Text Messaging

Can Text Messaging Improve Patient Engagement Outcomes?

Text messagesMedication non adherence is a significant problem, it always has been and it will continue to be so with an estimated cost to the NHS of £600m* a year! So what can be done to improve patient outcomes? Changing patient behaviour is key to this and there have been a number of clinically led studies conducted that demonstrate that apps can help to improve compliance.  But, when looking at patient engagement, perhaps there is another solution where a person-centric approach is more likely to improve the odds of success. A successful engagement programme needs healthcare providers to be able to reach their patients in familiar and effective ways and by doing this, patients are encouraged to take an active role in their treatment which will in turn lead to better healthcare outcomes.

This is where I think text messaging could be the answer.

It’s a cost effective way of providing a more personalised experience with a greater reach than just smartphone users. Last year over 145 billion* text messages were sent and despite the rise of instant messaging platforms among younger users, text messages remain device agnostic and one of the easiest ways reach anyone with a mobile phone.

The Personal Touch

Your health is a private matter and the more personalised the experience, the more likely patients are to respond and take an active role in managing their own treatment. Medication reminders, exercise reminders, appointment booking, pre-op instructions, post op advise can all be communicated ‘one-on-one’ and doing this on a personal level, knowing that a real person is supporting them, can be a real motivator to empowering them to make the necessary changes.

A GSMA study in 2012 showed that 54% of consumers wanted to improve their healthcare using their mobiles in more personalised ways, taking more control in their treatment.

Patient Preferences

Reach

In order for any patient engagement programme to be successful the number of patients you are able to reach is very important. Patients comes from a variety of backgrounds and demographics with a range of communication preferences. Combined with the fact that it’s not always possible to be connected to the internet, text messaging offers the lowest common denominator and most reliable way of contacting patients. Text messaging also is the quickest way to reach the most people. The average text message is read within the first 90 seconds, whereas the average email is opened within the first 90 minutes*.

Security

Clearly security and compliance are also considerations for any healthcare system that communicates patient information. The text messages can be stored securely inline with HIPAA compliance but because security depends on the cooperation of all parties involved in the transmission process there are bound to be challenges. However if the tool is used correctly, with guidelines in place to support patients with their treatment plans and not for discussing medical issues, many of these security concerns are negated.

Conclusion

There is no doubt that apps and smartphones will make communication easier, reduce costs and improve efficiencies throughout the NHS. But let’s not just assume that apps are the answer before considering all the technologies available to us and the way in which patients use them. Familiarity, reach and simplicity can play a big role in the success of an initiative like this and, used in the correct way, could see tangible benefits in terms of outcomes and cost savings.

*http://europe.newsweek.com/health-apps-created-surgeons-put-patients-control-313531
*http://www.hsj.co.uk/resource-centre/best-practice/qipp-resources/how-improved-medication-adherence-can-prevent-costly-medicine-waste/5041067.article#.VVXLXJNVhBc
*http://www.theguardian.com/technology/2014/jan/13/number-text-messages-sent-britain-falls-first-time
*http://www.pewinternet.org/2012/11/30/the-best-and-worst-of-mobile-connectivity/
Image credit: Amancay Maahs (https://www.flickr.com/photos/amanky/3211478871/)

Connecting your medical app or website to the NHS : The N3 Network

Many ideas for apps and websites we deal with are based around some interaction with the NHS but integrating with NHS services and facilities isn’t always straight forward. One of the barriers to entry is the NHS N3 network. N3 is the broadband network for the NHS which connects all NHS locations and over a million employees. It connects hospitals, GP surgeries, pharmacies and many other service providers to securely facilitate sharing of healthcare data including sensitive patient records.

If your app, website or service needs to interact with NHS data then you may well need to be connected to the N3 network. As specialist providers of health related apps and websites, Genetic Digital’s customers often fall in to this category with web services we develop (which are often the backend of an app) requiring access. However, just to muddy the waters somewhat, N3 connectivity isn’t always mandatory (which can be true for non Patient Identifiable Data only); some NHS trusts have a more relaxed approach than others depending on their internal IT policies and configuration.

So who needs an N3 connection? There are no hard and fast rules but, broadly speaking, if you want to exchange data with an NHS trust (or trusts), especially sensitive data such as patient records, then you’ll need to be on N3. Even if it’s not a requirement if you are offering an on-premise solution, it’s often a commercial advantage if you can offer it. Given two competing services, an NHS trust could well choose one that offers services via N3 over one that doesn’t.

