Changing Patient Experience Using Health Technologies: A Small-Scale Literature Review

Patient Activation and Bureaucratic Models

Question:

Discuss about the Change Management in Healthcare for Smaller and Smarter.

As the technology drives the pace of progress in healthcare and biomedical research, the thin line between medical science and engineering grows thinner. The use of computers and medical machines become faster, smaller and smarter, the medical industry has made advancements that make medical practice easier for healthcare professionals and better patient experiences in the healthcare system (Hollis et al., 2015). Change management is happening at a fast rate in healthcare system that is devoted to planning, organization and coordination of resources necessary for transition among individuals from current to future state in the healthcare organizations (Radnor, Holweg & Waring, 2012). Medical technology is improving patient experiences and key drive for change in the healthcare organizations. For example, Electronic Health Records (EHRs) is the most able and skilled project that drive healthcare professionals to share patient’s data effectively and enhance patient safety for better health outcomes (Jensen, Jensen & Brunak, 2012). Therefore, the following report involves the small-scale literature review and critical appraisal of articles under themes on changing patient experience using health technologies.

A review article by Lupton, (2013) is focused on the aspects of patients’ experiences and their engagement in self-care and self-monitoring via new digital media technologies. Patients become digitally engaged become active participants in self-care and self-monitoring. There is patient activation and development of bureaucratic model where patients are the representatives and effective managers having control of their health and healthcare services (Greene & Hibbard, 2012). The author also highlighted the use of telemedicine as a form of active engagement of patients where it is a major part of healthcare delivery. Telemedicine encourages patients in self-monitoring of their medical conditions and as a result, reduction in healthcare visits and communication with healthcare providers through technologies rather than confronting face to face (Lin, 2012). The chances of readmissions are reduced due to self-monitoring and employment of technologies like video conferencing and wearable sensors that record body functions like physical activity, respiration and heart rate (Mukhopadhyay, 2015). Patient monitoring via ingestible medications that are embedded with sensors sending signals to armbands and detecting heartbeat through wireless stethoscopes are at the heart of patient monitoring (Ringquist, 2013). From the review article, the question arises that whether these digital technologies can be incorporated in our daily life and can be remade through embodied use.

Telemedicine and Patient Monitoring

Another review article by Lupton, (2013) illustrated the use of social media tools and digital devices like mobile and wearable bands offering new ways for measuring, monitoring and representation of bodily functions. These devices are capable of producing biometric data of individuals that can be used and shared. Digital devices promote self-tracking practices that can be used by patients in understanding the concepts of health, identity and embodiment (Woods et al., 2013). Digital technologies like mHealth’ technology provides patients an opportunity to monitor their health conditions (Whittaker, 2012). Mobile and wearable digital technologies in mHealth not only provide positive health experiences for the patients, it is also a way to communicate with public and monitor their behaviour in conducting health promotion programs using mobile devices (Kaplan & Stone, 2013).  As this article is a review, the author has incorporated his views and as a result, the review is biasness of the reviewer.

Archer et al., (2011) in their study stated that Electronic personal health record systems (PHRs) are patient-centered and support them by making health information accessible to them assisting self-management. The literature review studied on PHRs’ functionality, design, applications, benefits and outcomes illustrated that it plays a key role in patient health and support self-management allowing disease prevention and improvement in health outcomes. The However, the study requires further trails on PHRs in studying the sustainability and effectiveness for patient self-management as adoption rates are different because of varied adoption rates.

A study was conducted using Health Information Privacy Questionnaire (HIPQ) (before-after survey) to study physicians and patients’ experiences of sharing EHRs (Perera et al., 2011). The main findings showed that more than 90% of participants agreed that using EHRs enhanced privacy and confidentiality while sharing patient information for clinical purposes. Patient’s experiences on using EHRs are that there is less privacy loss and better use of health information by the clinicians (Goldzweig et al., 2013). The strength of the study is that it is one of the largest surveys conducted to view the physicians and patients experiences while using EHRs on privacy. The study can be generalized to other populations like people with diabetes and population using EMRs. The results showed that patients greatly embraced the benefits of EMRs in terms of integrating, sharing and evaluation of information involved in direct care. However, the paper has certain limitations and research gap for future studies as study did not clarify that those people who were unwilling to share data lack trust on EHR or want control over it or unaware of the benefits and harms of sharing information.

