People who are less engaged in their own medical care have more negative health consequences, including higher readmission rates, poor care coordination, and less confidence. It is therefore imperative to keep patients engaged in their own healthcare, and current technology plays an important role in achieving this goal, according to Sangeeta Agarawal, RN, CAS, MS, Founder and Chief Executive Officer, Helpsy Health, San Francisco, CA.
Engaging patients in their care requires an understanding of where they are in their cancer journey. If patients don’t know what to expect from treatment and survivorship, they can be disengaged and overwhelmed.
“They may not know what to expect with their treatment, what side effects to anticipate, or what kind of social and emotional support they will need,” said Ms Agarawal at the 2019 Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology annual meeting. “That results in a loss of clarity.”
But the confusion that patients have is often not a result of apathy on the part of clinicians. Most oncologists want to support their patients as much as possible, but the reality is that physicians spend a minority of their work hours with patients. Research has shown that less than 30% of physicians’ time is spent on direct patient care, even when they work overtime.1
“So we know that it’s not because we don’t want to help, it’s because we lack the processes, tools, and support to enable the level of services that our patients need,” she said. “But what if we could automate some of that work?”
Enter Digital Health
Technologies such as remote monitoring, mobile health, and telemedicine have led to great strides in access to care, but when it comes to digital health and innovation, disconnected care has been a massive hurdle.
“As much as all of us support our patients, we are only seeing a fraction of these people’s lives,” Ms Agarawal said. “The data are siloed, and portions of their lives are locked in different areas, so it’s difficult for us to know exactly what is going on with our patients and how to address it.” But those siloes are beginning to be broken down, she says, as a result of standards that allow technologies to communicate with one another, and to enable the interoperability of data.
“Not just to enable it, but to mandate it,” she noted. “Organizations have to unlock those data and give it back to patients. This gives them the power to have all their data in their own hands, and to be able to make decisions about their health.” As more companies come into the space, they will be able to aggregate data across various aspects of a patient’s life to paint a meaningful picture of that patient’s health that can be addressed, Ms Agarawal says.
It is important to understand who is building the technologies that will affect patients with cancer. She encourages oncologists to get involved in the development of digital health tools and technologies.
“At the end of the day, someone is writing [these technologies]. It’s someone’s knowledge, expertise, ethics, and priorities getting baked into that cake. So if you are not the one making the cake, you don’t know what ingredients are going in,” said Ms Agarawal. “If we are not doing it, then we won’t be able to have our voices heard, and we won’t be able to provide the knowledge and the tools that our patients need.”
The Importance of Ease of Use
Today, telemedicine has become mainstream, and is now expanding beyond mobile phones and home computers toward television and even smart home devices such as Alexa and Google Home.
“It’s serving the purpose that it was meant to serve, which is to connect people in meaningful ways to address their needs,” Ms Agarawal said. “And now this technology is beyond the prototype stage. It’s scalable, it’s mature, it’s reliable, and it’s being reimbursed by CMS [Centers for Medicare & Medicaid Services].”
In fact, many large healthcare institutions are making an active push to move patient consults away from in-person visits toward telemedicine, and even drones are being explored in emergency care and delivery of medications.
But if it’s not easy, patients won’t use it, she emphasized. Technology can be useful, but to enable patients to take control of their own health, they must use these technologies. One way to enable ease of use is through wearable devices.
“The reason why there is such an interest in health with these wearable devices is because of passive data collection. It knows when you slept, what your heart rate is, and whether you’re feeling good or bad,” she said. “It allows for the insight on people that allows us to help them.”
A common argument against using digital health in cancer care is that many patients with cancer are old and don’t use these devices. However, she says, they do: approximately 50% of people in the United States aged >65 years use smartphones,2 and this number is steadily growing. A 2013 survey indicated that patients are more willing to use a digital app prescribed by a physician than they are to take a prescribed medication.3
Based on these findings, Ms Agarawal and her colleagues have been working to assemble an automated care plan for cancer symptom management: an artificial intelligence nurse named San supports patients throughout their cancer journey, addressing their physical needs, emotional health, social connections, and support services.
Technology helps to alleviate clinicians’ burden, while still supporting patients and providing a high-level view of their lives; perhaps most important, says Ms Agarawal, it helps to identify the patients who still most need in-person care rather than virtual care.
- Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016;165:753-760.
- Pew Research Center. Mobile fact sheet. June 12, 2019. www.pewinternet.org/fact-sheet/mobile/. Accessed September 12, 2019.
- PM LiVE. mHealth: patients open to app prescriptions. June 28, 2013. www.pmlive.com/pharma_intelligence/mhealth_patients_open_to_app_prescriptions_486119. Accessed September 12, 2019.