By Matt Fisher, General Counsel, Carium
Twitter: @matt_r_fisher
Twitter: @cariumcares
Host of Healthcare de Jure – #HCdeJure
So often, healthcare is about the personal connection established between a patient and a physician, another clinician, or general members of the care team. At least, that is what the ideal scenario may look like, leaving aside the current realities of insufficient time, interferences, and other issues demanding attention. If healthcare should be about personal connection though, how can that be better promoted? Given evolving expectations and considerations about how to create that connection, enabling and implementing a strong combination of the human touch and technology touch is essential.
Human Touch
What is the human touch component of healthcare? It may be slightly different for each person, but the expectation is also very much informed by the historical, glorified picture of healthcare. Specifically, it is a patient and clinician being able to spend a meaningful amount of time together discussing issues, identifying means of addressing, and then pursuing a treatment plan without considering time limitations or economic pressures. It could be a lengthy visit and an ongoing relationship where the clinician knows what is happening in a patient’s life. Arguably, it is the rosy-eyed picture of the old general practitioner who lived in the neighborhood and personally knew everyone.
The old picture of the physician in the neighborhood making rounds or even just a readily available physician in an office has slowly (or maybe quickly) eroded over time. That reality is not necessarily a reflection of why many physicians and other clinicians decided to get into healthcare though. When many are asked, the reason for pursuing medicine was to be able to engage with patients, learn about them, and establish long-term relationships.
As hinted at though, the corporate structure of healthcare changed over time in a direction that prioritized packing in visits and not allowing room to breath within a visit. The potential reasons or explanations for that change are likely numerous, contested, and without one consensus point. Without diving into those debates, the impact has been the reduction of human touch and understanding of what happens beyond the walls of a healthcare facility. The daily experiences of patients cannot be sufficiently pursued or explored. It is not for a want o desire to understand those issues so much as time and insufficient financial support to get into the issues.
Enter Technology
The government driven adoption of electronic medical records (EMR) and explosion of digital health solutions have both been touted as resolving the problems of time, resources, and more. The argument has been that technology can enable broader interactions and engagement. However, that promise has not fully occurred yet. The still early days of EMR use have focused on an increase in screen time and actual or perceived interference with interactions. The argument goes that the need to check off so many boxes within the EMR is not driving better engagement or documentation.
On top of the argument of interference, most EMRs were not designed to broaden the relationship between patients and clinicians or cleanly drive better insights. Instead, the growing perception is that EMRs are more designed to capture and drive claim submission and billing. Systems designed for that purpose are not necessarily ideal when trying to analyze data or extract new meaning.
That is where digital health solutions have entered the picture. New solutions try to layer on top of, below, or in the middle of the EMR, or just substitute and later push data into the EMR. The aim is to create more wholesome tools actually designed and geared to engagement. The solutions range from telehealth enabling virtual care to remote monitoring to mimicry of general non-healthcare consumer experiences.
A significant amount of the hype is that these tools will result in a fully interactive experience and shift the discussion on healthcare. The big push (and arguably the false promise) is that the technology solutions will resolve the engagement problem and create better outcomes for patients. It is not necessarily clear how technology will do that in isolation though.
Arguments that solutions like chatbots or other automated interactions can drive the full change feel misplaced. How can technology by itself address all of the nuances and intricacies of healthcare and the practice of medicine? While it is admittedly impossible for a human individual to know and remember all available information or variables, there is still a lot to be said the connections that can be made during a person to person interaction or just the power of a personal conversation.
Human Touch and Tech Touch
If a combination is needed, then finding how to let technology enable and enhance human interactions is essential. Think about this scenario. A technology based remote monitoring system pulls in daily information from a patient from both connected devices and potentially daily surveys. The patient reported data are then filtered and aggregated through analytics built into a digital platform, which can be customized by a clinician to provide alerts if readings go out of range, if data are not recorded, or any other set of parameters. Further, the technology platform can be used to send reminders or information from the clinician to the patient to encourage certain behaviors.
At the same time, if concerning trends are identified or other concerns arise, the clinician can quickly reach out to engage the patient whether asynchronously, by text, by audio, or by video. The quick intervention can have a significant impact and prevent a small concern from growing into a major issue.
Going the next step, the additional, real-time information can provide new insights into what is happening with the patient. Those insights can drive different questions or perceptions when an interaction between the patient and clinician occurs. For example, the clinician might now know to ask about environmental conditions or living conditions that are impacting the patient. As the clinician learns that information, new avenues for care or support can be identified. Getting more personal facilitates a deeper, more empathetic relationship along with more creative solutions.
The basis for the new interaction is the needed direct engagement between people that is enhanced through the technology.
How to Foster Human Touch and Tech Touch
One of the biggest hurdles to the described intersection of human touch and tech touch is the limitation of fee for service (FFS) reimbursement models. FFS does not pay for the more comprehensive and wholesome interactions that are needed to look at a patient as a whole person. Since FFS is premised on specific services, it does not really have the capacity or capability to reimburse for interactions that may stray beyond traditional healthcare services.
Newer value based care models are arguably better suited to drive the complete engagement that is needed to provide whole person care. It is not clear whether current models fully embrace that capability, but the good news is that value based care is still in its early stages and there is a lot of room to tinker with the models.
Beyond reimbursement, it is also necessary to modify thinking about how healthcare should operate and how to construct care pathways. To some degree, it is reintroducing the much older, very personal model of healthcare, but it should go much beyond just glorifying how things used to be. It is a fundamental challenge to the healthcare industry and beyond. Now, hopefully, all will accept that challenge and work together to produce a system that produces higher quality care with better outcomes.
This article was originally published on The Pulse blog and is republished here with permission.