Supporting patient access to care
Strategic account director at SDL since 2014, Jessica Roland works with selected enterprise customers to help them reach global audiences and enhance customer experience, increasingly via AI. Prior roles include leading enterprise software globalization teams and international product management.
n the not-so-distant past, patients’ experience with healthcare was often characterized by their sense of feeling through the dark about symptoms and diagnoses. Patients sometimes expressed that lack of time and attention from busy medical staff often prevented full discussion, and they did not have the means to engage in proactive discussion. That changed when credible websites like WebMD.com began to offer online access to useful information, which empowered some patients to ask more informed questions and push back when they felt it necessary. The concept of proactive patients began to take hold. The patient-doctor relationship was no longer a one-way discussion. Patients were now able to interact with the healthcare system in a more fluid, rapid, informed manner. At the same time, healthcare providers have been faced with ever-increasing costs, resource constraints and information overload. Happily, a trend has emerged that synergistically addresses both the patient and provider challenges: connected health.
The emergence of connected health
Connected health (technology-enabled care) represents the convergence of health technology, digital media and mobile devices. It enables patients, care givers and healthcare professionals to access data and health information in an easy, more accessible fashion to improve the quality and outcomes of healthcare. Patients and healthcare providers can interact in a more real-time, accessible fashion, enabled by widespread access to the internet, market penetration of smartphones and tablets, and other connected technologies, as well as increased digitization of data and content. They can self-serve with many kinds of information and tasks over the internet now, without waiting hours on the phone. Increasingly, clinical data can be collected without healthcare providers’ physical presence. Healthcare providers are also more connected to each other, enabling collaboration in holistic teams, which gives them greater access to accurate, timely information when they need it.
There was already a strong trend toward connected health before the Covid-19 crisis, but in these days of home quarantine, social distancing and overburdened healthcare workers, connected health can literally be a lifesaver, helping to provide the right information, at the right time, in the right language. Here are three key examples of emerging best practices in connected healthcare.
Helping patients help themselves with mobile apps
The example closest at hand is literally that: the smartphones we hold in our hands every day. As consumers became accustomed to searching information and performing a variety of tasks and interactions via their mobile phones, healthcare organizations began to use these devices to manage a wide variety of customer activities via mobile app.
In the market today we see four types of connected health applications:
- Single use (smartphone apps, wearable tech, consumer drive)
- Social (social health and wellness networks; encourages users to meet personal goals, mostly consumer driven)
- Integrated (where linking apps and devices with the healthcare system connects patients with healthcare)
- Complex connect health (where enterprise systems use integrated analytics to model and or predict healthcare issues and treatments often disease centric)
Relative to the first three categories above, there are now over 300,000 health apps available across the major app stores. According to an industry analysis by Global Market Insights, the mobile health market is expected to have a 38.5% annual growth rate over the next few years, reaching $289 billion in 2025. As Statista notes, at the end of 2019, there were over 44,000 healthcare apps in the Apple Appstore alone.
Figure 1: Mobile health apps allow patients to interact remotely on a variety of topics. This one is from Stanford Health Care’s MyHealth app.
By using an app — or a wearable device — patients can engage in a variety of activities, such as being reminded about appointments, checking in for appointments, getting test results, sending questions to doctors, getting pharmacy refill reminders, and managing fees and payments. They can even connect with social care communities to compare experiences and access resources (Figure 1). Connecting patients to clinicians through these methods enables patients to engage directly with medical staff pre- and post-treatment.
Besides making access to the above activities faster and more convenient, mobile apps also help ensure that the right information is being delivered to the correct person. Doing this in a patient-centric way raises confidence that all the right information is in place. However, creating individual content for many individual patients is not scalable. Providers have found that technology and automated processes can provide a more personalized patient experience and provide a better information flow between different systems, integrating information silos. One such approach is via Clinical Care Pathway Templates, which map out a standard sequential set of information that should be provided to the patient at each stage of a given treatment for a specific diagnosis. The patient’s smartphone healthcare app is a convenient and reliable way to receive this information. Findings show such standard templates are suitable for 70% of the population undergoing a particular treatment, thus saving time on the standard majority, and freeing up time for the 30% that do not fit the standard pattern.
