How User-Driven Design Produces Digital Health ROI
I read a white paper today called “The ROI of HIPAA Compliant Texting and Telemedicine: Improve CMS Core Measures and Reduce Transfers.” But not one return on investment (“ROI”) metric about a texting and telemedicine solution was mentioned.
Digital health needs to be more transparent about ROI, and specifically, how new healthcare solutions can produce ROI.
Translating Healthcare Experiences into Real ROI: a case study
Let’s examine Healthvana, a cloud-based patient engagement platform that is quantitatively and qualitatively impacting ROI for patients and healthcare providers. The company uses modern UX design principles to deliver lab test results, optimize clinical workflow and enhance the overall patient and provider experiences.
Healthvana is initially focused on sexual health clinics, where high patient volume and limited resources lead to a set of solvable problems. For instance, when people in the U.S. go to a clinic for STD testing, they do not receive negative test results. Instead, they are told, “you can call back for your results in 7–10 days, but if you don’t hear from us, no news is good news.”
Nor do patients receive positive test results in a timely fashion. When patients test positive for an STD, providers must call them over the phone. If the provider connects with a patient, it can take days or weeks to get them back in for treatment. If the provider does not connect with the patient (e.g., because the patient’s phone is disconnected or they do not answer), the patient never comes back for treatment. And provider staff spends a large portion of their day on the phone with patients, as patients call back for negative results and providers must call patients to deliver positive results. Patients in this scenario are fraught with anxiety and providers are overwhelmed with demand.
Healthvana is redesigning this experience through a dual sided digital platform. The company’s mission is to make health information accessible and actionable, while removing barriers from traditional healthcare processes. Healthvana is almost five years old, and initially started as a consumer-facing company that helped patients obtain sexual health test results from providers. At the end of 2013, however, the company shifted its focus to healthcare providers and began making evidence-based, user-driven design decisions while at the same time, measuring ROI.
“We spent years dealing with really bad patient experiences in terms of helping patients obtain test results from their providers. We were at a 50% test results delivery rate even with us on the phone every day advocating for our users. And it took too long (days or weeks) to get those records,” said CEO, Ramin Bastani. That was when the company realized that the best way to help patients was to partner directly with the healthcare providers.
Healthvana acquired a strategic customer in the AIDS Healthcare Foundation (AHF) and launched a six-month pilot study in July 2014. The aim of the pilot was to electronically deliver timely test results, next steps, and reminders to patients to improve the patient experience, and free up staff time by reducing daily phone calls to the clinics.
User-Driven Design Iterations
“Before planning requirements or designing products, we spent weeks onsite at AHF’s largest clinic in Florida to understand their clinical workflow. We designed a minimum viable product (“MVP”) in phases, staying in constant contact with AHF. We then launched a true MVP, essentially a customized, mini-EHR (electronic health record), and watched how staff and patients used the product, and iterated accordingly,” said Head of Product, Sean Crockett. “That clinic sees over 100 patients per day, most of whom end up calling or returning for their test results. We assumed that if we could solve the fundamental results delivery problem, we would address the corollary problems of patient anxiety and staff workload.” Healthvana integrated its technology with AHF’s labs to enable patients to get results as soon as the lab. A patient using Healthvana now receives a notification (SMS/e-mail) that the results are in. Patients have instant access to health records in real time.
When the pilot went live, “the first three weeks were very busy with code fixes and tiny design iterations because there were all sorts of problems we didn’t anticipate,” said Crockett. At that time, the design team totaled two people: Crockett and Healthvana Chief Technology Officer, Jonathan Kawa.
Increasing Patient Engagement
Healthvana defines patient engagement as any person who tests at a customer’s clinic, elects to receive test results electronically, and then logs in to Healthvana to check their lab test results. Because staff manually registers patients for Healthvana, the biggest factor affecting engagement was registration typos (i.e. staff mistyping patient data). For example, patients need a correct e-mail address to receive activation links, and then must match date of birth and other unique identifiers to access their accounts. Therefore, typos in registration prevent patients from viewing test results. To decrease typos and increase engagement the team:
- Changed the date of birth field from open text to drop-downs.