Personal Health Record Systems (PHRs)

In an article by Lupton, (2014) it illustrated that the digital experience of patients is phenomenal that provides them a platform to share their experiences and benefit from it. Patients gain knowledge, become informed about their health condition, and take an active part in the healthcare decisions. This big data use in the medical technology support patients by providing them an online platform for better development of medical treatments and healthcare services and conducting research (Raghupathi & Raghupathi, 2014). Online sharing networks support patients in the form of sharing information and engaging them in clinical decisions by becoming active members in healthcare services (Chung, 2014). In the article, the author argued well that there is a configuration where patients who they are digitally engaged (patient assemblage) and digitised patient experiences (data assemblage) being the most recent form of digital technologies in the medical field. These assemblages configure together that enact and there emerges digital patient experience economy. This big data accumulation in the digital data technology is an innovative way for the healthcare system making patients more informed and economically efficient in receiving medical treatment. The article provided limited information on how understanding of concepts of health, self-care, expert and lay knowledge and doctor-patient relationship shape the digital technologies in the medical field. As the source of information was an article and no such research design and methods are explained in the paper, its validity is questioned.

 In an article by Ahern et al., (2011) the use of healthcare technologies by patients have meaningful uses improving healthcare quality, patient safety and population health. Patient-facing technologies play an important role in supporting them and make them more informed and active members in the healthcare decisions. There is also enhanced self-management, health, satisfaction, improved healthcare quality, patient safety and overall increase in healthcare system (LeRouge et al., 2013). Patients are better informed about their health conditions and quick in seeking healthcare services via digital healthcare technologies (Kumar et al., 2013). However, the research gap and future aspects lies in identifying the most useful and effective technology for the patients for better health outcomes.

Another study by Woods et al., (2013) also stated that patients who use medical health records take active participation in their health and clinical decision-making. From the results, four themes were characterized for patient experiences using health records. There was positive and effective communication of patients with health providers. Enhanced knowledge among patients with improved self-care and proactive role in self-management, better follow-ups and active participation in decision-making was also observed in patients using EHRs. This research study was the first qualitative study of experiences of veteran patients using EHRs that included test results and clinical notes. This study is also important as its main findings have potential implications for EHRs development. There is need for further studies to evaluate the overall impact of clinical health records on workload that likely to change their experiences necessitating new communication skills while interacting with patients.

Health Information Privacy and Electronic Health Records (EHRs)

In a retrospective cohort study by Palen et al., (2012) for the assessment of online health care utilization by patients via health records illustrated that there was increased use of clinical services as compared to group members who did not have online health record access. The main outcome of this study was that there were increased rates of telephone encounters, office visits, emergency departments, after-hours clinical visits and hospitalizations among online medical health record users as compared to non-users. The study was significant as there was increase in medical services like e-mail communication with clinicians and in-person clinical services as expected as compared to previous studies. The findings were consistent among age groups and can be generalized to populations without chronic health conditions as variability was found among medical health users who were suffering from chronic illness using telemedicine for monitoring. The research gap is this study is that it lacks information regarding why patients seek online medical health records subsequently and whether this use affects their health outcomes or not. Cost and benefit of online health services also need to be evaluated along with evaluation of clinical decisions.

Conclusion

For the above literature review, it is evident that healthcare technologies is on the horizon providing positive health outcomes for patients with better health experiences. Telehealth, EMRs and big data have facilitated better heath exchange information and effective communication between patients and providers. There is ensured privacy, patients acting as proactive participants in healthcare and self-management, self-care and increased use of clinical services as themes deduced from literature review. Although, patients’ experiences have enhanced by using health technologies, there is need for its incorporation in everyday life and awareness among individuals in using health technologies for better health outcomes.

