Welcome to the Bitjam medical health app blog series. Last week we discussed the increasing number of apps available on the market, how HCP’s are dealing with conformance and compliance and the effects of app technology on interoperability in healthcare today. If you missed it or want a chance to refresh your memory you can find part one here.
Part two will investigate the technology designed to help patients change behaviours based on Prochaska & DiClemente’s ‘Stages of Change’ model, and the difference between informing and changing – striking the balance between giving accurate and useful information
Many of you reading this article will have first hand experience of trying to change certain behaviours, whether that’s by exercising more, eating more healthily or spending more time relaxing. We know that these changes in behaviour don’t happen overnight, but over a period of stages beginning with precontemplation and ending in action maintenance. As we know, maintaining the changed behaviour so that it becomes normalised day to day rather than short term is very tricky, and in many cases relapses occur, that’s if the idea even makes it beyond the precontemplation stage.
The Stages of Change Model
Different to a theory, this is a model and highlights the various stages and states of behaviour change. It’s also known as the Transtheoretical Model.
- Precontemplation – the earliest stage of change consideration. It can take around another 6 months to take any action during this phase. More often than not people will emphasise the cons here rather than the pros
- Contemplation – also known as the recognition stage, this is when people start to see how adopting healthy behaviours could have an positive impact on their wellbeing and might consider action in the next 6 months, but are perhaps likely to still feel ambivalent to the idea of change
- Preparation – people are ready to take action within the next 30 days, perhaps by taking small determined steps to assist behaviour change. They start to realise that healthy changes could make them happier
- Action – people have recently changed their behavior and intend to keep moving forward with their healthy habits
- Maintenance – people have sustained their behavior change for more than 6 months and intend to maintain the behavior change going forward. This stage is where the work to prevent relapse occurs
- Termination – this is the final stage of the model, in which people are sure they will never return to their unhealthy lifestyles. This stage is very elusive, as most people will always stay in the maintenance stage, working continually to manage their healthy behaviour but still at risk of relapse.
How Technology Can Assist Behaviour Activation
The role of technology not only aids the initial action stage but can support maintenance and deal with potential relapses. As the model in figure 1 suggests, during the stages of change, relapse, exit and re-entering between Determination and Maintenance is a common occurrence. People need as much support as possible to stay – or return back to – the track.
Yet it’s not about how sophisticated the tech is, the key to success is in cracking the psychological obstacles indicated in the Transtheoretical Model, changing the mindset of the person and supporting then offering continual support during maintenance.
Technology is offering a new fix for one of the most confounding health-care challenges: getting patients with chronic disease to take better care of themselves.
This quote perfectly demonstrates the challenge faced by developers of digital health apps. As well as the technical complications – such as data privacy, regulations and synchronisation with older systems – the developer has to present the user (who will now be in the preparation stage”) with compelling language and data that will convince them to move forward into action. The developer will need to have a thorough understanding of the difference between informing and changing, depending on the intention of the app.
The Transition from Informing to Changing
Informing is simply passing useful information on to somebody that’s relevant and beneficial to their treatment, but changing is the act of using this information, implementing the learnings and actively applying the treatment in order to provoke positive and longer lasting behaviour changes. Changing is the activation of positive behaviours. The app must strike the balance between giving accurate and useful information in the most appropriate way and at the right time. This is why understanding the Stages of Change Model is crucial to the performance of a digital health app, the developer must know where their user currently sits in the model.
How Apps Can Actively Assist in Behavioural Activation
- They are more readily available to the patient, using device platforms that they are likely to carry around in their pockets
- The user has 24 hour access
- The user can monitor their progress, which can stimulate positive mentality towards healthy changes
- Accessibility promotes patient empowerment, provided the developer has also considered the challenges of accessibility to those with disability, lack of computer skills etc. Inclusivity needs also to be at the forefront of development
In part three we will be talking with Lisa Sharrock, CBT therapist and registered mental health nurse for North Staffordshire Combined Healthcare NHS Trust, and Bitjam partner to discuss our project BeAble – a post-discharge app currently in phase two of BETA testing designed to assist with relapse-prevention support.
To find out more about digital health apps or discuss your own healthcare technology project, you can make an appointment here to pop and see us at our new location at Keele Science and Innovation Park.
What Is Interoperability in Healthcare
Interoperability is the extent to which systems and devices can exchange and interpret shared data. In healthcare, effective interoperability occurs when IT and software systems to exchange shared data to create information that can be used to assist clinicians and other medical professions with patient care.
Issues Healthcare Staff Are Currently Facing
“Staff suffer from increasing workload and stricter performance measures with less flexibility. This has caused psychological and physical stress…” Science Daily.com
It’s no secret that digitising healthcare IT systems has been a slow and frustrating process for all stakeholders involved, especially the end users who have the responsibility of delivering safe patient care in a secure manner. This adds further pressure to staff who are already suffering from increased workloads and limited resources.
“We physicians have the longest training time of any profession, yet we now spend roughly two-thirds of our workday as data-entry clerks, tending to digital paperwork and administrative burdens” – WSJ.com
How Is Data Currently Manifesting Itself in Healthcare?
- Notes entered into the EHR (electronic health record)
- Documents that have been scanned as image files or pdf documents
- Discrete data such as lab test results.
