Trend to Watch: Improve Patient Engagement With Communication Apps

Some time ago, an experiment was designed to get patients to be more active during their post-surgical recoveries by using pedometers. Everyone in the controlled study was given their weekly pedometer data, but half were given their step counts during virtual meetings with an avatar coach named Karen. The patients would type chat box messages about their recoveries and Karen would respond with instructions and supportive comments based on the comments. It turns out that the group that was connected with Karen was significantly more active in their first several postoperative weeks compared to those who were simply informed of their pedometer data by traditional means.

“In exit interviews, patients reported that they didn’t want to disappoint her and that they really valued the relationship — and it was a relationship with a coach who looks like a cartoon,” says Joseph C. Kvedar, a Harvard Medical School professor and board chairman of the American Telemedicine Association, a nonprofit that provides clinical practice guidelines for virtual care. “Our brains are wired to interact with things, and it doesn’t always have to be a human being. It can be software if it’s well designed.”

Enter phone apps and web platforms that healthcare providers use to educate and send reminders to patients before their procedure, communicate with loved ones on the day of surgery and help patients to actively participate in their postoperative care. Their use increased by necessity during the COVID-19 pandemic and there’s no sign of the burgeoning telehealth movement waning any time soon.

The use of remote platforms makes perfect sense for ASCs and surgeons’ practices that are low on administrative staff and often must deliver the same preoperative information to multiple patients by phone, which takes a lot of time. Information such as reminders to fast after midnight on days of surgery, how much time before procedures patients should arrive and other boilerplate messages are the lowest hanging fruit for digital health, according to Jayson S. Marwaha, MD, MSc, a general surgery resident at Beth Israel Deaconess Medical Center in Boston and a postdoctoral fellow in informatics at Harvard Medical School in Cambridge.

“There’s no reason for surgical schedulers to call patient after patient to tell them the exact same things that have no variation from one individual to another,” says Dr. Marwaha. “None of this requires sophisticated artificial intelligence or computer vision, so developing and implementing this kind of automation doesn’t require technical complexity or much time or effort. Digital health should be used routinely by surgical professionals.”

If this sounds impersonal, Drs. Kvedar and Marwaha argue the opposite is true. Many patients, in fact, prefer to ask questions or disclose pre-existing conditions during virtual communications with providers to doing so in person. “Sometimes patients want an anonymous sounding board,” notes Dr. Kvedar.

Delivering written information about the reason for surgery, the specific goal of the operation, the general steps of how the procedure is going to unfold, its associated risks, and the impact on the patient’s quality of life and functional indications is better than giving it verbally.

The reason? Patients are extremely anxious before surgery and meet an entourage of providers when they arrive at the facility. Plus, the preoperative meeting with the surgeon is typically very brief. “Patients tend to not clearly remember anything they were told when they’re nervous,” says Dr. Kvedar. A pre-op experience with a chatbot or virtual avatar, on the other hand, allows patients to repeatedly ask a series of questions until they understand the answers. It also gives them the opportunity to review an answer four or five times so they remember it.

“In these settings, patients don’t have to pretend they’re smart and understand what they’re being told, as they might when they’re in front of their surgeon,” says Dr. Kvedar. “We know a lot about adult learning, and it doesn’t happen on the spot, especially when we’re nervous. Patients will have a deeper understanding of what they’re told in a different platform that puts them at ease, as long as the information is presented with sound learning and educational principles.”

Dr. Marwaha says delivering virtual messages to patients saves staff time by eliminating the need for the pre-op call. It also reduces the inevitable time-consuming follow-up calls from patients who didn’t remember everything that was said during the initial conversation. “Asynchronous information delivery is a tremendous advantage because the patient can refer back to the talking points that they might have forgotten if they were given to them once over the phone,” says Dr. Marwaha. “The ability for the patient to refer to a repository of information at their convenience is incredibly valuable and powerful. Many patients don’t remember how to change their wound dressings or any other instructions if they’re told about it once.”

Another added benefit of using virtual apps and platforms to connect with patients: Getting the rudimentary information out of the way through virtual communications before the day of surgery — so it’s already understood by patients — increases the quality of provider-patient interactions in pre- and post-op because more advanced and nuanced care topics can be discussed.

An app’s platform should also allow you to modify standard scripted instructions so they can be tailored to each patient’s needs. The ability to do so gives these platforms a leg up on printed booklets that explain the episode of care, because there’s an individualized component to each case. Some platforms, for example, allow patients to read summations of every conversation they’ve had with their physician. Dr. Kvedar says virtual physical therapy is a growth area as well because research has shown that patients do well during in-person sessions but rarely follow through on the written instructions about what to do at home. Interactive visits with a physical therapist improve adherence to their aftercare program, according to Dr. Kvedar.

Remote patient monitoring platforms are also on the rise. Collecting information on recovery statuses from patients allows physicians to better conduct follow-up care. A simple example is when a patient takes a photo of their uncomplicated wound and sends it to the surgeon in an electronic exchange for a post-op wound check, says Dr. Kvedar. Another example is collecting real-time data on patients’ post-surgical pain levels. This two-way stream of information allows physicians to better tailor a patient’s post-discharge recovery trajectories. 

“There’s an opportunity to learn from patient-reported data,” says Dr. Marwaha. “If enough is collected, we might be able to use the information to improve care for future patients.” 

When deciding whether to purchase a third-party app, first assess its compatibility with your existing IT network to make sure data can be securely sent, received and stored on all platforms. “In fact, I strongly recommend asking your current IT vendors if they have these kinds of apps available, because purchasing one from a company you already work with would be better from an interoperability perspective than exploring other options,” says Dr. Marwaha. “The firm that is already providing IT functions is definitely the place to start.”

Whether texting patients with pre-op instructions or keeping family members abreast of their loved one’s status during surgery, people of all ages appear to be embracing technology as part of the surgical process. Dr. Marwaha points to how well older patients adapted to virtual care during the height of the pandemic.

Early data shows automated information delivery can improve outcomes, according to Dr. Kvedar. “They reduce surgical cancellations, patient misunderstanding and noncompliance with instructions,” he says. “Surgical facilities should make these systems a priority, because patients who use them are better prepared for surgery and better able to care for themselves afterward.” OSM