Not everyone uses a smartphone, so information provided to patients via mobile apps is generally also available via the provider’s website. Consistency of information across access methods is critical. To ensure consistency and to avoid managing different information silos, a key best practice is to use an agile content management software system. These systems allow publishing content across multiple types of devices; for instance, laptops, smartphones and tablets. These systems use responsive design so that the content adapts fluidly to changes in screen sizes and formats across devices, enabling authors to create once, publish to many.
No matter what device patients are using, it is critical that they understand the content and communicate effectively with their medical team. Having the content available in the native language of the reader is essential — it can literally make a life or death difference. So, translating both the mobile app/website user interface as well as the content displayed on it is critical. Timeliness and perfect quality of translations are necessary in healthcare applications and should be supported by reliable language technology that manages translation memory and workflow, and allows for varying combinations of domain-expert human and machine translation.
In addition to producing high-quality translated content, healthcare apps and website providers must take care to manage translations so that they stay in sync with the original source content. When the source changes, it should automatically trigger a review and update workflows for the translated content. It’s also critical to retire all language versions of outdated content at the same time. To achieve this synchronization, it is key to use an agile content management system that hierarchically relates the parent source content to its translated children, preserving content relationships throughout changes in state (Figure 2). The system should also be flexible enough to allow for variations in content if local regulations require a locale-specific approach.
Helping providers be heroes with connected content
Patients’ expectations for fast and convenient access to information have risen with advances in mobile technology, and providers have had to change to meet those expectations. Most adults can remember the frustration of interacting with different healthcare professionals who were unaware of each other’s advice or prescriptions, or who had trouble locating information from past visits and treatments. Common challenges for healthcare providers have involved storing and managing a vast amount of paperwork in their own offices, with systems that were set up as information silos, not able to communicate with other providers’ systems. An even bigger challenge has been the exponential growth in the amount of new research and regulatory information that providers need to have at their fingertips to provide authorized and reliable services. This huge increase in information is further complicated by it being available in a variety of formats, covering a broad spectrum of activities such as billing, scheduling, financial records, imaging, clinical documentation, patient forms and medical research.
Figure 2: Hierarchical language versions in a web content management system.
One improvement that helped providers face these challenges was the emergence of affordable scanning technology that allowed documents to be digitized into a common format (often PDF). That made storage simpler but did not ensure that the content could be understood by a computer and found easily, once stored. Flat and static document storage also did not foster collaboration on review and revision (Figure 3).
A parallel development in content management helped significantly — the emergence of structured versus unstructured content. Structured content is organized in a predictable way, and is usually classified with metadata. XML is a common storage format. The predictability and the labeling with metadata enable the content to be processed by software.
Figure 3: Challenges of content management in traditional healthcare settings.
Unstructured information, on the other hand, is not organized with metadata, or possibly at all. It is typically text-heavy, which may result in ambiguities that make it difficult to understand.
Content management systems have evolved to take advantage of structured data and content so that information could be processed by software, faster and more cost-effectively than by humans. Content that was previously in unstructured form was transformed to a structured format in order to be similarly handled (Figure 4). While the content explosion remains a challenge, structured content management is a powerful tool in the race to keep up.
Structured content management works best when it breaks content down into components and classifies it. Those components can thus be individually recombined to make other content, enabling reuse, instead of rewriting from scratch each time. Use of DITA as an industry-standard XML format for structured content also facilitates the breakdown of information silos as information can more easily be communicated between different systems. Having content divided into components also makes it easier to keep it updated, as authors do not have to revisit all the content, just the individual part that needs changing. If that content is translated into other languages for patient consumption, those same benefits of reuse and targeted updating apply as well, helping to minimize translation and publishing costs and save valuable time.
Figure 4: Managing content in connected health environments.
As an example, a life sciences analytics provider that implemented structured content management to solve their global documentation challenge was able to decrease translation cycles from three months to 15-30 days; they reduced publishing time from over ten days to 15 minutes.
Another aspect of translation that is facilitated by structured content is the use of machine translation (MT). This is because MT quality benefits from predictable patterns and tagging to help it understand the source content and correctly translate it. In the healthcare domain, content that will be published and consumed by patients should generally also be reviewed and post-edited by humans, although the emergence of neural machine translation (NMT) has greatly improved raw MT quality. However, for content coming to the healthcare provider in other languages, for example letters, emails or chatbot content from non-English speaking patients, raw NMT can be perfectly suitable for gaining an accurate understanding of the message, sufficient to enable a human response. In the healthcare domain, where protection of private data is extremely important, it is critical that a secure MT system be used, and not a free internet translation tool, as translations using the latter are indexed on the internet and searchable by anyone.
