In this presentation for Digital Health Institute Summit 2020 I will explain how we overcame barriers for patient engagement and achieved very high response rates using our ePRO ZEDOC Platform. I'll give real-world insights from a project we ran at the Rheumatology service at NUH in Singapore. I wear two hats - this talk is with the first one!

1. Overcoming Patient
Engagement Barriers
Koray Atalag, MD, PhD, FAIDH
CIO & Head of Research - The Clinician
Senior Research Fellow (Honorary) - University of Auckland
Paper#:167

2. ● HQ in Auckland, hubs in SG, AU & IL
● Value-based care / strong focus on
PROMs in routine care
● Founded and led by clinicians and
health informaticians
● ICHOM Partner (APAC / Middle East)

3. The coming ubiquity of PROMs and PREMs
● Better health outcomes - ones that matter the most to patients!
● Improving patient-provider communication & satisfaction
● Enabling shared decision making
● Clinical quality and service benchmarking / improvement
● Assessing true burden of disease / impact of care / equity
The Value of Patient-Reported Outcomes

4. The Problem: Patient Engagement
Barriers:
● Poor user experience ⇒ adherence
● Low patient activation / motivation
● Lack of provider acknowledgement
● Typically low response rates in
industry: 15-20%.

5. Cloud based Platform as a
Service (PaaS), powerful, highly
configurable and scalable
solution for the end to end
assessment of health outcomes
with a special focus on PROMs
& PREMs
ZEDOC Platform

6. Auto & Manual Scheduling
Alerts Dashboard
SMS and Email
Reminders
ZEDOC: An Outcomes Measurement
Platform
Analytics Dashboard Provider Portal
Patient App

7. Patient Engagement in Real-World
Settings
The project
● National University Hospital (NUH) in Singapore
● RAPID3 PROM delivery - 1 day before consultation
● Key symptom and QoL info back to clinic
● Allowed for focused consultations
● We used some key strategies to enable
very high response rates

8. Key Patient Engagement Strategies
Methods:
1. Patient onboarding / provider branding
2. Engaging patient experience
3. Minimising respondent burden
4. Behavioural analytics
5. Closing the loop
6. Value droplets

9. 1. Patient Onboarding
Working with the clinical team to
create an optimised on-boarding
process to ensure patients understand
the value of the PRO and their direct
impact on their own health - their
voices to be heard
‘We listen to you and act upon
it’

10. Hello Ruth,
Please complete this assessment prior to
your visit.. Looking forward to see you
tomorrow,
Drs. Iris
● Patient greeted with first name
● UI and questionnaire in own language
● Attending physician’s photo and clinic's
branding
● Invitation specific to clinical context
2. Engaging Patient Experience

11. 2. Engaging Patient Experience
> 80% response rate in community
Multiple languages supported
PROMs Functional Assessments

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3. Minimizing Respondent Burden
CAT-IRT
- Are you able to get in and out of bed?
- Are you able to stand without losing your balance for 1 minute?
- Are you able to walk from one room to another?
- Are you able to walk a block on flat ground?
- Are you able to run or jog for two miles?
- Are you able to run five miles?
Using AI to optimise surveys
Questionnaire Reconciliation

13. Insights for optimal
patient engagement
4. Behavioural Analytics
In-Clinic PopulationCompletion RatesOver Time Distributionof Ageby Gender & Completion
% Completion and 95% CI,by Clinician & Time WeeklyResponse Ratesby ClinicianIn ClinicDevice HeatMap

14. 5. Closing the Loop - Shared Decision Making
● Real time actionable insights to the care
team
● Pre-visit reminders to review patients’
responses
● Highlights of patient’s key health concerns
● (PREMs) Patients’ structured feedback on
care provision drives service improvement +
NLP on free text

15. 6. Value Droplets - What's in it for me?
● Feeling connected / involved
● Expectations met
● Ease of describing own health status
● Improved health literacy and
informed decisions
● Real continuity of care

16. Key Takeaways
1. The “little things” matter
2. Less mechanical - more human
3. Collect and analyse key learnings
4. Always be willing to adapt your methods

17. Patient & Caregiver Testimonials
“Love it, I can pour my heart out and
won’t do it to anybody else”
“I was never able to describe my
condition so well!”
F, 49 Singapore F, 54 Australia
“I never mentioned my depression to
my doctor because I thought it wasn’t
related to my visit”
“My mother loves the extra
attention and finds the app
very easy to use”
M, 32 Singapore F, 58 Australia