Geisinger has been investing in mobile technologies to engage patients and their families in their care since 2011. In my blog post last year, I shared Geisinger’s texting programs, mobile data capture and experiences with their first mobile app to support Cardiac Rehab.

Geisinger continues to explore new technologies to involve patients and to improve the patient and physician interaction.  “Mobile apps are just another way to drive patient engagement. We think we will have better adoption by patients if we use technology that they have already adopted in their lives”, explains Chanin Wendling, Director, eHealth, Geisinger Health System. “Our goals are to improve patient outcomes and reduce costs.  We pursue patient engagement because of studies from folks like Hibbard & Greene 2013 and Veroff & Wennberg 2013 that show that engaged patients have better outcomes at lower costs.  We want to provide patients with tools that help them understand their condition and follow their care plans so they can stay as healthy as possible.”

Piloting Mobile App Supporting Bariatric Surgery 

Geisinger Get 2 Goal Mobile AppGeisinger began piloting their second mobile app Get~2~Goal in September, 2012 to help manage patients’ surgical weight loss expectation and provide a journal for tracking weight loss after the surgery. The Get~2~Goal app presents the patient with personalized weight management goals using her own entered data (e.g. age, weight, height). She can monitor her weight loss towards that goal and see how she is doing compared with other patients like her. 

The app was developed by Geisinger’s Obesity Institute in collaboration with Bucknell University’s computer science staff and students. 

Patients have shared positive comments including:

   “Great App! Surgery on Tuesday, so this will be a great motivator”

   “I like it. It's very helpful and lets you know whether you're on the right track or not weight wise. So far I'm doing above average. Woo hoo to us!”

The clinical sponsor for the Get~2~Goal project was Dr. Christopher Still, Director of Geisinger Obesity Institute and Medical Director for the Center for Nutrition & Weight Management. He uses the app when discussing bariatric surgery with his patients and, recommends that they download it to their mobile devices. Dr. Still has observed an improved patient/physician interaction when a patient sets realistic weight loss expectations with the guidance of the clinician. “This app allows patients and their physicians to discuss patient specific outcomes regarding gastric bypass surgery. It is important for both the patient and their physician to have real expectations and assess the risk/ benefit of the procedure.”

Building Mobile Apps Ourselves

In addition to experimenting with Cardiac Rehab and Get~2~Goal apps, Geisinger wants to expand into apps for different chronic conditions and set out to research the market. “We were disappointed with what we found. Most vendors had apps focused only on one chronic condition. Although vendors had plans to expand into other chronic conditions, we had a hard time picking a reasonable partner based on their stated direction”, Wendling explains.

Wendling feels the mobile health app market is still in the early stages. She explains that vendors are approaching her organization with a business model that just doesn’t scale. “If a vendor charges us a rate of $10+ per member per month, how do we make that work for patients with multiple conditions? We have over 75,000 patients with hypertension and 30,000+ with asthma. Although the app will not be appropriate for all of these patients, the costs add up rather quickly.”

After evaluating many mobile apps, Wendling points out that the patient experience is not thought through. She has asked vendors about how patients can personalize their app.  “I may be a patient who works night hours so why shouldn’t I be able to set the time of the reminders to fit my schedule? Also, why can’t I select the method of receiving the reminders, through email or text messages”, adds Wendling.

The final reason that Geisinger has decided to build mobile apps internally is because integration is important. “We’ve found that many solutions do not integrate with our EMR which is essential since we need to incorporate the patient information into our clinical workflow” Wendling explains. “Although it is not unusual that the early innovated apps do not integrate with the EMR, vendors do recognize that they need to get there.  So any app we purchase, we would most likely have to do the integration ourselves anyway.  We haven’t made any decisions that we will always develop our own apps.  If we see something out in the marketplace that works and we have the budget, we will go for it.  We just may need to wait a little longer until the marketplace matures.”

