Perspectives on Safety—Patient-facing Technologies: Opportunities and Challenges for Patient Safety

In an accompanying perspective, Ronen Rozenblum, PhD, MPH, and David Bates, MD, MS, both of Brigham and Women's Hospital, explore how patient-facing technologies can enable patients to be more responsible for their care and improve the way clinicians practice.

Perspectives on Safety
Published November 2017

The Role of Patient-facing Technologies to Empower Patients and Improve Safety

by Ronen Rozenblum, MD, MPH, and David Bates, MD, MS

Perspective

Patient-centered care and patient engagement have become central components of the modern clinical encounter. The National Academy of Medicine defines patient-centered care as "care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions."(1) Technology, with its array of capabilities to measure data, manage information, and automate processes, plays an integral role in health care's ability to adequately respond to patient preferences, needs, and values in the guidance of clinical decisions. Central to fulfilling this role is ensuring that care is delivered in a safe and effective manner. With literally hundreds of thousands of preventable deaths and millions of avoidable adverse events happening each year, the stakes are simply too high not to employ every tool at our disposal to improve patient safety.

Health information technology (IT) represents one of the most important tools providers can employ to improve safety. Substantial gains in safety have been demonstrated with the enhanced management of health information using electronic health records that support standardized documentation and easier access to patient records, along with approaches that improve and standardize communication. Even though significant challenges are associated with this digital health age (2), the electronic management of health care information and the automation of clinical processes are making important strides to address the patient safety risk inherent with variation in care delivery.

However, these technology-enabled standardized approaches only get us so far to delivering patient-centered care. Information technology must also enable patient engagement across the continuum of care, so that the same level of attention toward preventing adverse events is paid to understanding and addressing patients' preferences, needs, and values. For example, the growing demand for improved and more efficient communication between health care providers and patients has created an impetus to harness patient-facing technologies and consumer e-health tools to promote patient engagement and empowerment.(3,4)

All in all, some of these patient-facing tools give patients the opportunity to be more responsible for their care by providing them with the ability to access health information, choose providers, and manage their health care.(3) For example, patient-facing health records and patient portals allow patients to view, verify, and act on their health data from preferable access points outside of the traditional provider environment. Other tools allow patients to communicate directly with their care team, coordinate care across caregivers, and interact with other patients with similar health conditions, creating a broader and more connected health care network.(3) Patients also now have access to mobile health apps that offer tailored information, education, networking, and monitoring that align with patient needs and values. These are only a few of the many illustrations of technology's ability to make the delivery of health care more patient centered.

Technologies that engage patients to report their care experience, outcomes, and follow-up activities empower them to improve the way health care providers deliver care and measure their performance. Telehealth and secure messaging open communication channels between providers, between patients and providers, or between similar patients. Together, these tools can increase transparency, manage expectations, and instill trust when patients are at their most vulnerable. Novel platforms like social media also create new opportunities for patients and families to participate actively in their care, self-manage their medical problems, learn from those with similar conditions, improve communication with their health care providers, and even report safety issues.(5-7) Moreover, they give providers new channels to engage with patients in ways that patients prefer to communicate, furthering the move toward patient-centered care.(5-7)

Enhancing patient engagement via health IT has been shown to promote patient behavior that leads to positive health outcomes, improved satisfaction and care delivery efficiency, reduced costs, and better quality of care and patient safety.(8,9) For example, in a study that we conducted recently in the medical intensive care unit (ICU), implementation of a structured patient-centered care and engagement training program and information technology platform (including an ICU safety checklist and patient-facing information tools) was associated with a reduction in adverse events and improved patient and care partner satisfaction.(10)

While technology holds immense promise to help improve patient safety and outcomes, it can only serve as an enabler for better care, rather than supplant the processes and people that deliver and receive it. As in any major change management initiative, three major components determine the endeavor's success: technology, processes, and people. Our recent study of key figures from leading US health systems, policymakers, and vendors found that success of health IT in general and new predictive analytics tools in particular depends less on the tools themselves than on getting buy-in at all levels from the start.(11) Therefore, technology's next frontier in improving patient safety and quality of care is engaging the people that deliver and receive it.

