Electronic Health Reporter

Guest post by Mike Hoaglin, a fourth-year medical student at the University of Pennsylvania School of Medicine.

“Patient engagement” is a phrase that reinvigorates the doctor-patient relationship and prioritizes the patient experience. With many designers scrambling to “engage” patients in their healthcare journeys, it is easy to get lost in the chaos. But what lies at its core is simple: healthcare leaders need to find easy methods that better connect people with the environment and the technology.

One way this is already proving effective is with the smartphone physical. Led by medical students from John Hopkins and University of Pennsylvania, quick diagnostic tests using devices connected to a smartphone are changing the face of the traditional physical and begging the question as to why modern medicine struggles to become more patient-centric.

The smartphone physical uses a series of peripheral devices attached to a smartphone to measure and analyze patient data ranging from weight to blood pressure to even heart activity. Patients are then able to receive an overall health picture and potentially electronic health record (EHR)-ready results from the smartphone physical immediately after the experience. Essentially these robust handheld digital devices are re-engaging patients because they promote more personalized, data-driven decision-making at the point of care.

In partnership with Nurture, a healthcare solutions company, smartphone physical develops mobile healthcare spaces at a number of exhibitions and conferences to not only assess how these re-imagined physicals are received by participants, but also to showcase how the environment can be designed in a way that effectively promotes the goals and values of this different kind of patient encounter.

For instance, a recliner chair, known as Empath, is featured in place of an exam table. The goal is to have the patient in an upright, more dignified posture — allowing him or her to partner eye-to-eye with a physician and have a more balanced, relaxed relationship. This way, patients also assume a more equal role in their own health. It’s then no longer just a paternalistic patient encounter, it becomes a real conversation. An unobtrusive Pocket computer tablet, is also utilized, so a physician can take notes electronically while still remaining next to the patient. A large flat-screen display is also placed in the setting so that the physician or patient can share relevant data immediately and talk through it together, allowing for real time analysis of results and more effective collaboration.

Feedback collected from participants of the smartphone physical swayed in favor of this new triad connecting the environment, the patient and physician, and the technology.  When asked to describe in one word their last traditional physical experience most participants answered that it was clinical, average and uneventful. In comparison, the most common words used to describe the smartphone physical were awesome, easy and engaging.

Aside from holding the attention of patients and, in turn, encouraging greater patient engagement the smartphone physical also helps overcome other common challenges of the traditional physical. For instance, maneuver reliability can be a hang-up when interpreting exam data. There are a number of physical exam maneuvers that suffer from dubious reliability because of limitations with the maneuver itself or examiner variation.

Another element is data collection.

Even if the data are obtained reliably, they are often described in vague terms that do not provide an adequate baseline for future care visits. For example, primary care physicians may currently describe ophthalmic fundoscopic exams as “unremarkable” or “w.n.l” (within normal limits), which is an ambiguous and unhelpful term when the patient needs to see an ophthalmologist years or even decades later.

Then there is the obvious advantage of time and expense.

Clinicians may be too pressed for time to conduct detailed physical exams and comprehensively record their findings. Some may also not be willing to pay for expensive pieces of equipment.

Patient engagement requires a behavior change in healthcare and change is never easy. But there seems to be an all-round consensus that in order for healthcare to move to where it needs to be, understanding consumer behavior and coupling that with patient engagement will help drive a more balanced and adaptive system.

The smartphone physical, combined with an intentionally designed space, is one step towards a new era in patient checkups. 

Mike Hoaglin is a fourth-year medical student at the University of Pennsylvania School of Medicine. He focuses on the intersection of health and technology. He has written federal health policy on the meaningful use of health information technology and advised Dr. Mehmet Oz on bringing engaging medical content to daytime television.