- Enabled provider staff to resend activation emails after correcting email addresses.
- Hired a full-time patient support professional to assist patients with correcting typos and account management.
Healthvana initially sent one notification to patients as soon as results were available in the patient’s account. Realizing that patients did not always check their emails, Healthvana began sending up to three notifications to ensure that patients received their results and care instructions.
“We also implemented opt-in SMS notifications,” said Crockett.
Optimizing Staff Efficiency
To design for staff efficiency, the team implemented several tools such as:
- “One click” to add labs to a patient’s chart (compared to the many clicks and popups required to add labs to a patient’s chart in a typical EHR or similar platform).
- “One click” to add negative results for rapid HIV tests (all other results are added automatically with lab integration).
- An “exception report” to allow staff to handle exceptions when labs do not match a patient’s chart.
Healthvana’s design enabled Crockett and Kawa to train AHF’s 100+ staff members on the software in an average time of 30 minutes. Although it is not a direct comparison, it takes a provider an average of six weeks to learn Epic, the most widely used EHR in the world.
Return On Investment
Healthvana’s design iterations led to significant increases in engagement and ROI. In the year since launching their pilot study, Healthvana has onboarded nearly 15,000 new patients in the following phases:
Pilot (July 2014 — December 2014):
- 3 total clinics
- 2,000 new patients
- Approximately 70% of those patients checked their test results (positive and negative) in Healthvana within a few hours of delivery
Expansion 1 (January 2015 — March 2015):
- 7 total clinics
- 2,000 new patients
- Approximately 76% of those patients checked results in Healthvana
Expansion 2 (April 2015 — July 2015):
- 13 total clinics
- 11,000 patients
- Approximately 81% of those patients checked results in Healthvana
The team is closing in on a 90% engagement rate. The technology is easily scaled, and feedback from users confirms this level of engagement delights patients and results in ROI for AHF. AHFs largest clinic in Florida historically received 100 telephone calls per day, primarily from patients inquiring about test results. Since launching Healthvana in April 2015, this clinic has measured a 75% reduction in daily phone calls, which frees up staff time and helps the clinic see more patients. It also ensures that patients who test positive get back into care more quickly.
On the topic of ROI, AHF’s Senior Director of Public Health, Whitney Engeran-Cordova, said, “We are excited about our collaboration with Healthvana and are already seeing stunning results in folks accessing their STD results and accessing treatment more quickly as a result.”
Other Known Factors
In addition to clinical efficiency, patients are relaying stories about driving hours to use a Healthvana enabled clinic. People are learning that Healthvana lets them geolocate a testing clinic, read information and reviews on the clinic, and then receive their test results back as fast as the lab has them. Meaning, an increase in patient volume and ROI.
Although HIV positive results are not delivered through the platform today, patients are being given positive test results for chlamydia, gonorrhea, and syphilis electronically for the first time in a public health setting. When a patient receives a positive test result, Healthvana first tends to user anxiety, then provides a specific, simple action step. “We want to make health information accessible and actionable,” said Bastani. “Our design philosophy is, ‘Can my grandma figure this out?’ It must be something super simple for both patients and providers,” said Crockett.
What patients care the most about is the speed of test results and an ability to share results with a doctor, caregiver or partner. Healthvana is designed to optimize both. Said one user, “I hate waiting for my test results to come back. Healthvana makes this easy.”
Thirteen AHF clinics now leverage Healthvana technology, with plans to expand to their 20+ testing clinics nationwide. Separate from AHF, Healthvana has other strategic customers, with several more expressing interest.
*This article is the result of a 4-hour interview conducted on July 9, 2015. The author has never formally consulted with Healthvana, nor does the author own any equity in the company.
*Thank you to @davidhabif for help with editing this article.