Earlier, I discussed having standardized clinical care pathways that ensure patients with specific diagnoses have a consistent path of treatment and information flow. Healthcare providers are also looking at how to better provide personalized treatment based on a number of factors, including collated patient data (“big data” techniques usage), likely patient outcomes, individual patient risk factors and healthcare professional prognosis. For example, in the area of big medical data, genome sequencing is opening new frontiers.
The power of personalization, alongside the ability to collate data in a consistent way, with consistent terminology, is where connected health really takes off. It marries the “Dr Google” self-diagnosis approach of the average patient with the wealth of data and information available to healthcare professionals. This means that patient expectations (and more importantly) care can be managed and tailored to their medical needs and, in some instances, affordability. Structured content can lay the foundation for this level of data exchange, personalizing services through the use of metadata and conditional content.
Forward-thinking healthcare providers are thus also contributing to a more connected health experience for patients, by managing their content so that it is easier and less costly to keep up-to-date, secure and available in relevant languages. The most advanced providers are thinking even further, and combining unstructured web content with structured document content in content mashups. For example, they may use intranet portals for standard procedures or for internal clinical research libraries. With the advent of artificial intelligence (AI) tools, it is even possible now to have abstracts of the content automatically created. In this new era where healthcare providers are faced with pandemic challenges that engulf resources and time, having a highly automated, AI-reinforced content management process is an important strategic advantage.
Helping suppliers be reliable with connected medical devices
Another way that patients experience connected health is via direct interaction with biomedical devices that collect physical data and transmit it digitally to the healthcare provider. It is now common for patients to be remotely monitored with this type of equipment; for example, pacemakers are remotely monitored to detect functional issues quickly. There are an increasing number of relatively low-cost devices that can be used in the patient’s home, and then connected digitally to upload data. Blood pressure or blood sugar levels are obvious examples. This equipment not only needs to perform flawlessly, but it also has to be understandable for patients. The user interface has to be in a language they can understand, and any documentation as well, and these have to match each other in order to avoid any confusion. Localized versions of the equipment must be as carefully tested as the original language versions, and the documentation as carefully reviewed, as risks are high and penalties for mistakes can be huge.
To ensure consistent, high-quality translations, a combination of robust translation management tools and expert human translation is key. An enterprise-strength translation management system will enable consistency and reuse via translation memory, have easily customizable workflows for different production needs, and integrate seamlessly with both machine translation and human translation environments. The translation provider should also have a strong multilingual functionality testing capability in case the customer does not have multilingual staff. The benefits of putting all these practices together can mean significant savings and faster time to market, bringing a strategic advantage to bear in a competitive market. For example, a global manufacturer of defibrillators and monitors saved 50% in project costs and 40% in overall project time via automation of translation and testing workflows, and by effectively leveraging past translation.
Figure 5: An end-to-end content and translation management flow facilitates connected health.
Here also, there is great benefit in looking upstream from the translation process, to ensure that documentation source content is optimized via content management best practices such as the structured content management mentioned earlier. Because medical device documentation is frequently still printed, any mistakes in the process can be very costly. Structured content management will make it easier to track versions and revisions, and reuse standard content across publications. Creating medical device documentation often involves a large team, so having a strong collective authoring and review environment is crucial. Again because of the potential costliness of having to revise and republish, creating once and being able to publish to several different formats is an important money-saver.
In this time of Covid-19 distancing, nothing is more important in healthcare than staying connected. Whether it is patients self-serving on information, healthcare providers seeking to stay on top of their content explosion or medical device manufacturers needing connected reliability, an optimized content flow through creation, management and translation is key to success (Figure 5). Research shows that connected health technologies not only increase access and reduce healthcare costs, but also improve outcomes, due to the availability of the right information and data collection, for the right person, at the right time. Connected health makes patients feel they are getting personalized attention, and it helps healthcare providers and medical device manufacturers to save money and time because they are able to interact remotely using a combination of standardized content and procedures and individualized interactions. This is enabled by enterprise-strength, reliable technology used to intelligently create, collaborate on and manage content, then make it efficiently accessible in required languages and seamlessly available on a variety of digital devices. With that type of holistic, end-to-end approach, efficient connected health can be an affordable reality, in the current Covid-19 crisis and beyond.