One point worth noting is only traffic from England can flow over the N3 connection so you can’t manage the service from an Indian call centre for example or push or pull patient data from Scotland, Wales or any other country. Knowing where your data resides is vital in applying for your accreditation to connect to N3.

How do you go about connecting to the N3 network? It’s a multi-step process with the first being deciding who you will contact to request access. For this, there are two options, one is to deal with the HSCIC direct (the N3 service provider) and the other is to deal with an N3 commercial aggregator. Dealing direct the process tends to take longer and commercial aggregators are organisations who have been granted power by the HSCIC to vet, assess and grant end user access requests to N3. This latter route is often much quicker and enables you to work with experienced staff who can offer direct support to help complete the required documentation.

Once a request is made there are then two parts of a pre-assessment questionnaire that need completing:

  • The HIGCAP – an eight question form asking about the nature of the connection, name of the company making the request, contact details, ISO certification status etc.
  • You then need to get a sponsor to complete their portion of the form – a sponsor is a responsible individual within an NHS organisation who will vouch for your connection application, for example, a senior manager with knowledge of your project.

After the above two are completed they are assessed for pre-approval. Once pre-approved you move on to:

  • The LCA – Local Connection Architecture questionnaire – this is a comprehensive break down of why the N3 is required – what the connection is for, the type of data etc.

If using a commercial aggregator, a meeting or conference call is usually had to discuss the LCA and help complete it. Once completed to the satisfaction of the provider, N3 approval is granted and a connection is setup.

Once an N3 connection is setup, the end user (our client for example) is obliged to complete the IG Toolkit. This is a process similar to ISO27001 certification which ensures procedures and policies are in place to prevent misuse or negligence of the N3 connection and associated service. They have until the end of March to complete it, so, if access is granted on the 30th March they have 1 day to complete it, if access is granted on 1st April they have a full year. Yes, this is odd. Because of this, completion is not strictly enforced and can (and does) take longer to complete. However, ultimately it needs to be done annually.

What type of connection would I need? For our customers, the need is most often for hosting a server which can connect to N3. Commercial aggregators such as Redcentric own their own data centres with a direct connection to the N3 backbone.  Once approved, our clients can host their servers, either physical or virtual cloud based, in the data centre and their app or web visitor traffic flows in over the public internet and out over the N3. To ensure integrity of the N3 service, you are obliged to utilise a managed firewall that monitors and filters all traffic that crosses over the N3 boundary.

If your service is connected outside of a data centre, in a pharmacy for example, then, in addition to the N3 connection and firewall, you would need to purchase a broadband connection from the commercial aggregator at rates comparable to standard DSL providers.

What about the costs? There are no direct costs associated with obtaining an N3 connection but, like all network connections, there are ongoing costs for using it. There is a minimum 3 year contract and costs increase depending on the speed required. Connections are sold in increments of 1Mb/s which, despite sounding slow (a domestic high speed broadband connection is upwards of 50Mb/s), when dealing with low traffic levels and small packets of text data often used in apps, the basic 1Mb/s can sometimes suffice. Additionally, there are costs for the firewall, hosting in the data centre if necessary and costs for an external DSL connection if required. In all likelihood there would also be consultancy costs associated with completing the IG Toolkit.

In summary, there are commercial benefits to having an N3 connection available to your service and in many instances it will be a necessity. But it comes at a price, both financial and administrative so the decision to apply shouldn’t be taken lightly and should be based on your specific needs, requirements and business opportunities.

Thanks to Redcentric for their expert N3 knowledge that helped shape this article.

To find out more about how Genetic Digital’s expertise in building and marketing healthcare and pharmaceutical websites and apps could benefit your project contact us now.

Apple's HealthKit App

Is Apple’s ‘HealthKit’ really set to revolutionise the healthcare industry, or is mHealth all hype?

Apple will be officially launching iOS 8 this autumn, and at the same time it will also launch HealthKit. This new health app will provide Apple smartphone/tablet users with a dashboard of their health and fitness data. They have also created a new API tool for developers which will enable other health and fitness apps to work together. HealthKit has already been integrated with Nike’s running apps and the Mayo Clinic app, which will allow blood pressure to be recorded.

Apple are saying that HealthKit is going to revolutionise the healthcare industry so is this all hype or can mHealth solutions in the shape of mobile apps really help to tackle some of the key problems our healthcare system faces?

