By Dr Adrian Raudaschl and Esther O’Sullivan
Technology has the potential to reduce the burden on health services by empowering patients to support themselves better. Apps which record clinical data and then prompt users to undertake activities like exercise, remind patients to take their medication, or provide patient education, already exist, but the uptake is low.
This is because of the paradox that the people who stand to gain the most from these innovations are the least able to use them due to a lack of confidence and skills in the technology on offer. A systematic review of patient participation in BMJ Open stated;
“Qualitative feedback suggests that acceptability of monitoring is related to perceived validity, ease of practice, convenient technology, appropriate frequency and helpfulness of feedback…”
Convenient technology is crucial as digital skills are still low in Britain. Approximately 12.6 million adults lack basic digital skills, while 5.8 million have never used the internet at all.
This is bad news for those of us driving digital innovation to improve health care and worse news for society as a whole because:
“…The fact is that there is a huge crossover between those who are digitally excluded, those who are socially excluded, and those at risk of poor health.”
For example, patients in a cardiology ward in Southampton General Hospital, on average 60-80 years old, needed to make lifestyle changes after suffering heart attacks. When offered diet and exercise tracking apps by well meaning younger relatives, the patients turned them down as they couldn’t read anything on a small screen. It was not convenient for them.
That said, Southampton General’s non invasive cardiology department is using remote monitoring tool for patients with cardiac devices, the tool is very simple to use and supports less patients needing to be seen in clinics.
Product development is not taught in medical schools or on the wards, so how do we make patient convenient technology that goes beyond the app, and gets used.
One proven technique is to use ‘inclusive innovation’ to create products that are usable by people with the widest possible range of abilities, by ensuring we know everything about our end users. We need to create personas in order to do this.
Personas are fictional characters which represent your users. They typically have a name, picture, age, income, behavioural traits and a goal that describes the problem they want to see solved. Personas help us embrace a user-centric approach. Ask yourself whether your users have:
- low user literacy,
- poor language skills,
- disabilities – visual, auditory, mobility-related, cognitive,
- access to technology like smartphones.
A useful overview of persona creation can be found here.
Create a paper prototype and enlist all your family and friends that most closely match your persona to test it. This is a way of getting valuable feedback even before you have written a line of code. Keep it simple; fix one problem first then build on that.
If the tech has to be complex, the model delivered by The Good Things Foundation is a useful place to start. They suggest:
- running community outreach events,
- running digital surgeries to engage and train patients,
- training health and care professionals.
To summarise, get the product right and technology has the potential to empower patients, improve their quality of life and reduce costs. Get it wrong and you risk being left with a very expensive mistake, and a lack of trust in digital technology which could prove damaging to the uptake of potentially great future innovations. Ensuring that your technology is inclusive and convenient is paramount.
About the Authors
Dr Adrian Raudaschl is a medical doctor turned product manager. While working in the NHS (National Health Service) he created apps and games to help patients learn more about medical conditions. This demonstrated to Adrian the power great tools have to help people in times when they need it most. Currently he works with children, parents and healthcare professionals to create exciting medical apps and games, which both educate and delight users. Dr Raudaschl is a firm believer in the accessibility of medical information for everyone.
Esther O’Sullivan is Head of Digital Strategy for BMJ. She is a specialist in impact of digital transformation on Healthcare and Academic publishing and an expert in understanding where opportunities from these transformations can be strategically applied.