How Technology Will Shape The Future Of Patient Engagement: Three Major Takeaways from AADE

By Kelly Close

Twitter Summary: We’re on the edge of a new frontier in health care: How technology and social media will increase patient engagement.

At this year’s American Association of Diabetes Educators (AADE) Conference, speakers built upon the telehealth theme from last year’s meeting, taking the idea a few steps further to show how we might expect technology and digital health to shape healthcare in the future. First off – kudos to AADE, because they’ve been on the forefront of talking about digital health and new technology (indeed, it's been a focus of our AADE coverage for years!). The conference was packed with fascinating talks (and so many friendly faces all working to improve diabetes care!), and the three I want to share with you really drove home inspiration about our changing models of healthcare. I was so excited to hear educators talk about engaging patients and providers through social media, mobile health, and access to data. And hopefully, more engagement will mean better outcomes. As a sidenote -  just hearing more healthcare providers talking about engaging patients rather than “adherence” and it’s cousin “compliance” (which educators have been staying away from for a long time) was fantastic.

Engaging Patients Through Social Media

Susannah Fox, the newly appointed Chief Technology Officer of the Department of Health and Human Services, which includes the FDA, CDC, and NIH, kicked off the conference with an inspiring talk positioning social networking as the next frontier in healthcare. As many of us with diabetes know, social networking platforms have provided a way for people with the same health conditions to find each other, creating online health communities (such as our very own DOC, or “diabetes online community,” which was recently featured in this valuable peer-reviewed paper by Kerri Sparling, Jeff Hitchcock, and friends!). Social networking reduces the barriers to finding someone else with diabetes, especially because stigma prevents many from disclosing it. We, the people living with diabetes, are often the ones who have the most to offer to other patients from our own experiences; our next step is to recognize that this information can be (and should be) infused into the health care system from the patient level and seen as a legitimate tool. What experience has each of us had that could be useful to someone (or someone’s doctor or nurse or broader healthcare team, to the extent they are lucky enough to have a team) on the other side of the country or the world, maybe today, maybe in one year, maybe in five? Let’s take advantage of this remarkable, untapped opportunity we have in social media to focus on how to bend the cost curve in diabetes and improve health outcomes.

Engaging Patients Through Connected Health

Dr. Kamal Jethwani, director of Connected Health Innovation, gave us examples of how telemedicine can engage patients and providers in individualized care. Instead of patients seeing their health care providers just once every few months (or years, for some), telemedicine capitalizes on the fact that that so many people have their smartphones with them practically all the time, in some cases checking them more than 100 times per day! Eeek, we don’t recommend that, but wouldn’t it be great if we could make health as addictive as our smartphones? If we could be in more frequent communication with our healthcare providers, constantly keeping them up to date on our progress and challenges, how would our behaviors change? How would our outcomes change? Much more thinking on behavior is needed, that’s for sure.

Frequent communication is one way to take advantage of this medium, but sending one mass text to all patients won’t work when everybody has unique needs – obviously! We know that no one is advocating that, but it’s funny, sometimes we feel other elements of diabetes are advocating a “one size fits all” strategy – and that’s exactly what we want to get away from. Messages that are meant to motivate a “couch potato” to reach his goals won’t be motivating to a triathlete trying to reach her own goals. With technology’s computational power to analyze millions of patients’ behaviors and needs, we have the ability to not just send patients health reminders, but to personalize them using analytics, and therefore increase engagement. This is uber exciting even though we’re only in early days. In Connected Health’s “Text2Move” program designed to personally motivate participants via text messages to increase their steps/day (using information about their willingness to change their behavior and state of fitness), participants saw over a 1.0% drop in A1c over six months. I love the idea of being smart about the way we use our tech habits to change our health behavior, and seeing examples of how it’s worked. And what’s next? I want to see LOTS of organizations make LOTS of money making people healthier – it’s not just patients that need to be engaged, it’s also the commercial environment (otherwise, they can just walk away from diabetes, like BMS and Genentech have both recently done).

Engaging Patients Through Accessible Data

Will having accessible data increase patient engagement, further knowledge, and improve health? The evidence tells us YES. Doug Kanter, founder of Databetes and Meal Memory, provided a fascinating personal account of the power of accessing data. He tracked every data point that influenced his diabetes for the entirety of 2012, resulting in it being the healthiest year in his life and him seeing a nearly 1.0% drop in his A1c! It was amazing to actually see how his behavior affected his glucose levels and insulin levels, and how visualizing this data with beautiful graphics can really tell a story about diabetes management that helps people adjust their behavior for better outcomes.

However, we all know there are still SO many barriers to using data in a useful way. Even people motivated to look at their numbers often can’t because it’s been so hard to get data off devices – even though that’s changing, old habits can die hard. Diasend is a very cool EU-based company that offers a platform for viewing data from many devices in the same place, and allows patients to overcome these obstacles by making it easier to download and access data in a user-friendly way. Other organizations, such as Tidepool (an organization that was just awarded the White House “Champion of Change” honor - it was such a huge deal for diabetes to get onto the President’s radar) and Glooko aim to develop future products in a similar direction, ultimately envisioning a platform that allows developers to build apps on top of the data. Accessible data has already emerged and is gaining steam, and I could not be more excited for what that means for patients. For instance, FreeStyle Libre (only approved in the EU right now) makes it far easier for patients to see and understand their AGP (average glucose profile) – this is making a major difference with many patients we know using the device. As well, Dexcom Share makes it possible for all the data to be on the iPhone – though it’s basic information now, we know other app developers will work to make this data more interesting and accessible, like the Libre’s is (the Libre data, by the way, is great from my view but harder to use as this is an early–generation touch screen). What’s nice is that too will absolutely change – with so much of the technology becoming available, it’s not a matter of if, but w-h-e-n! We do hope patients won’t get too frustrated with early-generations and will see the forest for the trees – that all this will be improving and that as patients, we have a personal responsibility to society as well as ourselves and our families to understand our numbers as well as possible. I know for me, I’ve complained in the past – I’m done with that! I’m realizing I need to lean in to doing as well as possible, and I hope other people with diabetes agree. We are spending far too much money on avoidable costs – let’s work together to figure out how to reduce waste in resources over the short- and long-term.  

Yes, we’re entering an era in which social media and digital health are being taken seriously as tools that can improve patient outcomes and lowe costs for diabetes care. I’d love to hear your thoughts on this topic – what aspects of digital health and technology are you most excited or worried about as we think about increasing patient and provider engagement? Let us know!

very best,

Kelly L. Close