New levels of patient engagement, as observed in many studies, are proving that patient outcomes are improved and costs reduced when patients are more involved in their own care.  And the advent and continued development of mobile health apps (mHealth) is responsible for driving that patient engagement.

Studies have shown that on average, people check their phones 150 times a day. Healthcare providers have now realised the potential advantage of this “addiction” to engage with people over health issues.

The birth of mHealth could be attributed in large part to Joseph Kvedar, MD, the director of Partners HealthCare’s Centre for Connected Health in Boston.  Since he first began to launch ‘connected health’ through technology some eighteen years ago, the landscape has changed dramatically. Kvedar started with telemedicine as well as dermatological imaging.  The camera he used at that time had less than 1 megapixel resolution, and was the size of the average shoebox.  It cost twelve thousand dollars. In those early days, videoconferencing capabilities cost fifty thousand dollars. Since then, technological changes have been dramatic, with the number of mobiles in use greater in number than landlines.  Other tools like Skype and Facetime make it possible to videoconference anytime and anywhere.

Kvedar’s centre was also the origin of the moniker ‘connected health’ in 2005. This was in response to the lacklustre enthusiasm that there was to the terms telemedicine and telehealth. The mobile revolution was taking off at that time and now, it seems inconceivable to think of developing any program that does not involve the use of mobile technology.

From that point the rise and rise of mHealth has continued.  It is now one of the most exciting prospects for the management and interaction of patients with health care provision that there has ever been. Along with the concept of meaningful use, another important factor that drives the patient engagement trend is the rise of models of accountable care along with payment restructurings. Under these accountable care models, health providers are responsible for the management of an entire population with payments based on results  (keeping the population well and getting them better) rather than a fee based system based on services provided. This makes providers even more keen to find effective ways of engaging their patients in the management of their own health, in between visits to the surgery

Before rushing headlong into digital patient engagement tools, however it is worth mentioning information inheritance and the way in which most providers still currently engage with patients in their care. This includes printed copies of health records, discharge instructions, simple diagrams or descriptions of exercises, medication timetables, and other instructions.  There is still reliance on phone call reminders follow-up phone calls and one to one conversation with healthcare providers.

So, while some of the expanding tools for digital patient engagement aim to be replacements for traditional channels, most aim to be a complementary or offer augmentation to existing channels of communication and contact.  There is no doubt that mHealth has advanced fast since the iPhone came onto the scene just over 7 years ago.  So, it will be interesting to see what impact Apple’s HealthKit is going to have on the healthcare sector and what health and medical apps we’ll have access to in 7 years from now.

Babylon Health App

Babylon Health App – Our Initial Impressions

A hugely exciting development in the world of m-health is the launch of Babylon, a subscription health service and mobile app that allows you to book virtual consultations with doctors and at the same time track symptoms and receive prescriptions.

The system is not design to replace face to face consultations but to reduce the number face to face consultation required, cutting the burden on the NHS and associated costs with it. It’s also more convenient for patients being able to arrange virtual consultations at their convenience without having to take time off work and within a timeframe that suits them.  The company behind Babylon will keep all notes and videos from any consultation undertaken which, with the permission of the patient will share with other healthcare professionals like their GP.

The ultimate ambition of Babylon is to move healthcare from a reactive model to a proactive one. Ali Parsa explains “We are used to dealing with our health like we used to deal with cars; we’d wait until they broke down and then take them to the mechanics. Now cars have sensors all over them so it doesn’t matter what’s going wrong, we know ahead of time.”

Although Babylon won’t suit everyone, particularly those who have yet to own a smart phone, this is a huge leap forward in proving an integrated service designed to give patients a choice while providing referral and testing services.

Initial impressions

However, trying to access the app has proved challenging. It’s easy enough to download but using iOS, the sign up form is painful in its execution with a date selector that won’t stay on the day you’ve selected, returning to a default value of 4 and when a mistake is made and the next button is used, it overwrites exiting values already included on the form. Android is fine. Once the submission has been made, you’re then presented with a screen explaining that you cannot have access to the service yet and you’ll be informed as part of a rollout programme. This is really poor and should have been made clear well before the download was made. There is also nothing to support this from their website and no information about pricing for example if you had to sign up to a minimum contract length or you could just pay for a month at a time.

Whether it’s a success or not will depend on how well the business can be scaled to cope with demand, which they are clearly having problems with already and many people are comfortable talking to a virtual ‘locum’ GP rather than their trusted local GP. Opening up to a complete stranger about health issues, even at your own surgery, can seem quite daunting and the mere convenience of being able to do this via an app may not be enough of an incentive to use the service.

