Put technology in it's proper place

What do I expect from my healthcare providers?  Simple, I want them to use their skills at diagnosing and treating to fix me when I am unwell.  Will technology enable them to do that job better?  That is a complicated question. 

Let’s take a look at diagnosing.  A diagnosis is a ultimately a decision about what is causing a person to be unwell and that decision informs the treatment.  A recent study by Paley, examined the accuracy of diagnoses in an emergency department.  Residents were correct in their diagnosis 80.1% of the time, and senior physicians were right 84.4%.  Inversely 2 people out of 10 were misdiagnosed.  The study went on to validate the contributing factors to a successful diagnosis and confirmed that classic diagnostic tools such as reviewing patient history, physical exams and lab tests are critical.  It was identified that older clinicians rely on the history and physical to a greater degree than younger clinicians.  As a result, many recent graduates can only make cardiac diagnoses by echocardiography, relying more on technology for their decision making. 

This study reminded me of the discussions that emerged following Captain Sullenberger’s successful landing of Flight 1549 into the Hudson River.  The experts identified the primary reason for the successful ditching was the decision making of the flight crew members during the accident.  Captain Sullenberger’s years of experience with multiple aviation systems, including low tech gliders, directly influenced his decision making ability. 

I found it interesting that Captain Sullenberger, a safety expert was a proponent of building a balanced environment of learning and accountability to enhance safety and he even had a copy of A Just Culture in the cockpit.  A Just Culture is an environment where learning and accountability are fairly and constructively balanced and is critical for the creation of a safety culture. Without reporting of failures and problems, without openness and information sharing, a safety culture cannot flourish. 

Technology can be an important enabler to a just culture but it is only one part of a learning environment.  Technology provides skilled practitioners with a tool to do their job more accurately and faster, it does not replace the interpersonal skills and human judgement required to effectively diagnose and treat patients. 

A recent New York Times article The Face of Future Health Care  speaks to the role of technology in helping healthcare providers track patient care.  When Dr. Jennifer Slovis recently saw a patient, she was able to spot that the patient had an abnormal blood test several years ago. By reading through the patient’s medical history, she determined he was now overdue for an M.R.I. to check the status of a growth in his brain. She was able to e-mail his endocrinologist and schedule the necessary tests without the patient having to make an appointment with the specialist or her having to make her own diagnosis. “It saved a lot of starting over,” she said.

In measuring the value of technology in healthcare we need to focus on the practical 

applications not the hype. 

Forbes Magazine reported on the President’s Council of Advisors on Science and Technology who have concluded that “the impact of IT on health care over the past decade has so far been modest.” But, don’t underestimate what’s coming. It is nothing short of an explosion in innovation and creativity, facilitated by open systems and connectivity.  Here is where the real value lies.  Technology allows for a connected system that will help patients take responsibility for their health. Strong teams of physicians, nurses and caregivers will use an intelligent network to make their results better and their jobs easier. 

Sorry Watson, while we anxiously await your contributions to healthcare, you can’t replace the decision making skills of our healthcare professionals that are honed in a continuous learning environment. After all, your decision-making algorithms are informed by those of learned professionals and that learning, is constantly evolving.  Let’s all take a moment and think about the role of technology and how it can be used to build a just culture that encourages learning and rewards accountability in healthcare. 

I want technology to support my healthcare provider’s decisions, not the other way around.  After all, if my health stopped functioning and I needed an emergency landing, I’d put my trust in a medical version of Captain Sully any day of the week to guide me to safety. 

It’s your health.  It’s your health information.  Manage it well.  

How to fix healthcare? Start with carrots for consumers!

This week the Harvard Business Review took a stab at redefining the healthcare business model in What is the Business of Healthcare?   It was suggested the focus should be on health rather than healthcare, an honourable ideal.  Far be it for a simple goat to butt heads with HBR but I’m going out on a limb (goats actually can climb trees – google it) and take issue with this seminal magazine and its lofty school of higher learning.  The challenge with HBRs concept is, there isn’t any profit to be made in ‘health’ and healthcare in the US makes up 17.6% of GDP at a cost of $8,233 per person per year (highest per capita cost in the world). 

