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.