Originally published in HCPLive.com
by Gwenn Schurgin O’Keeffe, MD, FAAP
New technologies can make healthcare more personalized, strengthen the patient–physician relationship, put the right information in the right hands at the right time, and potentially improve outcomes and efficiency across the healthcare spectrum. So why are so many physicians reluctant to embrace these changes?
Wikipedia defines Health 2.0 as “the use of a specific set of Web tools (blogs, Podcasts, tagging, search, wikis, etc) by actors in healthcare including doctors, patients, and scientists, using principles of open source and generation of content by users, and the power of networks in order to personalize healthcare, collaborate, and promote health education.”
“Health 2.0” isn’t just a buzz phrase; it’s fast becoming the essence of our medical system, whether we want to admit it or not. Many savvy patients and key subsets of the medical industry are already on board. What I find simultaneously intriguing and frustrating is that the one group that seems to be holding out on full implementation of Health 2.0 and all the power it can provide is the group that would benefit from it the most: physicians.
Sure, there are a few patients who have computer and reading literacy issues; but by and large, today’s patients are not only health-, computer-, and reading-literate, but they are also utilizing social media and various high-tech tools to learn about healthcare, connect with healthcare providers and other patients, and negotiate the healthcare system.
In doctor-land, however, except for a relatively small, tech-savvy group, one of the following two responses is the norm when Health 2.0 issues are raised:
1. Sheer panic.
2. Total acceptance and excitement, an almost Zen-like state of “Yes! That’s it. That’s what I’ve been saying!” This is often followed by a lost look, as the physician has no idea what to do next or how to adopt any Health 2.0 tools in his or her practice.
The call to Health 2.0 is here. Getting all physicians on board will require breaking down four huge barriers: Fear. Many physicians are fearful of what they do not know and are worried that it will be difficult for them to learn about new technology. Many have not yet made the leap to using EMRs or even getting Internet access in their offices, so anything even remotely more exotic is scary. Cost and location are huge obstacles, depending on the size of one’s group and practice location.
Loss of control. Many docs worry that this new type of social media-driven medicine will lessen their control over their practices. Unfortunately, they don’t understand the power it gives them to control their day and help them be more efficient, so they shy away. From scheduling to e-mailing results to patients, they can’t look past the technology learning curve to see how much time will be saved by adopting systems that will actually decrease the busywork that wears them down.
Loss of connection with patients. Not understanding the world of social media and networking, many of these docs fear loss of connection with their patients. If physicians gave some of these systems a try, they would understand that they actually enhance communication and foster the doctor–patient relationship.
Blinders. Some docs simply do not want to acknowledge the wave that is moving the healthcare system in a new direction. Despite not liking the current system much, they don’t want to embrace something new. This is, perhaps, the toughest barrier to break down, and only time and education will help them understand the value Health 2.0 can add to their lives. It’s time we admit that some of the problems we see in healthcare today are partly the result of our own resistance to technological innovations that are begging to become widespread, as well as to changes that are already occurring by virtue of our patients’ wishes.
Our patients are embracing Health 2.0 now. If we all embrace it together, as an industry, think of all the systems issues we’d fix–from time management to patient communication. Put that way, how could anyone still be in favor of ignoring health 2.0?
Gwenn Schurgin O’Keeffe is a pediatrician who blogs at Dr. Gwenn Is In.
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{ 13 comments }
I think that widespread adoption of EMR’s will occur over the next three years and along with that physicians will become more comfortable with internet tools. I think that emailing, online scheduling and prescription refills are very compatible with most EMR’s. If additionally primary care physicians adopt the patient-centered medical home as laid out by NCQA, then electronic and email interaction between physician and patient will broaden.
Dr. Gwenn,
As someone who has a degree in IT and is an “early adopter” in my PERSONAL life I disagree with the premise that “except for a relatively small, tech-savvy group”, doctors avoid 2.0 for the reasons you suppose. I have practiced in a variety of settings and with at least 6 different EMR’s. HIPAA interferes with fluid use of Web based programs and I have yet to find any efficiencies from networking applications but the physicians with whom I have worked have definitely seen a rise in their uncompensated workload. Phone calls can be diverted to your nurse but in most cases your e-mails or Tweets must be personally handled. Additionally, the rise of Dr. Google is enormous in the amount of time now required to undo misinformation much less actually see, evaluate and treat the multiple issues with which most adult patients now present (and an increasing number of special needs kids). All these items are more time consuming especially if it means moving from verbal instruction to typing —- a skill not so easily acquired if not needed during a quarter century of practice. Until security in Web applications improve and MUCH BETTER interoperability exists I expect glacial adoption at best.
