Way back in 2014, the world faced a milestone—of sorts. It certainly said something about how far we had come in our technological lives. A man in Taiwan filed for divorce from his wife, claiming her smartphone addiction as the cause. I doubt it was the first time technology and relationships clashed in exactly that way, but it got the media’s attention around the world. It also happens to offer some lessons for technology and healthcare.
Feelings of neglect. Misinterpreted cues. Inappropriate expectations. Discomfort with face-to-face interactions. Lower empathy. And the ever-present danger of typos and autocorrect. (I once texted my attorney, “Let’s talk at boob.” Oops: *noon). Social scientists have been trying to understand and quantify “technoference” in relationships for years. The data is stacking up—against tech.
What researchers know definitively—from studies like this one and this one—is that our human needs are not well met by inhuman circuits. The spirit-lifting power of an emoji is a lot less potent than a sympathetic gaze, a genuine smile, or a hand held. At this point, I feel we all know this, even if we are not always great at practicing it.
So why is it that in medicine, where our human needs are greater than just about anywhere else, we pay less attention to these lessons?
Technology has been heavily influencing the course of healthcare for the last 50 years, and that’s a good thing. New and better imaging, medical devices, and diagnostic abilities have saved millions, perhaps billions of lives. But every year, a higher percentage of investment is going to healthcare IT, wearables, apps, data security, and Even Bigger Data collection and analysis.
A lot of people are putting a lot of faith in technology to get us out of the messes we’re in. I have felt conflicted, though, when I’ve tried to answer questions about the role it will play. I too see the amazing potential. As it is currently being used and developed, though, I do not believe it will help us solve some of the biggest challenges we face. Inspired by a visit to the Sherlock Holmes museum, I decided to follow the clues in my own experiences and in what I was hearing from practice professionals and providers to come up with an answer. Here’s where those clues led me:
Until technology becomes a tool that helps people
on the front lines of medicine build better relationships,
it won’t be the solution we need.
In Back to Balance, I explored why stronger, more trusting relationships are the key to achieving our big goals in health care. (Dhruv Khullar, physician and researcher at the Weill Cornell Department of Healthcare Policy and Research, wrote a great summary of the research that supports the importance of trust.) They are the key to better outcomes, greater collaboration, reduced costs, and better population health. They are the key to fulfilling our very human needs to care and be cared for, to heal and be healed—and when our human needs are met, we feel greater satisfaction all around.
What clues should we be looking for as we continue to innovate in technology and healthcare? Here are three that should guide us.
Good Relationships Require Time
First, the good news. In a Physician’s Foundation survey of patients in 2017, 64 percent of responders said they were very satisfied with their relationship with their primary care doctor. Now, the not so good news. Only 11 percent thought doctors have the time they need to provide the highest quality care. And only 14 percent of doctors feel that way.
Good relationship building is all about time spent focused on each other. (Just watch Will Ferrell’s hilarious device-free dinner PSA if you need a reminder.) Doctors spend less than a third of their time face to face with patients, though. They spend about 50 percent of it face to face with a screen. How does that help them put patients at ease, listen attentively, extract the full story, and build trust?
People who work in practices are equally overwhelmed. They want to meet patient needs, but they spend incredible time and resources inputting or extracting data, fielding requests for data they can’t easily share, trying to avoid violating HIPAA regulations, and so on.
If you want to know what problem to solve immediately to change the course of health care in America, here it is: create more time for relationships.
We’re getting closer to true interoperability every day, but we need to take a serious look at claims and billing, data gathering and reporting, and other intense burdens and use technology to eliminate them.
Good Relationships Require Connection
Absence may make the heart grow fonder, but long-term absence makes the heart forget. (Everybody knows long-distance relationships just don’t work.) In our new world of health care, where chronic conditions account for a massive percentage of doctor visits, hospital admissions, prescriptions, and costs, forgetting could be damaging or deadly.
Staying connected with patients with chronic conditions is challenging even when cost and distance aren’t creating barriers. But providers need regular insight into lifestyle, behaviors, medicine habits, and lab results to prevent escalations. In every community, practices have to figure out a way to be present in patients’ lives—wherever they’re living them.
When technology helps create easy connections between patients and practices, it can build relationships that help us better treat chronic conditions—and save lives.
Sanford Health provides care for roughly 2 million people across more than 300,000 square miles in North and South Dakota. The group uses telemedicine to help people get follow-up visits without driving 2 hours. Psychiatrists are using apps to help monitor outpatients’ moods day by day. The Aledade network, from Farzad Mostashari, the former National Coordinator for Health IT, is alerting doctors when their patients check into ERs so that their docs can call them and find out what’s happening. Slowly, providers are prescribing wearables to follow the daily health of vulnerable patients, according to an MGMA poll.
I am all for technology that creates better, more consistent connection between practices and patients.
Good Relationships Require a Power Balance
Virginia Mason and others in health care have used a few good questions to bring the art (relationship building), science, and business of medicine into balance. Innovators should pay particular attention to this one: How can we give the right people control? Too often, outside of wearables and wellness apps, technology development is all about the needs of regulators, payers, vendors, practice staff, providers, and patients, in that order.
Provider morale and patient engagement are buzzwords until you’re actually empowering people—a huge opportunity in technology and healthcare.
The Heal app is a good example. It is a cross between new-school telemedicine and old-school house calls. Open the app and request a doctor at your door. Patients are empowered to get the care they need when and where they want it. They also get convenience and time spent with a doctor rather than in a waiting room. And at $99, they spend a lot less, too.
It may seem like an odd example; some claim on-demand care can hurt relationships. I believe this kind of empowerment will help, though. First, it allows patients and primary care providers to focus on bigger picture, long-term health needs. Second, when patients feel more empowered in and satisfied with their health care experience overall, their engagement increases. More engaged partners in health care means more problems solved.
Rasu Shrestha, chief innovation officer for University of Pittsburgh Medical Center, shared his principles for the new world of technology and healthcare innovation at an AngelMD conference. Number 1 was “Design for empowerment.” I almost shouted, “Amen.” (Instead, I tweeted a photo of his slide.) But let’s make sure we’re taking an expansive view of empowerment. Let’s give providers and patients control of the things they want to control most.
The Game Is Afoot
Many of our most promising new tools are not improving our relationships. I believe we can turn the trend around, though, with the best kind of innovation. Because of decades of funding, regulatory pushes, and innovation, technology has established a foothold in every aspect of healthcare. And that’s a huge opportunity. So let’s make 2018 the year of the relationship in health tech. Because the game is afoot, and we need to reach the best solutions.