Mobile supports 'patient activation' of clinical decision support

By Neil Versel
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Doug ThompsonMobile and wireless technologies are helping give rise to a new form of clinical decision support that's being called "patient activation."

"We're making a category that really hasn't existed," according to Doug Thompson, a senior research director at the Advisory Board Co., a Washington-based research firm that is making a big push into healthcare of late.

"The term 'patient activation' can be simply defined as a patient's ability and willingness to manage their own health and health care," Thompson explained in a recent paper he authored, called, "Hello, It's Your Pill Bottle Calling: Decision Support Options for Patient Activation."

"Just as doctors and other clinicians need computerized help deciding on a diagnosis or treatment, patients need help playing the important roles in their own care processes," the paper says. "This is where patient activation CDS comes in."

There are four things patients can do to activate themselves, Thompson told MobiHealthNews at an Advisory Board healthcare meeting in Chicago last week. Individuals can help determine what kind of treatment they get, they can monitor their own conditions, they make the choice to comply with physician instructions and they make decisions when to seek professional care.

"We're trying to get patients to play their role in their healthcare," Thompson explained. Clinical decision support traditionally has referred to information delivered to physicians or other healthcare professionals. "We started thinking … hey, there actually is a category of patient activation CDS," Thompson said. "This really is decision support to the patient, not filtered through the doctor."

Advisory has divided patient activation CDS into three categories, all of which might have a mobile or wireless component: shared decision-making tools such as interactive video, patient education or information therapy; home-health status monitoring; and compliance alerts.

Thompson specifically mentioned Robert Bosch Healthcare's Health Buddy and Intel Health Guide, a communications hub now known as Care Innovations Guide, as examples of home status monitors. He also said he was fascinated by the Daiwa House-Toto Intelligence Toilet, a toilet with an integrated urinalysis machine that can transmit results to a nearby computer. "I love that one," Thompson admitted.

Compliance alerts might take the form of text reminders, or come from a physical product like Vitality GlowCaps. Add GPS-based location technology and you have clinical decision support. "I'm walking down the street and I get a little text that says I just passed my walk-in clinic and [my] kid is due for a vaccination. Why don't you just turn right and get it? That would be patient activation CDS," Thompson said.

"You may have heard of some of these, but have you thought about them as a category of CDS, which is what they really are?"

CDS once was limited to the clinical environment, but communication hubs now draw in pertinent data from many locations, providing the decision support engine with a more complete picture of an individual's health status.

"This is all real stuff," Thompson said. But it is a somewhat immature market, especially since there is no proven business model just yet.

"You need to start thinking about this stuff, but don't just go out and buy a million of these devices. Do some pilots." Thompson said. "It's not our first recommendation for a hospital" to spend money on.

"The other important thing is, people buy this stuff, too," the Advisory researcher added. Hospitals may purchase a supply of remote patient monitors, but Thompson thinks the consumer market could be larger—as long as the technology is simple to use, even for elderly patients. "It's got to be Apple-ish," he said.

Healthcare reform is changing some of the parameters, though. As providers turn themselves into accountable care organizations, it might be time to think about combining patient activation and CDS. With Medicare starting to deny reimbursements for preventable readmissions and payers generally paying more attention to post-discharge outcomes, patient activation CDS could become financially feasible, according to Thompson.

"Accountable care and payment reform are the drivers," he said.

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