actually increase engagement

@alextarling

does giving patients more data

& improve outcomes?

user experience research is about:

actually increase engagementdoes giving patients more data

& improve outcomes?

perceptions

emotionsbehaviour

s

beliefs

the Lothian COPD telehealth trial

the telehealth context of care

$10,000$1,000$100$10$1

Qualityof Life

Cost of Care / Day

Independent, Healthy Living

Community Clinic

Chronic DiseaseManagement

Doctor’s Office

Home Care

Assisted Living

Skilled Nursing Facility

Residential Care

Specialty Clinic

Community Hospital

Emergency Department

Acute Care

ICU

patients completed daily ‘health sessions’:• daily symptom questionnaire with 8

questions:– “I am more breathless than usual”– “My sputum has increased in colour”– “My sputum has increased in

amount”, etc– Answers are scored, scores above

certain threshold trigger a clinical response

• physiological measures on a daily/weekly basis or as needed:– Pulse Oximeter (Pulse, SpO2), Peak

Flow Meter (FEV1), Weight Scales.

Community Respiratory Physiotherapy team

the service model

Patient and carers at home

When alerted: physiotherapy team contacts patient by videoconference or home visit

Patient’s daily readings and symptom scores uploaded

Daily monitoring by Community Respiratory Team

remote monitoring vs. self care

• service designed as remote monitoring with patients playing a passive role as providers of data not consumers

– “As the doctor says: ‘You don’t have to tell us, we’ll tell you, we’ll phone you and tell you that your oxygen levels are down or whatever, and then there’ll be a prescription’” (spouse of patient)

– “It made me more assured. In a way it was a relief, thinking that should I ignore my own thoughts on getting a doctor or something like that, this organisation would get hold of a doctor if their readings showed I needed a doctor” (patient)

• apparent paradox in this service model...

– strategy for chronic conditions is to increase self-care – the model increases professional surveillance of the patient– clinician concerns over increasing dependency on healthcare service

1. participating in daily care plans as a regular, intentional, socially-connected activity for patients.

2. increased awareness of personal health status, awareness of significance of changes.

3. engagement and ownership: patients assuming a direct role in owning, interpreting and managing access to their own health data.

despite this focus on remote monitoring, we saw examples of ‘emergent’ self-care and enhanced disease awareness:

actually increase engagementdoes giving patients more data

& improve outcomes?

behaviours

emotionsbeliefs

perceptions

actually increase engagementdoes giving patients more data

& improve outcomes?

behaviours

emotionsbeliefs

perceptions

... in order to evoke an emotionally resonant response

data needs to elicit personal meaning..

System One

95%

5%

SubconsciousEmotionalHotInstinctsDoing“I love stories”Makes decisions

System TwoConsciousRationalCold/CoolPlanningThinking“I love numbers”Justifies decisions

@DeniseHampson

actually increase engagementdoes giving patients more data

& improve outcomes?

behaviours

emotionsbeliefs

perceptions

... in order to evoke an emotionally resonant response

data needs to elicit personal meaning..

Consumer fitness and wellness self-monitoring:

actually increase engagementdoes giving patients more data

& improve outcomes?

behaviours

emotionsbeliefs

perceptions

... in order to evoke an emotionally resonant response

data needs to elicit personal meaning..

.. which has the potential to drive intentional, goal oriented action

actually increase engagementdoes giving patients more data

& improve outcomes?

...no (however...)

they have an emotional engagement

when patients develop meaningful interpretations of their personal health data

which creates the potential for positive changes to beliefs and behaviours

@alextarling