Reputation vs. Effectiveness: Is Patient Engagement Real?
Whether it’s stock trading with a few clicks on a smartphone, streaming new music before the vinyls hit the shelves, or receiving a wardrobe from a personal stylist without ever stepping into a store, technology’s potential to revolutionize the consumer experience is ubiquitous across industries. The healthcare sphere is no exception to this, and in recent years a rash of digital health tools and connected devices have flooded the marketplace, promising cheaper care and better outcomes, all while personalizing the consumer experience.
The rallying cry of this digital boom in healthcare is “patient engagement.” Touted as the “blockbuster drug” of the new century, the term is slapped on every emerging product in the digital health market. The lure of such a label is patent in the consumer-centric economy, and the metrics seem to support its success.
So why did the president of the American Medical Association (AMA) call patient engagement the “digital snake oil of the 21st century”? While the pundits all agree that patient engagement is a net positive, academic professionals are less ready to endorse it. A study conducted with research scientists in Canada, attempting to determine the effectiveness and challenges of patient engagement in cardiovascular research, identified that many participants do not have any clarity on what the term actually means. A simple web search confirms that this confusion is widespread. Used in reference to everything from patient portals to social media strategies to wearables that track vitals, it is impossible to judge the effectiveness of patient engagement or measure its success.
The term has become simply a buzzword, a marketing strategy that obscures the effectiveness of digital health. Without any standard definition, “patient engagement” becomes like any other non-regulated drug. It covers a wide spectrum of apps and tools: some beneficial, others innocuous, many flat-out toxic. The label can provide a disguise for technology that is at best neutral toward a patient’s health and wellness, and at worst actually confuses and retards their progress. Without any regulation on the term, there is a danger of quack technology diluting the market under its guise.
Yet the hype around such tools continues to rise, and they are guaranteed a round of applause on the conference circuit. So why the disparity between reputation and effectiveness? The answer is multivalent, but partially lies in the kind of metrics that are being collected. While staggeringly high metrics like millions of downloads, thousands of page hits, hundreds of subscribers or monthly active users can be incredibly compelling, we forget that these statistics are transplants from non healthcare/consumer industries. Clinical tools are patently different from consumer tools — so why are we judging them by the same standards? The time spent accessing a patient portal, the amount of downloads for a health app, the number of FitBit purchases — these metrics are beneficial for something, to be sure, but they are not guarantees that patients are taking an active role in improving their health and wellness.
In that previous statement, I’ve made a claim about what patient engagement should be — the patient’s willingness and ability to improve their own health, which brings us back to the ambiguity surrounding the term “patient engagement.” In order to have any kind of conversation about effectiveness, and before value can be assigned to particular metrics, a coherent definition needs to be determined. What does “engagement” look like in the healthcare sphere? The answer is complicated. Digital health is a unique marketplace that defies any one-size-fits-all approach. Its standards are different from other consumer platforms because its goals are different — even different within the health industry itself. Understanding the specific complexities of the industry is the keyfirst step to developing a definition of patient engagement. Once we know what it looks like, we can start measuring it.
The first step to narrowing in on a definition is to think about what patient engagement is not. The term in itself is misleading because it ignores the patient/provider relationship that is essential to healthcare. It inclines consumers to equate such labeled tools with other direct-to-consumer (DTC) products — it should thus come as no surprise that these tools are being judged according to the consumer-based statistics. The appeal of DTC products is their elimination of the middle man: decreasing costs, saving time, creating efficiencies. But digital health apps that claim the same goal — promising a new digital-driven health industry in which the patient is self-sufficient, in which the clinician is eliminated — fly in the face of a field where the clinician is not a middle man, but an essential part of delivering proper care and improving outcomes.