Digital health solutions that facilitate patient engagement must put the patient in charge, not the physician. Outside of the clinic, where health happens, in the day-in, day-out lives of people, we have to let the patient take ownership of and decide how they are going to engage and be “compliant” (I hate that word).

Here’s a simple example:

I’m working with a start-up who is shipping a remote patient monitoring and engagement tool. One feature of the experience enables patients who opt-in to be able to communicate with the clinic by receiving text or smart phone push notifications from the clinic with test results and instructions to modify medication dosage regimens. This an on-going, monthly process for patients on this specific long-term therapy.

A physician who recently started using the tool wanted to work through his list of new test results in the very early morning hours before he went into the office for the day – but didn’t want to bother the patients with notification messages before 9am. So, he requested a simple feature to allow him to delay the outbound patient notification a number of hours, depending on when he was working through the list. This way he knows that all of his messages will be received by his patients at 9am or later.

On the surface that makes sense, and sounds very empathetic – let’s give the physician the ability to adjust his workflow to best work with his schedule while not bothering the patient at odd hours of the morning. Providing the physician this lever to make that work sounds kind of patient-centered, right?

But, what if one of his patients gets up at 4:30am every day and schedules time first thing in the morning to focus on her health issues. At 9am she is regularly taking a quick nap and later in the day, at 3:30pm, she is typically walking her grandson home from school and spending quality time helping him with homework. The last thing she wants is to be interrupted from her nap or time with her grandson by a regular on-going management message from her physician about her medication dosage.

The physician’s immediate response to the problem comes from a desire to be considerate to the patient, yes, but also from a familiar paradigm of being in control of the patient and determining what is best for her.

The team’s immediate reaction to this feature request was, yea, that makes sense and would be easy to do, let’s make the doctor happy and implement it. It is very natural to want to make physicians very happy with the software we are giving them, because the paradigm we are all used to is one where the physician is at the center of our healthcare universe, therefore they seem like the primary customer for our product.

The real answer of course is to let the patient set up “do not disturb” preferences in the app. The outbound messages from the system will be queued and only sent during hours that work for this patient, not a generic patient who is statistically likely to be sound asleep at 5am.

The physician mostly gets what he wants. He’ll be able to work in off hours without disrupting his patients at odd hours. But he won’t have complete control for when the days messages are sent for all of his patients. It’s a little more complicated to wrap your head around the idea that some of these messages I send will go out now, some later. There is more cognitive load required to deal with this uncertainty and lack of control.

This is a small, simple and seemingly insignificant example of giving patients the levers that enable and empower them to participate more fully in their health, instead of giving the physician the lever.

There is no silver patient-engagement bullet, it is a concept and a collection of small steps that lead to an overall culture and philosophy of shifting the final responsibility for health and wellness from the physician to the patient.