Mobile App Development Journey

As their first venture into internal mobile app development, Geisinger selected a simple procedure and defined key capabilities which are replicable across more complex procedures. With the new Colonoscopy mobile app scheduled to be launched next month, patients can prepare for their procedure through: 

• Education: explains what will happen during the procedure
• Shopping: lists can be created and transferred as a note to the mobile phone
• Reminders: for days before the procedure directing the patients to steps that need to be done
• Pictures: visual guides of their bowel movement during the preparation process

 “Geisinger’s colonoscopy mobile app is unique among health care related apps in that it provides a personalized experience for the patient.  From prep instructions based on scheduled appointment time, interactive ’am I ready for my procedure’ section to the ability to easily set reminders/alerts; this app takes advantage of a lot that mobile technology has to offer.  As a gastroenterologist, my hope is that this app will allow patients to feel more empowered and in control of their bowel preparation; typically the most difficult part of the colonoscopy experience. We know that with improved prep comes better outcomes and thereby, over time, lives saved. I feel that modern health care needs to embrace mobile technology as a rapidly growing and exciting tool to improve patient care”, explains Dr. Amitpal S Johal, Director of Endoscopy, Geisinger Medical Center.

“We are looking into other surgical procedures which can use this same set of capabilities. One area that we are considering is Vascular surgeries since we work closely with our Vascular department at Geisinger”, shares Wendling. 

Future Mobile Health Roadmap

As they look to the future, Geisinger is working on enhancing current mobile apps and is exploring the use of mobile to support patient care before, during and after a hospital visit.

The next version of the Get~2~Goal app is under development. Geisinger is improving the patient experience through a better user navigation, the capability for patients to enter their own weight loss goals, and the addition of recently developed calculations for other bariatric surgery outcomes (i.e. likelihood for remission of diabetes).

Geisinger is also looking into ways that mobile devices and apps can help patients pre, during and post hospital stay. They are starting with their Janet Weis Children’s Hospital which treats kids with complex conditions such as cancer, heart or neurological issues. Geisinger understands that being in the hospital is scary for the child and their family. “With mobile apps, children and their parents will be able to prepare for the surgery, use an iPad during their hospital visit to capture pain levels and then track their recovery at home”, describes Wendling.

In the future, Geisinger is planning for a personalized patient experience. “Our dream is to be tailored in our patient care.  Given the patient’s profile, s/he will have technology options and tools to gather preferences and schedules to guide the care plan. We want to use this information to also match the appropriate intervention”, Wendling concludes.

In 2008, Cisco launched their LifeConnection’s onsite health center which uses a Patient- Centered Medical Home model. Today, it supports over 42,000 employees and their families at Cisco’s corporate campus in San Jose, CA.

Cisco’s LifeConnections' Center offers primary and pediatric care integrated with care services including disease/condition management, health coaching, mental health, pharmacy, physical therapy and chiropractic as well as acupuncture services.

Cisco now has two physical LifeConnections' Health Centers, one at their headquarters and a second location at the Cisco Bangalore, India campus.  In addition, they operate a telehealth location in the Raleigh-Durham area of North Carolina.

Employees access LifeConnections’ services online for health management. “Within our Cisco LifeConnections' portal, our employees and their families can schedule appointments in real-time, view their medical records, communicate securely with their physicians and even send their doctor an attached document such as a food or exercise log”, explains Katelyn Johnson, Manager, Integrated Health at Cisco Systems. 

Cisco’s approach supports the findings from a recent Accenture Connected Health Pulse Survey which found that most patients (90%) want to use technology to self-manage which includes accessing their medical information, booking their doctor’s appointments and refilling their medications. The survey also revealed that patients do not want to give up the interaction with their doctor. 

Technology Transforms the Patient Experience

Working closely with employees and families, Cisco designed the LifeConnections’ Health Center to bring convenience, better care and transparency to the consumer.

