Martin Entwistle is Executive Director of theDavid Druker Center for Health Systems Innovation, a multidisciplinary group whose mission is to catalyze, invent and deploy innovations in health and wellbeing. Using a human-centered design approach and leveraging technology the center works to create scalable solutions that address the pressing health challenges of our time.
Entwistle spoke with me about the current projects at PAMF’s Innovation Center and how technology is empowering individuals to develop health-promoting habits.
What projects are you currently working on at the PAMF Innovation Center?
We are focused on two big initiatives. The first is a system called EMPOWER, a goal tracking, behavior modification, teachable-moment education system for people with chronic disease. The second, linkAges (look for part 2 of this post), is a system to help seniors remain in the community as they age and be closely supported by caregivers.
It has become increasingly important to get upstream on health issues and look for ways to get people engaged in preventive action, to focus on health and wellbeing and not just wait for an acute health event to occur and then for us to intervene. One of our key programs, Personal Healthcare Programs, is designed to change this traditional dynamic of treating the sick, versus managing health conditions. Employers that carry insurance for employees were a good target because they have a strong motivation to support their staff to be fit and well. The EMPOWER provides a seamless transition to more active management for individuals diagnosed with active disease.
Applying EMPOWER to support prevention programs and assist people to self-manage has been one of our early successes, as has been the realization that many features developed for prevention programs are equally valuable for disease management. Managing disease includes taking medications as prescribed, as well as lifestyle and helping people keep on track with their goals.
Using EMPOWER, we track information day-to-day related to an individual’s personal goals in prevention and disease management. We’re able to do this using tracker devices linked to smartphones that send data to EMPOWER. In addition to trackers, we use devices that consumers already have like blood pressure and glucose monitors and tie them into EMPOWER. A nurse has access to this data, sees what is happening with patients, then helps keep them on track with their care plan, using both direct interaction and EMPOWER tools to provide automated “teachable moment nuggets” giving nudges and reminders.
Our first EMPOWER pilot was completed in 2010 supporting 200 patients with diabetes. More recently we ran a pilot with 150 patients with uncontrolled hypertension from one of our PAMF clinics. Patients were recruited and equipped with a blood pressure monitor, pedometer, weight scale, iPhone, and Bluetooth device for transmitting blood pressure readings. Patients used an EMPOWER iPhone app to upload their blood pressure and their weight. Their data was tracked by a designated nurse care manager who formulated a personalized Action Plan, with goals such as increasing the number of steps taken per day, changing their diet, or reducing cigarettes smoked per week.
Because patients are receiving real-time feedback as well as continuing education and support without having to make frequent doctor visits, they are better equipped to self-manage. A patient may observe trend data and see that their efforts are indeed lowering their blood pressure. This may give them confidence that their actions can positively impact their blood pressure and consequently motivate them to take other steps.
How do you measure the success of your prevention programs?
We’re on a quest to understand how you get sustained, positive engagement from patients over time. We are working hard to reach and involve the people who are reluctant to engage. We’re not just interested in a whizzy piece of technology that’s exciting for a few weeks but then patients get bored and stop using it. We want to get people involved in challenges, like working as a group at work and helping each person in the group make progress toward goals that are both meaningful and helps them improve their health and well-being. At the end of the day it’s all about sustained changes in behavior. Of course we have to see if they are still doing it in 12 months. That will be the real test!
What healthcare innovations do you see on the horizon in 5-10 years?
We’re seeing a significant shift in the way we consume health care; it’s becoming more like retails, food and entertainment where service, choice, convenience and price are all important. In the current model you visit the doctor when you are sick and take action to fix your medical problems. We do this really well. But people don’t want to consume health care in that way. They want to interact with a doctor at their convenience, from their desk, or during a few free moments. They are looking for support in their quest to be healthy and well. So our system needs to go outside the bricks and mortar of health care. A lot more of healthcare has to be conducted within the community versus within facilities, and to engage with patients as consumers who have choices for care outside the traditional medical system.
We want people to be supported in their day to day lives in the community, covering all aspects of health and welfare, from ensuring people are not lonely or isolated to ensuring they continue to exercise and eat better. A key question we thread though all our health care innovations is: how can we provide the right level of support to people to help them achieve their personal goals for holistic health and welfare in the context of their day to day lives?