Very interesting post. I view healthcare 2.0 with a bit of a twist from the Wikipedia definition, less from the perspective of social media and more from the vantage point of moving the business of healthcare from Version 1.0 to version 2.0. I should note that I distinguish the business of healthcare (how it is run) from the healthcare business (the clinical side).
Having worked with executives in a number of industries, I think that for healthcare reform to be truly effective, the business of healthcare needs to evolve from an 0.2 model to a 2.0 model. I think the same issues you raise still come into play; sheer panic, loss of control, loss of connection with patients, and blinders.
Going from an in-house business model to one being transformed by reform and Meaningful Use to a national healthcare model will exacerbate further those issues. The in-house business of healthcare (how healthcare is run) was never built to handle a business model that will require every patient to be able to be connected to any doctor. The system advances over the past few years—EHR, CPOE, and ePrescribing were implemented without any idea that the rules would change after the fact.
Will healthcare 2.0 offer huge advantages to how healthcare is run? Absolutely. The first question to answer before aiming for 2.0 is whose 2.0 model should you follow; yours or the government’s. Are they the same? No, and they are diverging even further as you read this. The good news is that I think they will converge several years down the road. What you need to decide is which model do you pursue before that happens.
I read the article on @KevinMD’s blog about #health20 and was a bit baffled. As most pro-#health20 articles, the author was long on promises of the #health20 revolution but short on actual concrete examples of benefit. As expected the author blasted doctors for being scared of ‘joining the revolution’ because these anonymous but oh-so-powerful doctors feel #health20 brings loss of control and loss of connection with patients. I disagree even though I have a great love for technology and its progress.
The author defined #health20 and the usual laundry list of “blogs, Podcasts, tagging, search, [and] wikis” were stated as the tools needed for the #health20 revolution. What I still can’t seem to understand is how doctors leading the way in any of these activities is going to lead a health revolution? It won’t.
Besides search many of us pioneered “blogs, Podcasts, tagging, search, [and] wikis” by volunteering to work on the first projects to implement these ideas long before we went to medical school. These things were hobbies and specific tools for specific jobs. It was all about us techophilic geeks giving the layman on the street the ability to create and share content on the internet. As the tools became easier and the internet penetrated into the lives of people many of us realized that giving a voice to everyone meant the quality of the content decreased overall as the number of voices increased. The internet today represents a lot of noise with little signal and makes the ability to sort good information from bad even harder because the traditional academic or technophilic geek ivory tower is gone.
Much like little children that learn a new skill and suddenly use that skill on everything even if there are better skills for the job. Its a progression we see in child development from simple to increasingly complex tasks. However, technology and its application in adults doesn’t work that way. If people learn to use a blog or edit a wiki then they suddenly believe every problem in the world can be solved with those tools. Unlike children these adults don’t learn the limitation of certain technologies and try something new. Instead they keep pounding a square peg into a round hole and expect the rest of us to join in their futile endeavors.
These people keep going on and on about #health20 as if “blogs, Podcasts, tagging, search, wikis” will solve some yet-to-be-defined problem that is plaguing all of us. What is this problem? If its patient information sharing then HMOs like Kaiser Permanente have built an elegant solution for patients to be able to retrieve their health records, schedule appointments, and other relevant tasks. The doctors perform their duty as doctors and the information being recorded into the electronic medical record system is accessible to patients. I don’t see a problem in this solution as long as the EMR has a good workflow that isn’t jarring and uses natural human interfaces to ease data entry. Where blogs, Podcasts, tagging, and wikis comes in is beyond me.
If a doctor wants to participate in blogs, podcasts, and wikis then they should have the freedom to do so but I still keep coming back to the question: What do these technologies do for doctors? As a technophile doctor that’s been working with computers and technology for much longer than the current #health20-is-everything gang I’m still wondering that myself.
I have email and the result is long unpaid emails, consuming a lot of time. On the other hand, patients are not willing to pay extra for email access.
so, the real reasons are time and money.
It’s ironic that it actually requires a tech background (which I and many other young doctors possess) to recognize where similar lines of corporate-speak gibberish have spawned from previously.