Through ongoing interviews with patients, Cisco has heard feedback from consumers who:

     “Do not want to be burdened by the administration of healthcare”

     “Want technology to take away what I don’t like to do (i.e. clip board,

          discharge payment)”

     “Want to spend more time with my physician”

Cisco has used this insight to determine ways to leverage technology within the LifeConnections’ Health Center to increase patient satisfaction including:

Kiosk: Patients come into the Health Center and use a tablet to have a “paperless, self-service, check in” including verifying demographic information, paying co-pays and signing consent forms, taking less than five minutes of their time. 

Flat Screen Monitors in Care Suite: Within the patient-centric care suites, the patient and physician sit side by side to view and discuss health information projected on the flat screen such as the medical record with the latest vitals and lab results, x-rays and educational content about the patient’s condition. Cisco emphasizes the importance of providing transparency to the patient by showing them their medical record, in real time, during the visit. 

HealthPresence in Care Suite: Cisco has recently partnered with Stanford Hospital and Clinics to enable patients to access specialty care (tele-dermatology) through the use of Cisco’s own telemedicine solution called HealthPresence. A nurse assists the patient in the LifeConnections’ Health Center while the Dermatologist connects from the Stanford Outpatient center.  Cisco has found that connecting specialists with patients using this solution offers greater access to specialty care, reduces appointment wait times, and improves patient satisfaction. 

Matching Technology to the Employee Profile

Cisco has put healthcare technology in place to meet the needs and profile of their employees and families.

 “We are a high technology company and our many of our employees are engineers who literally live on-line.  Their average age is 42 years. Our employees expect our healthcare experience to mirror the way they work – which is surrounded by technology.  Specifically, they want technology to help enable care, remove access barriers and overall enhance their experience as a patient.” shares Sharon M. Gibson, Director Healthcare Business Transformation at Cisco.  “Not only do they want to see more information about their health status but they want to see trending data for themselves to better understand how their health stats change over time and how their behavior impacts those results.”

“Our employees are busy and always on the move.  They want to take care of their health in an efficient way.  Soon, we will also offer patients the option of e-visits with their doctors through WebEx, for example”, explains Sharon. “Online or e-visits would help engage employees in their health, whether from home or even remote sites, and bring the convenience that they demand”. 

CareFirst BCBS Medical Home SDM Tool

Over two years ago, I led a panel on patient decision support tools for a large interested crowd in Boston, despite the very snowy day.

Since then, I have noticed a few key changes. Physicians are now prescribing information to patients, using the EMR to send emails with links to health resources. And innovative health plans are playing a role in bringing shared decision making tools to engage and empower their members. Health Plans have a big cost saving incentive when these tools educate their members about less invasive and less expensive options.

3 Key Engagement Drivers With Shared Decision Making Tools

While evaluating technologies for my panel on “Evolving Web & Mobile Tools to Engage Consumers in the Shared Decision Process”, I identified how three key drivers of consumer engagement are being utilized:

1. Education

These tools show the consumer what the treatment entails and share patient stories which tell them what to expect.  This education reduces anxiety by putting the consumer in control to understand their health issues and presenting options to address them.

2. Evaluation

Shared Decision Making tools are ideally designed for “preference sensitive conditions” where there are multiple clinical options (For information about target conditions, see the recent report on the Dartmouth Atlas Project which was developed with The Foundation for Informed Medical Decision Making). The most effective tools offer alternatives, capture preferences and guide the consumer through the process while documenting their decisions. This helps set expectations for their experience and supports the discussion with their doctor or care coach. 

3. Collaboration

As the patient and clinician/coach review the SDM summary document together, they can discuss questions, concerns and comments to make the best decision.

Health Plans Leverage Shared Decision Tools

During the panel, health plans described using Shared Decision Making tools to engage members in two key areas:

• Medical Home

Panelist Zev Lavon, PHD, Director Solution Architecture, CareFirst BCBS emphasized “the story of the patient is not their last doc visit or lab test”.  CareFirst launched their Primary Care Medical Home initiative across a panel of physicians deploying communication tools to push information to patients to support the management of their chronic conditions.

