Sunday, 24 February 2013

Digital Health - Has the Doctor-Patient Relationship Become a Doctor-Patient-Digital Technology Relationship

Using digital technology to complement health care has certainly become a hot topic for 2013. It comes with the change in health challenges going from infections and acute problems to having to deal with chronic illnesses like diabetes, heart disease and depression, even in the developing world. And that shift to having to deal with long term problems puts new reliance on a longer term relationship between patients/consumers and their health care team. At the same time, because health care has become a large expense for countries and individuals, there is a lot of pressure on health services to be more efficient, cutting down the time they can spend with a patient. Many health care services are trying to make up for that lost or sacrificed time by trying to find technology that can replace the relative vacuum.

But what does that mean for the relationship?

The term "patient engagement" has also become a hot topic. But it's not about marketing. It's about having a person feel sufficiently engaged with the service they are receiving so as to try and work with the health team to improve health or reduce risk. They talk about the "medical home" where there is a long-term relationship with a health team, and at the same time there is a strong push to come up with mobile technology and on-line programs that can make looking after your health more affordable and more accessible, even while it is more remote and not quite part of a "medical home". 

So the health industry is borrowing from marketing and talking about "patient engagement" and "gamification" - getting patients involved in their health care by thinking about ways that computer games engage their users, or non-health products attract a customer and keep them interested. It's not the golden arches, but it's taking something that has been part of the consumer market for decades, but not necessarily part of health care. However the challenges do not necessarily lie in convincing the practitioner to want to talk more to their patients or to want to be more directly involved in the day to day management and care of a patient in their care. It's a real problem: how do you automate compassion or empathy? How can technology recognise when someone isn't paying attention and missing out on better health outcomes? How does technology imitate intimacy and build trust?

There are a number of challenges involved in patient engagement in health care, but many of these are being faced when it comes to engagement in a lot of other industries today. There are some enlightened folk who seem to think there are no alternatives other than try to understand how we can replace, replicate, simulate or in some way fill the gap left when technology becomes the solution and personal contact, compassion, empathy, responsiveness, intimacy and trust can't be as heavily relied upon to build the doctor-patient relationship.

We know that the world has become hectic, and people are bombarded with thousands of communications a day in all sorts of attempts to engage them and to encourage them to act. These messages are primarily marketing messages, but in today's world where e-health and m-health are playing roles in health care, for a practitioner to engage their patient they have to compete with all of this "noise" just to get a patient to have a conversation, or to read an email.

It's not easy.

Add to that the fact that studies in behavioural economics (such as this one by Dan Ariely) have shown us that people instinctively are less inclined to act based on a long-term benefit than on a short-term benefit and you POTENTIALLY run into a wall.

Health, when we look after ourselves, is a VERY long-term benefit. Throughout our lives we've all performed that morbidity equation in our minds. "Well... I know it's not good for me... but it feels good now, and it only costs me years at the end of my life... and who wants to be old anyway?"

Today we struggle with the reality that patient motivation, looking not at taking some pills for the next couple of weeks but looking at decades distant horizons, is harder to achieve, that long-term patient compliance is harder still, and that most of the health industry has not yet learnt how to build long-term patient engagement in a digitally enhanced environment.

I'm not a health "insider", but since my first engagement in the health information space almost a decade ago, experience has shown me there are many companies who have fantastic SEEMINGLY customer-centric solutions which provide real benefits to their customers BUT struggle to build what marketers call "engagement" and the result is that they fail to “help the customer help themselves”

Whether we want to use a term more palatable to healthcare practitioners like "doctor-patient relationship" or whether we are prepared to accept that the body of literature and science on "engagement" is far broader and probably going to be more useful than that on doctor-patient relationships, better understanding engagement will be at the heart of the success of many healthcare technologies and innovations such as EHR. Our goal as healthcare innovators must be to understand how this understanding can help us engage patients and, really importantly, keep them engaged in the long run.

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