I did a second stint on a talk radio a few weeks ago which I really enjoyed. The callers represent a genuine, down-to-earth view of the reality of connected health adoption. The first time around, most callers were cautionary, raising concerns about data security and wondering about physician endorsement. This time the theme that spontaneously emerged was one of people telling stories from the heart, about loved ones who have benefited from connected health. That was uplifting for me.
As the hour came to a close, the last caller, a physician, voiced a concern I’ve heard from the medical community before. He suggested digital technologies could negatively affect the doctor-patient relationship. He argued that digital tools merely get in the way of cultivated, face-to-face relationship building. Because of time constraints, the only comment I could make was, ‘If we implement it that way, then we will have failed.”
After the show, my friend, colleague and coauthor Carol Colman asked me to expound upon what I had meant.
The question was a timely one. Lately, I’ve been thinking more about how to move the needle on physician adoption, and came up with a framework for general discussion. This is a topic of concern and of great interest.
As I often do, I turned to non-health care services to look at the integration of digital tools into previously analog service offerings. I can think of three types of resulting consumer experiences.
The first is what I’ll call complete replacement of analog with digital. One easy example is the ubiquitous phone tree you get when you call an organization for customer support or problem-solving. These days, everyone wants you to solve your problems online, often with FAQs and chatbots first, then with an email. This makes human contact difficult, especially when the question you have can’t be plugged into this phone tree formula. For example, I recently forgot to renew my driver’s license before it expired. Although the Registry of Motor Vehicles was closed on Saturday, there was another company that could perform the renewal. I could not use their online option, because a new photo was required. So I called and went through about 10 minutes of the dreaded phone tree but could still not find someone to answer my questions about renewing an expired license. Exasperated, I got in the car and drove there. This is exactly the kind of experience the doctor who called into the radio show was worried about. Unfortunately, it is a very common one. As stewards of the implementation of connected health, we must do everything we can to avoid this experience for our patients.
By contrast, we now have several examples of optimized integration of digital and analog services. One of my colleagues had a recent experience with the online retailer Amazon that required changing an order. He was effusive in his praise for Amazon. Not only did he get to a person right away, the service representative knew him, his profile and his order history. His problem was resolved quickly and effortlessly. It may not be surprising that a company like Amazon, built on the idea of making it easy to do business on a new platform, is the model example here. Starbucks and Uber, like many other companies, also design their mobile apps to enhance our experience of what is ultimately an analog interaction. My doctor caller may not have had this type of experience, or perhaps he had yet to realize we could indeed provide health care this way.
There is also a middle of the road, which is increasingly common in today’s health care delivery model. I’ll call it side by side execution of both analog and digital. The best example is the current buzz around virtual visits. The offerings include video communication with an individual (patient/consumer) and, on occasion, a more email-like communication. When thoughtfully implemented, this type of service can increase both access and convenience for patients. Although it is possible, the overall care delivery experience (including virtual and the face-to-face interactions) may be a bit more efficient than our purely face-to-face process, most experts agree there is little gain. It really is an extension of the usual way we do business into the digital realm. The analogy would be if Uber was simply a way of speed-dialing your cab company. I want to underscore that virtual visits are an important advance, but we should think of this as only the beginning.
For years at Partners HealthCare, we’ve been remotely monitoring patients with congestive heart failure, using a combination of vital signs, patient-reported symptoms (the digital component) and a nurse call center run through Partners HealthCare at Home (analog component). These features work very synergistically. Our patients report feeling more cared for and more reassured than they did prior to being on this program. Interestingly, their comments belie how important the nursing component is. “They call me before I get short of breath,” and “I can’t cheat on my diet because my nurse knows right away,” are phrases commonly heard from patients.
These patients receive very efficient care. One nurse can oversee 100 or so patients at a time. Hospital readmissions are down, and there is an improvement in mortality and lower total medical expenses in the monitored cohort. This is an example of successful integration of digital and analog. We still have improvements to make, so I can’t say ‘optimized,’ but it is an early success story.
Can we move health care into the realm where we optimize for the integration of digital and analog experiences? I think we can. We have a ways to go, and health care delivery is slow to change.
I appreciated my caller’s concern. When connected health is correctly implemented, digital tools will not stand in the way of the doctor-patient relationship, but will strengthen and support it. Are you seeing evidence of that?
Joseph Kvedar is director, Center for Connected Health, Partners HealthCare. He blogs at the cHealth Blog and is the author of the Internet of Healthy Things.
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