•   Wellness Coaching

According to Mark L. Robitaille, MBA, Head of Care Management Support & Engagement, Aetna puts these tools into the hands of their health coaches to send emails with resources links to members or use the tools to look up information for the members without internet access.

Independent Health panelist, James J. Mis, MBA, Communications Manager, Health Care Services, described their interactive voice response campaign to inform members about viewing a shared decision making video (from Emmi Solutions) selected for their specific health interest.

Emerging Mobile SDM Tools 

With a high penetration of smart phones and strong usage across minorities, health care organizations are realizing the tremendous opportunity to deploy mobile applications to engage consumers. To date, most health mobile health applications have been focused on wellness with educational information and tracking.

Panelist Changrong Ji, Senior Solutions Architect, CareFirst BCBS described the opportunity for mobile shared decision making tools. In the future, she envisions that sensors will capture the context of the consumer’s daily life, database analytics will identify patterns and machine learning will be used to help identify relevant mobile messages to send back to the consumer.

Healthwise’s View on Patient Response

During the Shared Decision Making Summit, the chairperson, Don Kemper, Healthwise’s CEO discussed the opportunity for shared decision making tools to give a “voice to the patient”.  After the physician prescribes health information, the tool gathers patient’s preferences to document them in the medical record. I strongly agree with Don as he explains “there is no better way to engage the patient than to assure them that their voice will be heard in treatment and care plan decisions”.

Shared Decision Making Tools for Your Consumers

What are you doing to bring Shared Decision Making Tools to your consumers to motivate engagement in their health and wellness?  I can help guide you through the process of identifing, evaluating and piloting these technologies to deliver better outcomes and a better experience for your consumers. 

We see it every day and everywhere. Consumers are engaged with their mobile phones at restaurants, at the gym, by the pool, in parked cars and in the hallway outside of the doctor’s office. They have a strong need to stay connected and use every free moment to review and respond to messages as well as access online information through their mobile phones.

Over the past 6 months, I have heard health care providers, health plans, health care technology companies and employers express strong interest in reaching, engaging and influencing consumers through mobile health applications. Although mobile committees have been formed, most are in the beginning stages of identifying and prioritizing the applications that they will develop and deliver to consumers.

Seven Mobile Health Engagers:

Here are seven key capabilities that companies will want to build into their mobile health applications:

1. Guiding-  Sending personalized alerts and reminders for motivating specific actions such as taking medications, testing blood sugar levels or participating in healthy behaviors (e.g. lunch time walk with co-workers).

Consumer perspective: What do I need to do to meet my health needs and goals?

2. Educating- Providing access to a customized set of health information, pushing informational tips based on needs, interests and profile and testing health information knowledge.

Consumer perspective: How can you make learning about my health fun, personalized and easy to understand?

3. Encouraging- Delivering support messages from my social network, clinician and health coach.

Consumer perspective: How can you support me in reaching my health goals at the right time?

4. Consulting- Enabling access to a live discussion with my clinician, health coach or mother’s caregiver.

Consumer perspective: How can you connect me with experts for real time communication and collaboration?

5. Monitoring- Capturing and viewing information about my mood, pain levels, symptoms, activity levels, diet and sleep.

Consumer perspective: How can you help me aggregate and organize all of my health information so that I can see patterns to experience “aha moments”?

6. Deciding-  Accessing a decision support tool about my treatment options or viewing my PHR with links to relevant and "in context" content.

Consumer perspective: How can I make better decisions by combining my own information with trusted expert sources and accessing this wherever I am?

7. Managing- Delivering customized messages to help me effectively plan and respond to our health care needs.

Consumer perspective: How can I change from being reactive to becoming proactive about my health and the health of my family?