References

Ahern, D. K., Woods, S. S., Lightowler, M. C., Finley, S. W., & Houston, T. K. (2011). Promise of and potential for patient-facing technologies to enable meaningful use. American journal of preventive medicine, 40(5), S162-S172.

Archer, N., Fevrier-Thomas, U., Lokker, C., McKibbon, K. A., & Straus, S. E. (2011). Personal health records: a scoping review. Journal of the American Medical Informatics Association, 18(4), 515-522.

Chung, J. E. (2014). Social networking in online support groups for health: how online social networking benefits patients. Journal of health communication, 19(6), 639-659.

Goldzweig, C. L., Orshansky, G., Paige, N. M., Towfigh, A. A., Haggstrom, D. A., Miake-Lye, I., … & Shekelle, P. G. (2013). Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudesa systematic review. Annals of internal medicine, 159(10), 677-687.

Big Data and Digital Patient Experience Economy

Greene, J., & Hibbard, J. H. (2012). Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. Journal of general internal medicine, 27(5), 520-526.

Hollis, C., Morriss, R., Martin, J., Amani, S., Cotton, R., Denis, M., & Lewis, S. (2015). Technological innovations in mental healthcare: harnessing the digital revolution. The British Journal of Psychiatry, 206(4), 263-265.

Jensen, P. B., Jensen, L. J., & Brunak, S. (2012). Mining electronic health records: towards better research applications and clinical care. Nature Reviews Genetics, 13(6), 395-405.

Kaplan, R. M., & Stone, A. A. (2013). Bringing the laboratory and clinic to the community: mobile technologies for health promotion and disease prevention a. Annual Review of Psychology, 64, 471-498.

Kumar, S., Nilsen, W. J., Abernethy, A., Atienza, A., Patrick, K., Pavel, M., … & Hedeker, D. (2013). Mobile health technology evaluation: the mHealth evidence workshop. American journal of preventive medicine, 45(2), 228-236.

LeRouge, C., Ma, J., Sneha, S., & Tolle, K. (2013). User profiles and personas in the design and development of consumer health technologies. International journal of medical informatics, 82(11), e251-e268.

Lin, C. F. (2012). Mobile telemedicine: A survey study. Journal of medical systems, 36(2), 511-520.

Lupton, D. (2013). Quantifying the body: monitoring and measuring health in the age of mHealth technologies. Critical Public Health, 23(4), 393-403.

Lupton, D. (2013). The digitally engaged patient: Self-monitoring and self-care in the digital health era. Social Theory & Health, 11(3), 256-270.

Lupton, D. (2014). The commodification of patient opinion: the digital patient experience economy in the age of big data. Sociology of health & illness, 36(6), 856-869.

Mukhopadhyay, S. C. (2015). Wearable sensors for human activity monitoring: A review. IEEE sensors journal, 15(3), 1321-1330.

Palen, T. E., Ross, C., Powers, J. D., & Xu, S. (2012). Association of online patient access to clinicians and medical records with use of clinical services. Jama, 308(19).

Perera, G., Holbrook, A., Thabane, L., Foster, G., & Willison, D. J. (2011). Views on health information sharing and privacy from primary care practices using electronic medical records. International journal of medical informatics, 80(2), 94-101.

Radnor, Z. J., Holweg, M., & Waring, J. (2012). Lean in healthcare: the unfilled promise?. Social science & medicine, 74(3), 364-371.

Raghupathi, W., & Raghupathi, V. (2014). Big data analytics in healthcare: promise and potential. Health information science and systems, 2(1), 3.

Ringquist, L. (2013) Re-admissions: Is telehealth the answer?, [Online] Retrieved from: https://www.bhmpc.com/2013/04/re-admissions-is-telehealth-the-answer/, Accessed on 16 April 2017.

Whittaker, R. (2012). Issues in mHealth: findings from key informant interviews. Journal of medical Internet research, 14(5).

Woods, S. S., Schwartz, E., Tuepker, A., Press, N. A., Nazi, K. M., Turvey, C. L., & Nichol, W. P. (2013). Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study. Journal of medical Internet research, 15(3).