Many healthcare solution designers have ambitious goals for reshaping patient care with AI, genomics, neural networks, precision medicine and more. We hope to make advance diagnoses and prevent acute episodes before even the slightest symptoms appear.
But in our eagerness to build healthcare solutions based on these technologies, we ignore the scientific evidence that more than 70% of the causes of chronic illnesses relate to patient lifestyle, not genetics. So digital therapeutics aimed at chronic conditions must address these challenging social determinants, such as access to care, diet and exercise, emotional support and even living conditions and transportation options. Otherwise, we aren’t solving the real patient problems that amount to the $3 trillion spent annually on chronic conditions in the U.S.
That truth hit home for me when I led a team charged with ideating a digital healthcare solution to help chronically ill patients. We started with an ethnographic study, following patients recently discharged with a diagnosis of congestive heart failure (CHF). These individuals were simultaneously juggling new medications, dietary restrictions, stress from their diagnosis, and financial and logistics issues. Our team was humbled as we recognized the extent of the physical, social and emotional challenges CHF patients face daily. As one told us, “I had never been to the hospital, and then it’s like ‘bam!’ I got hit with everything.”
Listening to Patients
These patients taught me firsthand how sensitive social and personal issues directly affect their health – and their risk of hospital readmission. To ensure patients could effectively care for themselves immediately after discharge and over time, it became clear our healthcare solution had to address the following four factors:
- Make it easier for patients to follow their medication regimens. In healthcare, we send home chronically ill patients with prescriptions to fill and supplies to buy and expect them to successfully incorporate an average of seven medications into their daily routines with minimal support. It shouldn’t shock us that medical adherence is poor. Some patients in our study group also struggled with copays and deductibles, which interfered with their ability to even fill one of the many medications prescribed. Others didn’t have easy access to pharmacies. Any of these factors make it easy for patients to miss doses, especially when a lack of educational support makes it difficult for them to fully appreciate what the medications could accomplish.
- Design an effective first line of defense against hospital admissions. Physicians simply don’t have the capacity to monitor all patient symptoms remotely and act as effective barriers to hospital readmission. So, the industry leaves patients to make judgment calls about whether they’re facing an emergency – a decision they have neither the knowledge nor experience to make. One patient asked what “sudden weight gain” means. “Is it like I swallowed a cow?” she asked. (Generally, two to three pounds in 24 hours or five pounds in a week suggests the body is retaining fluids, a common CHF danger signal.) Is lethargy caused by depression or a struggling heart? When is a cough not from a cold? Faced with frightening symptoms, many patients choose to call 911, resulting in a return emergency room visit within weeks of being discharged.
- Help patients make and sustain lifestyle changes more easily. Exercising more and avoiding salty, sugary and fatty foods are typical lifestyle prescriptions for CHF patients. But patients don’t always have access to fresh fruits and vegetables or knowledge about healthy food preparation. Some individuals in our study group wanted more detail. “What does ‘take it easy’ mean for a younger guy like me?” asked one patient who wanted to get back to weight lifting. Frustrated and discouraged, many patients quickly fall back into old habits.
- Provide authentic, warm support. As one patient told us, “With any disease, if you don’t have support and love, you’re done.” But patients also told us family members don’t always understand their emotional and physical struggles. Patients felt isolated and scared and wanted down-to-earth advice and empathy from other people on a similar journey. Yet healthcare’s tough privacy laws make it difficult for physicians to connect patients with each other.
Avoiding the Vicious Cycle of Readmissions
We chose to address these signals holistically. Patients who don’t follow their medication regime will likely not feel well enough to exercise, and with no support group to encourage them, they may reach for comforting but high-sodium food. Their fluid retention increases, their breath gets short, and they call 911 again.
I started this journey eager to create a precise, clear healthcare solution that would eliminate all friction for patients. Our ethnographic work with CHF patients taught me successful solutions need to adapt to each individual’s specific situation while offering warmth and empathy. In testing the prototype, it was fulfilling to watch as patients held conversations with our digital companion and took advice from it. Most said they wished they’d had a solution like that when they’d struggled previously after a hospital discharge.
I still look forward to how AI, machine learning and precision medicine can change healthcare – but first we must understand the actual problems of real patients, and then think of how technology can be used to solve them.