Generating Your Mobile Health Momentum…

How can you define and design these mobile applications to be most valuable to your target consumers?  Unlike many of the mini-applications that consumers can buy in online stores, you have an opportunity to connect these capabilities such as “monitoring” and “deciding” so that consumers can not only track their activity but also make decisions with the patterns of data that emerge.  

Think about how you can use “personalization” with your mobile health applications to motivate consumers to stay engaged in their health. How can you help consumers use their mobile phone to communicate and collaborate with their support network and caregivers for better health outcomes?

How far along are you with your mobile health strategies? Have you selected your priority consumer segments? Have you conducted research to deeply understand their needs, mobile behaviors and attitudes? Have you conceptualized, defined and validated a solution for each segment? Are you ready to pilot the solution with the target segment? Have you defined your measurements for success?

With experience and industry knowledge in the mobile health space, how I can help you move your mobile initiatives forward?

Read more about my mobile health technology expertise.

In a recent post on “Blazing Your Social Media Engagement Path”, I touched on the value of listening to your target consumers. Their words can bring tremendous insight to your organization about their needs and frustrations around managing their health and the health of loved ones, young and old.

Start Thinking about the Value of Listening Online

Consumers are talking in discussion forums, on Facebook, through tweets and blogs. They have the power to impact their social network while sharing their thoughts, experiences and ideas. To tap into this insight and influence, companies are using an online listening platform which gathers, filters and reports on these consumer conversations. Companies are acting on this new information strategically and tactically through their product, program, marketing and customer service groups.

In addition to these very public venues, companies are investing in private online communities and inviting consumers to share their health experiences using words, photos and videos. Not all online community platforms are the same. There are only a few platforms that enable the consumers to brainstorm, vote and prioritize ideas for new products, services and programs. Companies are leveraging this cost effective online research space by describing new concepts, presenting product screen shots and prototypes and even mocked up marketing materials to ensure that their offering is properly positioned and messaged. And they are getting this input and feedback within hours instead of days for immediate response to meet market needs.

Although businesses are often tempted to get started and figure it out from there, they can significantly benefit from beginning with an online listening plan which can be refined every step of the way.  Once their goals are identified, it is easier to evaluate public and private online venues, potential technology platforms, determine resource requirements and define success metrics and measurements.

Online Listening Goals

Part of the planning process entails understanding best practices. While defining your online listening plan, consider these ‘use case’ goals:

• Increase Consumer/Patient Satisfaction. Listen to the words and the tone that these consumers are using. What are they complaining about? Is there a misunderstanding that you can clarify? Are they having difficulty finding resources that you already offer? Can their stories be shared internally for training purposes?
• Improve Consumer/Patient Education. People are actively discussing their health issues online. Many industry experts recognize the anxiety that they feel trying to understand their health problems or interpret their options. Which health issues cause the most confusion, concern and cost? Which patients are having the most “risky” problems (e.g. medications, treatments)? What are their biggest challenges? Are there more effective treatments, less costly options that consumers need to consider?
• Co-Create with Consumers through an Online Advisory Board to Design Offerings for Engagement
  • Enhance Online Products.  Within a private online community, your target customers can provide input and feedback on your proposed offerings. Which features are “need to haves” versus “nice to haves”? How can you identify and define the functionality that is missing such as mobile? Within the context of their life, how can your product be enhanced to help them maintain control over their health?
  • Develop and Market Compelling Programs. The online private community can also be leveraged to “capture the words” of your target audience, shaping both your program design and the marketing of that program. How are these consumers articulating the value they see in the program? What changes would they make if they were creating the program?

Benefits of Listening Extends Throughout your Company

As you devise your own list social media goals, think about which departments within your company will benefit. One best practice is to assemble a cross- functional team to participate in the planning and realize the gains of your online listening efforts.

It all begins with the first step of listening. Engaging consumers is the next step.