Challenges to patient-facing technologies are many, ranging from low patient and provider awareness to structural challenges to technology implementation. The available adoption data suggest that ongoing patient usage rates of health IT modalities remain low.(12,13) Some of the challenges to patient adoption of health IT could be related to lack of patient awareness, limited health literacy, lower socioeconomic status, older age, inadequate computer skills, and unmet technical support needs.(3,13) Some of these challenges are related to organizational strategies (or lack thereof) for promoting patient and provider uptake of patient-facing technologies, such as personal health records.(14) Organizations should make such uptake a strategic investment priority, targeting specific populations and monitoring their uptake.(14) Another challenge is related to patient-facing mobile health applications (mHealth apps). While the number of available smartphones and mHealth apps has grown substantially, research suggest that few apps address the needs of the patients who could benefit the most, and many of the apps are not safe or secure.(15) Finally, in some cases patient-facing health IT may raise ethical and patient privacy issues; for example, when patients lack decisional capacity and their proxy decision makers use the health IT tools on their behalf.(16) Nevertheless, health IT tools that enable patient engagement are likely to grow in importance, as their potential is further understood and harnessed by policymakers, providers, and patients.

Patient-facing technology has the potential to improve quality and safety by enabling patients to take a more active role in their care. By maintaining focus on the people as much as the processes, technology will boost the progression toward patient-centered care—where patient preferences, needs, and values are emphasized as much as efforts to prevent adverse events. By combining these two endeavors, technology can play an unparalleled role in making health care safer, more efficient, and more coordinated.

Ronen Rozenblum, PhD, MPH
Assistant Professor, Harvard Medical School
Director, Unit for Innovative Healthcare Practice & Technology
Brigham and Women's Hospital

David Bates, MD, MS
Professor of Medicine, Harvard Medical School
Chief, Division of General Internal Medicine and Primary Care
Brigham and Women's Hospital
Medical Director, Clinical and Quality Analysis, Information Systems
Partners HealthCare System, Inc.

References

1. Corrigan JM, Donaldson MS, Kohn LT, eds. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.

2. Wachter R. The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age. New York, NY: McGraw-Hill; 2015. ISBN: 9780071849463.

3. Rozenblum R, Miller P, Pearson D, Marielli A. Patient-centered healthcare, patient engagement and health information technology: the perfect storm. In: Grando M, Rozenblum R, Bates D, eds. Information Technology for Patient Empowerment in Healthcare. Berlin: Walter de Gruyter Inc; 2015: 3-22. ISBN: 9781614515920.

4. Grando M, Rozenblum R, Bates DW, eds. Information Technology for Patient Empowerment in Healthcare. Berlin, Germany: Walter de Gruyter Inc.; 2015. ISBN: 9781614515920.

5. Rozenblum R, Bates DW. Patient-centered healthcare, social media and the internet: the perfect storm? BMJ Qual Saf. 2013;22:183-186. [go to PubMed]

6. Rozenblum R, Greaves F, Bates DW. The role of social media around patient experience and engagement. BMJ Qual Saf. 2017;26:845-884. [go to PubMed]

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10. Dykes PC, Rozenblum R, Dalal A, et al. Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: the promoting respect and ongoing safety through patient engagement communication and technology study. Crit Care Med. 2017;45:e806-e813. [go to PubMed]

11. Kakad M, Rozenblum R, Bates DW. Getting buy-in for predictive analytics in health care. Harv Bus Rev. May-June 2017;95:2-5. [Available at]

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13. Ahern DK, Woods SS, Lightowler MC, Finley SW, Houston TK. Promise of and potential for patient-facing technologies to enable meaningful use. Am J Prev Med. 2011;40(suppl 2):S162-S172. [go to PubMed]

14. Wells S, Rozenblum R, Park A, Dunn M, Bates DW. Organizational strategies for promoting patient and provider uptake of personal health records. J Am Med Inform Assoc. 2015;22:213-222. [go to PubMed]

15. Singh K, Drouin K, Newmark LP, et al. Many mobile health apps target high-need, high-cost populations, but gaps remain. Health Aff (Millwood). 2016;35:2310-2318. [go to PubMed]

16. Brown SM, Aboumatar HJ, Francis L, et al; Privacy, Access, and Engagement Task Force of the Libretto Consortium of the Gordon and Betty Moore Foundation. Balancing digital information-sharing and patient privacy when engaging families in the intensive care unit. J Am Med Inform Assoc. 2016;23:995-1000. [go to PubMed]