October 8, 2013
Frontline Innovation: Empowering Patients to Manage Their Own Health
This evening’s dynamic event was kicked off by our moderator John Oster who began by polling the audience with the following question: “What amount of effort does my company invest in empowering patients to manage their own health?” 50% of respondents answered <10% and 36% answered 10-30%. The key speaker, Dr. Joseph Cafazzo, was then introduced. He is the lead for the Centre for Global eHealth Innovation, a state-of-the-art research facility devoted to the evaluation and design of healthcare technology. He is also the Senior Director of UHN Healthcare Human Factors and an Assistant Professor in the Department of Health Policy, Management and Evaluation, and the Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, at the University of Toronto. In 2010, he was the recipient of the Career Scientist award by the Ontario Ministry of Health and Long Term Care.
Joe began by telling the audience that, as a biomedical engineer, he has seen a lot of terrible technology, and that he has made it his purpose to try to root it out and try to fix it. He confessed that he’s seen a lot of poorly designed technology in healthcare and feels that the notion of “empathy in design” has been lost.
One of his main concerns is giving patients personal access to their healthcare records. He is an advocate for patients having electronic health records, as he feels that giving patients access to their health information will help them better manage their health. He is also a great believer in “empathy in design”, meaning that the usability aspect of technology must always be considered to create systems that are in tune with the individuals using them. He cited Chernobyl, Three Mile Island and the 2000 US election as examples of when technology had failed to serve people as it should have. In order to provide an example of direct relevance to the pharmaceutical industry, Joe pointed out the design of pharmacy pill bottles. He noted that there is no standard design and currently the most prominent message on the bottles is the pharmacy brand name, which is of little use to patients. In order to address this, a graduate student worked on the design of the pill bottle and redesigned the top of the bottle to display the name of the medication. The design also incorporated a clean, clear list of instructions and warnings for the drug as well as a colour-coding system. This student’s design was recognized by the Museum of Modern Art in New York for its innovative design.
Joe said, “We’re not in this to create great technology that people won’t use”. The point of technology is to create things that people will use and that will further the ability of patients to mange their own heath. An example he gave was the idea proposed by a nephrologist at the Toronto General Hospital who put forth the bold idea of home dialysis for patients. This idea would allow patients to have dialysis more frequently, including overnight, allowing them to improve their function and perhaps go back to work or to school. When initially proposed, this idea was met with some disbelief due to the complexity of dialysis machines. However, it was done and the female patients who learned how to use these machines were able to dialyse themselves and carry children to full term, which would previously have been impossible. This experiment demonstrated many health improvements and was shown to be more cost effective than treating in the hospital.
Joe mentioned that one of the unnecessary complexities of the dialysis machine was the potentiometer, a dial on the machine. This dial makes the machine more complicated to use than it should be and is another example of engineers not having empathy in their design. By adapting the technology on this machine, it could improve patient outcomes and quality of life, but due to the complexity of its technology, it prevents the self-care of many patients.
Joe provided an example of his work creating technology that was “empathetic in design” for kids with type 1 diabetes. This group is difficult to manage as they tend to be non-adherent. To meet the needs of this patient group, Joe and his group developed the BANT app, which allows for fast, discrete blood glucose transactions. BANT is named after Frederick Banting, the Canadian who discovered insulin. His group also created an adaptor to facilitate blood glucose measurements from meters to smart phones via Bluetooth. Their app also allows users to track their readings over time and allows them to communicate via the BANT “community”, which functions in a similar fashion to social media. This system also has a rewards system, which gives points for every blood glucose reading, and these points can be redeemed for various rewards. Feedback from the program has shown that kids test 50% more frequently when they use the app and that kids have felt more motivated. With BANT, Joe and his group hope to spur companies to develop technologically. However, he noted that the industry had yet to develop a Bluetooth-supported blood glucose meter, despite the fact that there is published evidence showing that such technology results in an improvement in self-monitoring blood glucose.
Another app Joe and his team developed for the Heart and Stroke Foundation is called “30 days” and it is designed to create awareness of risk of heart attack and stroke. They also created an app for heart failure patients to help with self-monitoring. All of these technologies are aimed at improving patient self-awareness and self care. Self-awareness leads to improved health outcomes and medication adherence, which in turn results in lower dependence on physician care and less spending for the healthcare system.
To gauge the impact of Joe’s talk on the audience, John polled them with the same question he asked at the beginning of the evening, which was “What do I think the amount of effort my company should invest in empowering patients to manage their own health?” The responses demonstrated that Joe managed to change their opinions over the course of the evening, as 45% replied 30-60% and 32% said >60%.