{"id":21885,"date":"2021-06-28T15:08:22","date_gmt":"2021-06-28T19:08:22","guid":{"rendered":"https:\/\/participatorymedicine.org\/epatients\/?p=21885"},"modified":"2023-02-20T11:06:46","modified_gmt":"2023-02-20T16:06:46","slug":"from-the-heart-my-patient-engagement-journey","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2021\/06\/from-the-heart-my-patient-engagement-journey.html","title":{"rendered":"From the Heart: My Patient Engagement Journey"},"content":{"rendered":"<p><span style=\"font-weight: 400\">When my daughter Ada was an infant, a cardiologist told me that she needed open heart surgery, the sooner the better. Ada had been born with a small hole in her heart (a<\/span><a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/ventricular-septal-defect\/symptoms-causes\/syc-20353495#:~:text=A%20ventricular%20septal%20defect%20(VSD,right%20side%20of%20the%20heart.\"> <span style=\"font-weight: 400\">VSD<\/span><\/a><span style=\"font-weight: 400\">), which, the doctor said, could stunt her growth and potentially cause heart failure or brain damage.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">I\u2019m grateful for modern science and medicine, but the thought of Ada\u2019s tiny chest under the knife, the risks of anesthesia, infection, medical error, and, at a minimum, a full torso scar, terrified me. <\/span><span style=\"font-weight: 400\"><br \/>\n<\/span><span style=\"font-weight: 400\"><br \/>\n<\/span><b>Patient engagement changed my perspective<\/b><\/p>\n<p><span style=\"font-weight: 400\">Ten years ago I was already deeply committed professionally to patient engagement supported by digital health, an idea that was far from mainstream at the time.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">I had set up a Telemedicine Task Force for the<\/span><a href=\"https:\/\/www.fcc.gov\/general\/rural-health-care-program\"> <span style=\"font-weight: 400\">Federal Communications Commission<\/span><\/a><span style=\"font-weight: 400\"> and helped to<\/span><a href=\"https:\/\/www.markle.org\/markle-common-framework-connecting-professionals\"> <span style=\"font-weight: 400\">develop a framework<\/span><\/a><span style=\"font-weight: 400\"> for nationwide health information sharing at the Markle Foundation. Then I went out on my own to consult for others on how to engage consumers and patients by leveraging technology.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The more I learned, the more I saw the mostly untapped role patients could play in improving their own health. Rather than merely following their doctors\u2019 orders, patients could be actively engaged in defining their own health goals and achieving better outcomes by using digital information and tools.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Suddenly, here I was, with my own baby in my arms, under pressure to put her through open heart surgery, but wondering if there might be another option. I was inspired by the pioneering patients and care partners whom I\u2019d seen leverage technology to change the course of their health journeys. So I followed their lead.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">For my family, patient engagement meant using the Internet to research baby Ada\u2019s condition and to connect with other families who had kids with VSDs, one of which even invited me and my husband into their home to learn about their experience with surgery. We also rented a hospital-grade scale to weigh and record Ada\u2019s weight before and after each feeding.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">We found that Ada, though light by American standards (a key justification for surgery according to our cardiologist), was much closer to the average weight of babies in Europe. Since my husband and I had both been unusually lightweight growing up (one girl called me \u201cskinny wrists,\u201d while my husband had been compared to a toothpick!), we thought a low weight might not be such a big deal in the context of our own histories and mixed European roots, especially since<\/span><a href=\"https:\/\/www.cdc.gov\/obesity\/childhood\/index.html\"> <span style=\"font-weight: 400\">Americans tend toward being overweight<\/span><\/a><span style=\"font-weight: 400\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Even more importantly, we saw that Ada showed no signs of the fatigue, lethargy, or weakness that could indicate that the VSD was impacting her ability to grow.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The description of patient engagement laid out by the Society for Participatory Medicine\u2019s<\/span><a href=\"https:\/\/participatorymedicine.org\/manifesto\/\"> <span style=\"font-weight: 400\">Manifesto<\/span><\/a><span style=\"font-weight: 400\"> is consistent with what we did, including asking questions, voicing concerns, doing research, and reaching out to others for help.\u00a0<\/span><\/p>\n<p><b>Why patient engagement is so critical\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">There\u2019s a compelling logical case for engaging in your own health, both in the course of everyday life and in navigating the healthcare system. Everyday behaviors shape<\/span><a href=\"https:\/\/www.americanactionforum.org\/research\/understanding-the-social-determinants-of-health\/#:~:text=Recent%20estimates%20attribute%2010%20to,non%2Dmedical%20determinants%20of%20health.\"><span style=\"font-weight: 400\"> 40% to 50%<\/span><\/a><span style=\"font-weight: 400\"> of a person\u2019s health over the course of a lifetime, while healthcare is responsible for only about 10%. Using digital tools to improve your diet, exercise, and sleep, for example, makes sense because it\u2019s now possible to track and adjust factors that were much harder to measure in the past.