maturing fetal lungs in the event of preterm birth) to the hospital. The nurses use that kit to perform a test, then send the results back to the urban location via the drone.

“This simulation was designed to promote creative and viable decision-making by nurses,” Darlene Showalter, RN, CNS, a clinical associate professor and DNP program coordinator at UAH who led the simulation, said in a UAH press release. “We are equipping our students to collaborate and think through real-life issues that serve as obstacles to healthcare equity.”

The project is the latest of several conducted by UAH that focuses on using drones for healthcare services, and one of several healthcare organizations around the country that are testing or using drones in both urban and rural areas. Utah-based Intermountain Healthcare recently launched a program to deliver prescriptions and other medical supplies in and around Salt Lake City; others testing the idea include WakeMed Health & Hospitals in North Carolina, Kaiser Permanente (which is using drones to deliver prescriptions to a retirement community in Florida) and the Rady Children’s Institute for Genomic Medicine in San Diego.

At UAH, Azita Amiri, PhD, MSN, RN, an associate professor of nursing at UAH who has been leading the research program with RSESC research engineer Casey Calamaio for about two years, says the latest simulation is a step toward using drones throughout healthcare.

“This simulation model can also be used as a pilot for medical services delivery in our hospital systems in Huntsville,” she said in the press release. “Our team is now working on a simulation where we have a case of an overdose in a rural area, and a drone is used to deliver the life-saving medication naloxone to reverse the effects of opioids.”

“This demonstration provided a simple scenario to test unmanned aerial delivery solutions in a campus environment,” Calamaio added. “We also had a chance to identify areas with radio frequency interference in urban environments, considerations for UAS traffic management, and to discuss effective ways to introduce UAS in the local medical community.”

While drone services are closely regulated by the Federal Aviation Authority and currently restricted to package delivery, healthcare organizations are working with the federal agency to develop and launch pilots and programs.

“Significant coordination with the FAA to safely implement a rural UAS delivery system is required,” Calamaio said. “Challenges in assured operational safety and regulatory compliance need addressing before UAS are used as delivery mechanisms on the scale to tilt the medical supply chain in a significant way.”