The need for a new approach to patient engagement and care collaboration

A couple of weeks ago, Microsoft announced that HealthVault, their personal health record platform, would close on November 20, 2019.  Their letter to us, as a HealthVault partner, gave no indication that they wanted us to migrate to another Microsoft product or, indeed, that they had any sort of follow-on strategy.  The writing has been on the wall for a long time, and we moved away from a dependence on HealthVault, so the closure will have no impact on the strategy for White Pine.  (I’ll write more about the rise and fall of the PHR market in another post.)

Just about the same time, almost to the day, we were applying for a provisional patent for our innovative technologies for patient engagement and care collaboration.  Why are we bullish on patient engagement and care collaboration technology just when the biggest of the PHR players threw in the towel?

The answer is both simple and complex.  In the simple expression, there are two big reasons:  First, simply putting information in the hands of the consumer was never a viable model, either to improve outcomes or to make a buck.  From the beginning, we focused on what people could do with their information, not where the data was stored.  Second, when considering what to do with the data, the early approaches built on PHRs enabled people to manage and improve their health, but did it mostly with standalone apps, independent of clinicians and healthcare providers.  Unless these technologies were carefully and fully integrated into the larger healthcare workflow, their value proposition was simply to small to affect behavior.  As a result, PHRs never gained the critical mass needed to change the world.

So why are we psyched about the market and the opportunity today?  As I was about to write down a few thoughts, I realized that I already had written it down, as the background section of a provisional patent application we filed with the USPTO on April 10, 2019.

The discussion from the PPA below does not address all aspects of the market, regulatory environment or the technology, but it does speak to one critical dimension of innovation that we are on top of.   In the next few days, I’ll post a summary of our patent innovation.  And we’ll have a new web site up in the next two weeks.  Here you go.



Studies have shown that the most costly and challenging patients are those with co-occurring physical and behavioral health issues combined with challenges involving social determinants of health such as food insecurity, housing instability or involvement with the criminal justice system.  Research has also shown that collaboration between physical health, behavioral health and social service providers improves outcomes and lowers cost.  Although the evidence is less definitive, studies have shown that technology-enabled workflows for patient engagement and care collaboration, including online and mobile applications, can improve health outcomes and lower cost.

Unfortunately, conventional electronic health record and social service systems have several disadvantages related to allowing organizations to create and distribute electronic workflows for patient engagement and care collaboration. For example, conventional electronic health record and social service systems fail to account for the fact that many organizations lack experience in designing, implementing or managing an effective electronic workflow system for patient engagement or care collaboration. In particular, conventional electronic workflow systems often rely on one or a few users within an organization to select an underlying evidence-based practice model, to design the organization’s specific implementation of that evidence-based practice, and to evaluate pre-configured software applications, or to manage the process of configuring, programming, evaluating and training users for a complex workflow system.  Moreover, few organizations have the knowledge or expertise to bridge the gap in practice standards and workflow between physical health, behavioral health and social supports.  Using conventional electronic health record and social service systems for patient engagement and cross-domain care collaboration is a time-consuming, costly and risky effort for most healthcare and social services organizations.  Accordingly, because of these complexities along with the need for specific expertise and costly design and programming services, most organizations choose simply not to adopt technology-enabled workflows for patient engagement and care collaboration.

Despite these challenges, there is an increasing demand for technology-enabled patient engagement and community care collaboration.  Early versions of technology-enabled patient engagement and care collaboration began to show up in the 1990s, generally following one of three tracks:

  1. Personal health records put the patient in control of their information, but the systems had little connectivity with provider electronic record systems, even less relationship to clinical workflows and no connection with social service providers.  Thus, PHRs were of limited value and have seen very low rates of adoption.
  2. Patient portals began showing up as extensions of electronic health record systems, focused on the transactional side of healthcare supporting tasks such as scheduling appointments, requesting medication refills, viewing and paying bills, and providing limited access to view personal health information and links to educational resources.  They also bore little relationship to clinical workflows, evidence-based practice or social services.
  3. Standalone apps and programs were narrowly designed for specific health interests, such as addiction, depression or hypertension.  Designed around specific evidence-based practices with a limited- scope workflow, these “freely-spinning-wheels” provided some value but bore little relation to the clinical workflow and made little effort to address collaboration across health or social domains.

However, beginning with legislation early in the 21st century, including HITECH and ARRA in 2009 and the Affordable Care Act of 2010, the market began to see an increased focus on the role of technology with closer ties to funding models including Medicare, Medicaid and private insurance.  These requirements focused on replacing paper records with electronic records and promoting electronic health information exchange of clinical data.  The requirements and financial incentives were primarily focused on physical health with limited incentive for behavioral health and no provisions to address social determinants of health.

More recently, policy and regulation at both the federal and state levels are providing new incentives for electronic workflows for patient engagement and care collaboration that extends across healthcare and social services.  Following are the key barriers and challenges that remain:

  • Standards and workflow requirements for physical and behavioral health are not aligned with social determinants of health, resulting in a fragmented marketplace with little collaboration and systems that lack interoperability.
  • Evidence-based practice (EBP) and standards, including regulatory and reporting requirements, are constantly changing, requiring continuous monitoring and frequent updates to remain in compliance;
  • Within the set of EBP and standards, providers have broad discretion in how they design and implement their own workflows. That means that one-size-fits-all solutions are not effective nor can they achieve high rates of adoption;
  • As mentioned above, most healthcare and social service organizations lack the expertise to design, construct, deploy and maintain these systems, and are uncomfortable assuming the risk for new technologies and workflows, and;
  • The costs of consultants and programmers to design, configure and update these systems using conventional systems is prohibitive for most organizations.

What is needed is an electronic workflow system that guides user/administrators to easily design, test, evaluate, deploy and manage electronic workflows without the need for costly consulting and programming services.    The electronic workflow system also needs to guide users to understand how well their systems conform to evolving evidence-based practice, standards and requirements.  While other industries, such as web-page design and surveys, have adopted similar technologies, no one has previously designed or developed solutions for the guided creation for the unique requirements of healthcare and social services for patient engagement and care collaboration.  That is the reason for this provisional patent application.

As you have no doubt noticed, this background description focuses on the provider side of  designing and managing engagement and collaboration workflows more than the underlying engagement and collaboration technologies themselves.  We know how to engage people and promote collaboration.  We do it every day in every other aspect of our lives.  What’s missing is an easy way for healthcare and social service providers to configure and manage their engagement and collaboration technologies that conforms to how they run their practice.  That is what this patent is all about.

Stay tuned for the summary description of our innovative solution to this important problem in our next post.

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