How apps could help to improve medication adherence

Playing Games With Your Medicine

The stampede towards campaigns on social media and mobile apps designed to increase health awareness, continues.  The same media is also being used to promote patient adherence to medication regimes.  Some of the most inventive ways being employed to get patients involved have been with the use of gaming apps.  Inelegantly labelled SMAG’s which stands for Social, mobile and games, the technology is still very much a new innovation and the question is – are they just a gimmick or will they really do anything to help the adherence to medication in those that they are aimed at?

There is no doubt that medication adherence is now a multi billion dollar per year problem, and one of those working on using gaming to address the problem is Mango who have observed that the industry has tended to focus on two main areas.  The first is tracking the consumption of medicine by patients.  The second area of focus has been analysis of patient data to better identify the populations at risk in various scenarios.  However, it is now thought that the root cause of patient non adherence is likely to be due more to behavioural issues.

mango drug adherence app

With the app that Mango produce the patient can enter any supplements or medication that they need to take as well as the timing and the dosage of that medication.  The app, that is typical of the many adherence apps on the market, will advise patients of the time that they need to take their medication.  It will also alert the user to any potential reaction between medications that might prove dangerous.   But it is the gaming side that the makers are hoping will give their app the edge.  The game involves a currency that is unique to the game and the user will ‘earn’ the virtual money by being rewarded for taking medication on time, for instance.  There is a levelling up scheme that means that the users of the gaming system of adherence can progress to actual rewards from Mango’s partners. The type of rewards on offer will include items such as donations to charities and rewards that can be redeemed at retailers.  Another interesting feature of the gaming app is that the user can see how their adherence to medication compares with others suffering from the same condition. The Mango app is aimed at middle aged people diagnosed with certain conditions although in practice the makers have found that they have had users in their twenties as well as in their seventies.  Maybe it never is too late to teach an old or a young dog new tricks!

Apple healthbook mock-up

Apple’s Healthbook app could make it easier for you to manage your own health

In line with the current trend towards health apps and wearables, Apple is due to launch their own app, Healthbook.  The release of the app is likely to be timed to coincide with the release of iOS 8.  It will collect and then organise specific information as well as data points that relate to the health of the app user.  Included in the app’s offerings is the chance to access statistics on fitness, delivered from the new M7 processor in the iPhone 5.  Other data will be collected from a new wearable device (the iWatch – rumoured to be a ‘smartwatch’ that acts as a small wearable computer worn on the wrist and synced with the iPhone.) The app will be preinstalled and will be capable of tracking data points such as information on things like blood pressure, heart rate, hydration levels, and has the potential to monitor other significant data for conditions like diabetes with measurement of blood glucose levels. Another feature could be the capability to remind the user of times at which they should take their medication.

Taking multiple user interface cues from the Passbook app, also produced by Apple, the Healthbook app has been developed to store such things as coupons and loyalty cards as ‘virtual cards’ removing the need for the actual item to be carried in a physical purse or wallet.

Apple's Healthbook Screen Mockup

Essentially the interface of the new Healthbook application is a virtual store of cards that can be swiped with ease. Each of the stored cards signifies a different data point for a health or fitness parameter. The logo for the Healthbook app bears a striking resemblance to the Apple Passbook icon.  The design of the Healthbook app, however, is decorated with graphics that depict vital signs.  Along with this new app, Apple are rumoured to be working on the design of their iOS 8 with the iWatch very much in mind.  Sources also suggest that both the iWatch and iPhone will be dependent on each other to a great extent to enable the health-tracking features.  It is thought that the iWatch will be able, in the same way as the Healthbook does, to measure health parameters that include vital signs such as heart rate etc.

An Apple App a Day Will Keep The Doctor Away

Although as yet the speculation as the launch date of the app is just that, sources do suggest that Apple have managed to combine several of the health sensors into just one chipset to keep the size as small as possible.

Recently, Apple has also even requested a few patents. According to one document filed with the U.S. Patent and Trademark Office, the company is developing technology that could possibly unlock a device like an iPhone by identifying the owner’s unique electrical signals from the heart. And last year, Apple hired several health, medical, and fitness experts to work on these hardware and software projects.

None of the above comes as a surprise to me as Apple are looking at a number of new areas to diversify into to help re-ignite its growth and with the healthcare app development market set to grow to over $20 billion by 2017, I guess Apple want a slice of that tasty pie and with lashings of cream on top!