In some cases, let the machines take over
A doctor’s prescription for integrating digital tools into healthcare
IN MY FIELD, the lost art of listening is vital to greater learning and understanding. As a doctor, I’ve spent more than two decades listening closely to better understand when technology can be used most successfully to advance patient care.
I recently heard from a physician who emphatically asserted that new technologies hinder the doctor-patient relationship. I knew immediately he’d articulated a deep-seated fear of many doctors. My response was simply: if we design them that way then we will have failed. What did I mean by that?
As physicians, our everyday experience with technology includes typing into electronic medical records that are difficult to navigate. This convoluted documentation effort takes away from personal patient contact. Both patients and doctors are complaining loudly. Only to accentuate the fears of technology, we read about studies such as one published earlier this year in Nature where a computer algorithm was trained to diagnose skin cancer just as well as a dermatologist. This finding sent shock waves through the dermatology community. We’ve not yet recovered.
But before we surrender our healthcare interactions to Amazon’s Alexa or one of those automated chat bots you hear when calling tech support, let’s consider how other industries have integrated technology with human service delivery. I can think of three such strategies: when the digital replaces a human; when a new digital channel is opened but still remains disconnected from the human experience; and when digital integration enhances the service experience. I believe that the most compelling path is category 3 and that the others have significant deficiencies.
A company called PS Dept. has a business model that’s a good example of category 2. PS Dept. lets you send a text message directly to a personal shopper who then purchases clothes on your behalf. Nonetheless, the service itself is still very analog in nature.
Similarly, in healthcare we see the emergence of virtual visit offerings from retail pharmacy and health insurers. A patient with limited symptoms can video chat with a doctor from one of these companies who will diagnose, advise, and treat. This is emerging as a parallel, side-by-side universe to the health care you get with your own doctor. There is no real gain in efficiency on the service delivery side and minimal effort, if any, to make sure your doctor shares the record of the visit with the patient’s primary care provider. New research continues to show successful healthcare delivery outcomes can be designed with less patient-physician interaction. For example, we recently developed a mobile app for cancer pain management and found that users had a 40 percent improvement in their pain scores but felt the need to access their doctors less.
Although there are many examples of category 3 in non-healthcare industries, the best one is probably Uber. You receive service from a driver, but the entire wraparound experience involving hailing the ride, paying, etc. is smooth as silk due to digital integration. Retail pharmacies are doing what Uber is doing in the healthcare space. Both CVS and Walgreens have apps that simplify the experience of tracking and refilling your prescriptions, so you’re more likely to come to the store and purchase other higher-margin items. The digital aspect is simply more efficient than a live person.
The future of healthcare delivery is about the people behind machines. For example, when the ATM machine came into widespread use in the early 1970s, the demise of the teller was predicted. But the industry now employs more tellers than before, because the economics of ATMs created demand for the building of even more branches.Technology, when properly employed, allows us to focus intensely on human relationships and matters of complex judgment. As doctors, we need to remember the cornerstones of our profession: emotional intelligence, judgement, and quality so we can use our doctor time to get to the most nuanced aspects of care. We can’t be afraid to let machines take over.
Dr. Joseph Kvedar is the vice president of Connected Health at Partners HealthCare.