Yes, that’s right folks… the return of Web 2.0! That hilarious, bizarre concept that was going to revolutionize our entire lives in various never quite specified ways.
Blogs? Podcasts? Twitter? Is this a joke? It is not a coincidence that this article is devoid of any actual ways in which these “amazing developments” ought to revolutionize our current practice. Whatever the hell “Health 2.0″ is, it appears to be far more relevant to online communities than somehow dramatically changing day to day medical practice, whatever the claims of the author.
The recent Kaiser Permanente hack does not inspire confidence in present day patient privacy safeguards. EMR is still not ready for prime time.
Justifiable on-line road rage. I run a consulting firm. You know what? I hate it—running the firm, that is. The consulting is great fun. I am guessing that being a physician is a lot like that. Very few of you became doctors to run a business, let alone one that is front and center on the evening news, Twitter, and every other blog on the planet. Add to that a government who is changing the business model without any thought to how it impacts your business. They want a nationalized healthcare system whereby each patient can be accessed by any doctor—that has nothing to do with your effort to treat actual people.
Interesting discussion, and the comments are spot on, especially the, “Where’s the beef” comments. It is silly to expect that overlaying a few technologies makes things better. This reminds me a little of Dorothy running around in ruby slippers, and the magic answer was clicking her heels three times. Unless K-mart had a big sale on ruby slippers, there is no quick win technology for doctors lining the shelves of Office Max.
To rub salt in the wound, the government is forcing more technology on physicians, namely EHR. If the technology was as great as the prognosticators write, doctors would be scrambling to be first in line. Has that happened? Of course not. Instead, the government is taking a Tony Soprano approach, offering rebates for doctors who take a course they don’t want to take, alternatively, burying bodies off the New Jersey Turnpike.
So, some tactical thoughts starting with EHR. Don’t do anything yet. You have at least a year. Yeah, you won’t get the ARRA money—that’s according to what’s written. Guess what? Nobody else will get it either. The ONC will have to change either the timing of Meaningful Use, or the rules, or both. I think they will push it back. Twelve to eighteen months from now, someone will offer a robust, shrink-wrapped solution that makes sense. If you’re interested, here’s a link to an audio interview I did for doctors about an EHR strategy—it’s just ideas, I’m not pushing anything. Go to EMRFIX.com and search for the link.
Other practical thoughts. There are a few hundred thousand doctors, none of whose Hippocratic Oath said anything about healthcare 2.0, or offered any training on how to get there, or whether you should even try to get there. Most of my physician friends set up their business model on a whim and a prayer, like all entrepreneurs do—like I did. There are probably as many business models for doctors as there are doctors. The good news is that some have done better figuring out the business side of healthcare than others. It’s not an ego thing. It’s not about being intellectually gifted and not being smart enough to figure out something as simple as running a business. Why? Smart has nothing to do with it. There are things to be learned from the efforts of others, and there are ways that some of the technologies can help.
Those things? Blocking and tackling. Business processes. Social media. Eliminate the rework. Eliminate whatever tasks that don’t add value to your business. Are there activities you can outsource? Payroll? Can you have someone design a website that will answer questions for your patients so they don’t have to call you? Can you collaborate with other doctors?
Just some ideas. You are justified in your angst.
There is no evidence to support any of the far-fetched claims in this article.
Statements such as “Many physicians are fearful of what they do not know and are worried that it will be difficult for them to learn about new technology” are incorrect and condescending.
Written by an “actor” in “doctor-land.”
Yes, I do live in “doctor-land” but unless one does, one can not really understand the issues of today’s doctors. As a practicing pediatrician, I understand the issues today’s pediatricians face and recognize the challenges posed by today’s practice world.
But, I also live in “social media land”, which is why the AAP, HCP Live, and my health care colleagues call upon my to provide guidance on how doctors can utilize social media tools more effectively.
A clarification:
I was signing my post as a fellow physician in “doctor land,” as Dr. Gwenn calls it.
good thing you did not pick something controversial about which to write
I’m going to also vote with the young-doctors-who-love-tech-embrace web 2.0-have their own domain, podcast, blog-communicate with their patients via email-are programmers-are just as comfortable using linux, PC, OSX etc who are a little ticked off by the constant insinuation that doctors don’t like change, technology or are old and scared of it. As many have said above me much more eloquently, the tech just isn’t there and is no magic bullet. Health 2.0 is very much a buzz word.
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