Digital Culture – a Critical Component for Successful Connected Health

Delivering connected health services to patients relies on many things: technology, connectivity, and the ability to collect and analyze data. It requires clinicians who are empathetic and willing to engage patients as full partners in care delivery. Patients have their own challenges to overcome as part of a successful connected health program. They must be able to bear the costs of a program, whether the hard costs of acquiring technology and connectivity or the soft costs of time to alter routines and pay attention to their own care needs.

Patients often tell us that they engage in connected health programs "when my doctor pays attention." Researchers like Dr. Joe Kvedar have talked about the Sentinel Effect as a powerful motivator for patients to engage in their health. The Sentinel Effect is the tendency for people to perform differently when they know someone is evaluating or judging them, which makes sense when you think about it. I have seen first-hand in focus groups patients say they adjusted their behavior because they did not want to disappoint their clinician.

The dynamic of the Sentinel Effect adds some complexity to the relationship between patients and clinicians though. It requires trust by the patient that the clinician who will be evaluating them is capable, fair, and "on their side." Building that trust takes effort by provider organizations in ways that might not be apparent when first thinking about building a connected health program. Part of the trust building process is establishing a digital culture that makes patients confident that their providers are capable of accepting and evaluating the digital data that they provide. Many providers may not realize the hidden signals they are sending about their digital cultures and how these things play into a patient's willingness to trust and engage in a connected health program.

HEWSi: the Health Empowerment Web Strategy Index

HIMSS is working on methods to evaluate a provider organization's digital culture, and we are beginning with a survey instrument called the HEWSi: the Health Empowerment Web Strategy Index.

Developed by Lorren Pettit, the HEWSi is the first step in evaluating an organization's digital culture by looking at their overall web presence and verifying whether some essential components are present.

Why is a provider organization's website critical to developing patient trust?

• It is often the most visible statement of an organization's embrace of digital technology and the area where patients are most likely to begin their interactions with a healthcare organization.

• In short, it's the part of a hospital's digital health strategy that patients can see and feel.

When chef and author Anthony Bourdain wrote his breakthrough book Kitchen Confidential, he talked about how, as a chef, he will never eat in any restaurant that has a dirty restroom. He said at the time, "I won't eat in a restaurant with filthy bathrooms. This isn't a hard call. They let you see the bathrooms. If the restaurant can't be bothered to keep the toilets and floors clean, then just imagine what their refrigeration and work spaces look like." The same applies to patients and building digital trust: if an organization's website is a mess, imagine how it handles the rest of its digital data.

The HEWSi looks at five domains for an organization's web presence:

1. Orienting: Does it give clear directions on how to find, navigate and engage with the organization?

2. Alignment - Social Marketing: Does it have targeted messaging for different communities messaging that promotes desired health behaviors?

3. Alignment - Product/Service Marketing: Is there messaging to facilitate the transactional relationship between the patient and the provider organization?

4. Health Literacy: Are digital resources made available providing general health information?

5. Patient Empowerment: Are there digital resources allowing patients to push and pull information to/from their provider?


We are currently piloting the HEWSi survey and are looking for healthcare organizations to fill out the simple survey and provide feedback. In particular, we would like to engage with the digital marketing teams at hospitals and physician groups.

The survey only takes a few minutes to complete. If you are part of your organization’s web team or can forward the link to the people responsible, you can have a role in shaping this assessment of digital health culture.

Participate in the survey here or contact Lorren Pettit or Rob Havasy for more information.