“The data arrives from many different sources and systems and in multiple formats. It has to be parsed into a format that everyone understands and has been trained to act upon in an appropriate manner” Alan Brookstone
- The Tech
Data presentation can negatively influence decision making if it is presented in an illogical or intuitive way
- Human Skills
The computer skills of all staff members and knowledge of their EHR has a significant impact on data interpretation. There are many reasons why some people are less digitally literate than others.
- Upgrades and Disruption
According to AmericanEHR one of the most frequent complaints of users is that their EHR does not have the necessary tools or capabilities to perform a certain function. Sometimes the staff are unaware that their EHR has the functionality as they haven’t been trained to use the product properly. In other cases their system may require an upgrade. Upgrades can be complex and entire servers may need to be shut down for maintenance. Consequently, upgrades are often delayed because of the disruption.
How Can We Succeed?
Lack of interoperability leads to poor outcomes, therefore the issue must be tackled to ensure quality control.
We believe merging simple-to-use, reliable technology and adequate human support and training will result in the ultimate success of any EHR implementation.
So a move towards cloud-based systems will have a definite advantage as the software is updated centrally by the vendor with limited need to update technology at the user end.
The most significant impact would become apparent with changes to government regulations. G Cloud is an initiative that assists with the procurement by public sector departments in the UK of cloud based commodity IT services. Traditionally, vendors have to be certified as compliant by the Department of Health which inhibits better products and slows down new system implementation. G Cloud is a way of shifting away from more primitive systems and offers a positive step towards improving the efficiency of EHR software and communication tools.
At Bitjam we pride ourselves on finding continuous ways to improve developer documentation, with cloud-based systems and use of more consistent data design at the forefront of what we do. Our mission is to use technology for social good, so if you have a digital healthcare problem that you’d like to solve, email us at [email protected] to find out more about our previous work.
It seems the UK isn’t the only country frustrated at the state of their healthcare system. American businesses have also voiced their concerns over the rapidly spiralling cost of medical treatment.
This has led to the allegiance of some of America’s biggest corporations, including Amazon, to team up to form their own independent healthcare company for employees, based on data that they’ve gathered themselves (perhaps world domination is next?!)
And if the venture indeed launches and becomes integrated within the company, how long will it be until Amazon rolls out the system to the wider consumer?
Virtual Healthcare Assistants?
Amazon is one of several large tech companies who’ve ventured in to the world of virtual assistants, with the launch of Amazon Alexa in November 2014.
The voice-responsive AI can be called upon to assist with all sorts of digital tasks such as prompting connected apps or ordering products online. Amazon have been able to learn the behaviours and preferences of the consumer, and have drawn data from these statistics that have led them to them confidently moving into the world of healthcare.
Given that many people already “self-diagnose” using websites such as WebMD to validate their symptoms, (you can also activate this site using a virtual assistant such as Alexa or Google Home), it wouldn’t be unthinkable to imagine a time where we seek medical advice from the comfort of our own homes.
Having access to fast, effective medical solutions solves healthcare system issues such as a lack of workforce and wait time, and potentially reduce the spread of disease.
Home health aides are testing the use of Amazon’s Echo platform to assist elderly patients. They are finding this system gives clients more access to family members and assistance to ensure they get their medication on time. Other tech companies are now rushing to capitalise on this opportunity and provide similar services.
But what about the challenges? It would be both illegal and morally wrong to sell prescription drugs next to toys and household products. AI could potentially obtain inaccurate data leading to misdiagnosis or ineffective advice. There’s also the loss of human interaction, resulting in an impersonal experience, a lack of empathy and trust, and potentially increased paranoia around sickness.
“What we’re seeing is going to be a whole new look at privacy. HIPAA regulations … [are] 20 years old — and they don’t even take into account the technology and the data processing capability that we have today. There have to be a lot of adjustments before this becomes part of routine practice.” – Dr Eric Topol Scripps Health.
What the Health Tech Experts Think
Here’s how some experts believe an Amazon healthcare system might be adopted:
“Amazon, for example, might see that a customer has bought cough drops every week for the last month, and went to the doctor for a cold six weeks before but never filled his prescription. Amazon, or an “Amazon-like company” could use that kind of insight to encourage consumers to go back to the doctor, or drop by a nearby clinic for a nurse practitioner to examine them. That could solve the problem of getting the wrong care.” – Gil Irwin PwC
“One day, we could tell Echo our ailments and have recommendations and potentially some drug recommendations, which they could fulfill if they also have doctors available in live chat on an Echo Show device,” – Wendell Potter Tarbell.
AI’s and virtual assistants have been adopted into the mainstream very successfully, so it will be interesting to see how the IoT filters throughout our homes and personal lives to the point of acceptable dependency, even when it comes to our own health. We’ve noticed ourselves at Bitjam that we’re being approached by an increasing amount of businesses and researchers, including NHS, with regards to IoT projects.
What Bitjam are Doing
We have experimented with Alexa building simple question and answer skills based on health information (the core feature of Alexa). We have begun to think ahead with new products we’re developing integrating data design features for a plug and play capability into Amazon Alexa at future dates. It’s better to make small changes in data design earlier on rather than an after-thought.
To get in touch about your own IoT project, contact Carl for a chat at [email protected] (you could even tell Alexa to email him for you!)