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">When it comes to healthcare, you can use technology to identify and address possible errors in your medical record and co-design a plan for your care that reflects your personal priorities. Engaged patients have improved<\/span><a href=\"https:\/\/www.healthaffairs.org\/doi\/10.1377\/hlthaff.2012.1061\"><span style=\"font-weight: 400\"> health outcomes<\/span><\/a><span style=\"font-weight: 400\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Patient engagement also resonates with me emotionally. It makes society less hierarchical, more egalitarian. The idea that every person has a voice and can make a difference in the course of his or her own life and contribute to something bigger resonates for me on a visceral level.\u00a0\u00a0<\/span><\/p>\n<p><b>But what if your doctor doesn\u2019t support you?\u00a0\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">When I shared our findings and concerns with the cardiologist, she didn\u2019t take them seriously. Although I don\u2019t believe she had any ill-intent, it did not escape me that: 1.) surgery was her specialty (and thus the main tool she used to address patient problems), and 2.) her hospital was in financial trouble, which I happened to learn from the news. With the average open heart surgery for kids costing more than<\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26184611\/#:~:text=The%20median%20cost%20was%20%2451%2C302,children%20admitted%20for%20medical%20treatments.\"><span style=\"font-weight: 400\"> $50,000<\/span><\/a><span style=\"font-weight: 400\"> at the time, it struck me that her best interests might not be aligned exactly with my family\u2019s.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">My husband and I researched and chose another institution, where we found a cardiologist who listened attentively\u2014to our daughter\u2019s heart, to our concerns, and to the stories the data we\u2019d tracked were telling. He was in favor of watching and waiting, which is the path we chose. If your doctor isn\u2019t a good fit, find a new one.\u00a0<\/span><\/p>\n<p><b>How Things are Working Out for My Family\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Ten years later, my husband and I still take Ada for periodic checkups with the second cardiologist. Her heart is strong. The only constraint on her life from the VSD is that she can\u2019t scuba dive, because it could cause complications due to the underwater pressure. That\u2019s a small price to pay to avoid the risk and trauma of open heart surgery in the first year of life.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Professionally, I\u2019ve gone much deeper into supporting patient and consumer engagement in health. I\u2019ve held leadership<\/span><a href=\"https:\/\/www.fiercehealthcare.com\/it\/onc-memo-departure-lygeia-ricciardi\"> <span style=\"font-weight: 400\">roles in the federal government<\/span><\/a><span style=\"font-weight: 400\"> at the Office of the National Coordinator (ONC), and in the private sector at<\/span><a href=\"https:\/\/www.go.carium.com\/\"> <span style=\"font-weight: 400\">Carium, a tech company which has built a powerful telehealth platform for collaboration<\/span><\/a><span style=\"font-weight: 400\"> between patients and providers.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">During this time, the digital health landscape has grown up dramatically, just like Ada. There have been billions of dollars invested in digital health, thousands of new products and services, and considerable transformation of the healthcare system, one of the best examples of which is the <\/span><a href=\"https:\/\/www.healthcaredive.com\/spons\/the-ripple-of-telehealth-adoption-during-covid-19\/586900\/\"><span style=\"font-weight: 400\">rapid switch to virtual health delivery<\/span><\/a><span style=\"font-weight: 400\"> that took place during the early days of the COVID-19 pandemic.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Digital information can make the invisible visible, and allow us to make human connections as we need to in real time. Still, there is a great deal to be done to help consumers and patients take full advantage of this rapidly shifting landscape.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Which brings to me my next act: I recently launched <\/span><a href=\"http:\/\/www.adarose.com\"><span style=\"font-weight: 400\">AdaRose<\/span><\/a><span style=\"font-weight: 400\">, which I see as the next chapter in helping patients and consumers take charge of their own health. Women make 80% of healthcare decisions in this country, and AdaRose is a community that helps us, as informal \u201cChief Health Officers\u201d for families, leverage new apps, products, and services, to make that process easier and more fun. <\/span><span style=\"font-weight: 400\">The name AdaRose was inspired by my family\u2019s engagement in the health journey of our baby, who has blossomed into a thriving tween.\u00a0<\/span><\/p>\n<p><a href=\"https:\/\/www.linkedin.com\/in\/lygeiaricciardi\/\"><i><span style=\"font-weight: 400\">Lygeia Ricciardi<\/span><\/i><\/a><i><span style=\"font-weight: 400\"> is the Founder and CEO of <\/span><\/i><a href=\"http:\/\/www.adarose.com\"><i><span style=\"font-weight: 400\">AdaRose<\/span><\/i><\/a><i><span style=\"font-weight: 400\">. She is a long-time member and supporter of the Society for Participatory Medicine.\u00a0<\/span><\/i><\/p>\n<p>Did you enjoy this blog?\u00a0 Please go <a href=\"http:\/\/participatorymedicine.org\/manifesto\">here<\/a>, sign the manifesto and learn more about the Society for Participatory Medicine.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>When my daughter Ada was an infant, a cardiologist told me that she needed open heart surgery, the sooner the better. 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