The problem is, if people don’t get ill, the economy will and that is simply messed up. 

Too much of our economy is built on profits derived from an ill population and not enough is built on profiting from a healthy population.  And, since money is in the driver’s seat, we won’t see significant change until consumers change their spending habits. 

North America has created the gold standard for a business model that profits from illness.  We have a society with relatively high longevity rates for a population as unhealthy as it is which means people are living a long time with chronic illnesses.  The North American food and transportation industries create products that negatively impact health and market them as lifestyle necessities.  Consumers adopt these unhealthy consumption behaviours and inevitably develop risk factors that lead to chronic illnesses such as diabetes and cardiovascular disease.  The healthcare industry then steps in to manage illnesses at great cost while continually improving interventions that allow citizens to live longer with their illnesses.  It’s insane.  Incentives are continually thrown in the wrong direction.

Why do we as consumers put up with it?  We have the power to change this unhealthy cycle with our purchasing power and lifestyle decisions.  But we need help; we need a little carrot to incent us in the right direction. 

 

In a recent article Patients need pay for performance too, Matt Patterson, makes the sensible case for incenting the consumer to achieve positive health goals.  “We need to build models that show patients the impact of making good health decisions now.”  Governments have spent years and millions on incenting healthcare professionals and institutions to create efficiencies and what we have to show for it is staggering growth in healthcare costs and record rates of poor health outcomes.  The reality is consumers have to participate in creating the change needed … so why have we not provided incentives to them? 

This is not rocket science, its common sense.  First, start at the source, we know that there are a handful of risk factors that increase our chances of developing a chronic disease and they are ALL avoidable and they are all measurable.  If we all maintained the following behaviours we would save the healthcare system billions:

• Consume a healthy diet of whole foods
• Participate in daily physical activity
• Reduce or quit tobacco use
• Moderate alcohol consumption
• Maintain a healthy weight

How do we incent people to adopt these behaviours?  Start by encouraging individuals to measure their behaviours in order to track participation and allow a reward based system.  We have to start somewhere and the early adopters are providing an environment to test an incentive program. 

The timing couldn’t be better for consumer engagement and incentives.  The digital/mobile health industry is rapidly growing with an estimated 1.7 Billion to download health apps by 2017  (that’s a lot of people tracking health indicators and governments didn’t have to spend a dime).  Why can’t we encourage more of that, why can’t we offer individuals incentives to meet their healthy lifestyle goals and maintain them.  Let’s encourage people to consume health products, and avoid consuming healthcare and let’s reward those choices.    

Wouldn’t it be great if a portion of the GDP currently spent on healthcare was spent instead on healthy food and active transportation?  Or what about a realignment of personal consumption from those unhealthy options (tobacco, processed food, alcohol) into healthy options (fresh foods, active transportation, fitness activities and even mobile devices to monitor our health behaviours).  We can succeed if we shift even a small portion of our economy to benefit from a healthy population rather than an ill population?    Let’s start with carrots.

It’s your health.  It’s your health information.  Manage it well. 

They are Women, hear them Roar!

Wednesday March 8^th is International Women’s Day. 

In celebration of the enormous contributions that women around the world are making to science and technology I bring you my favourite female contributors to the empowered healthcare consumer dialogue.  These are just a few of the female voices that the Fainting Goat follows and there are  many more inspiring, teaching, living and learning how to improve health through technology that I have yet to encounter.    I salute you, learn from you, seek inspiration from you and follow you (in a twitter way).  You are journalists, physicians, policy wonks, politicians, industry leaders, patient voices, students of healthcare, advocates for social justice, technologists, bloggers, developers and entrepreneurs.  You are also mothers, daughters, sisters and friends.   Happy International Women’s Day, may your efforts and voices stay strong for years to come.

Esther Dyson – Self-proclaimed “Internet Court Jester” – I first heard her speak recently at a broadcast of an Economist interview with Dyson and Dr. Daniel Kraft about Healthcare in 2013 and I was drawn to her refreshing voice and have been following her ever since @edyson on Twitter.   Esther Dyson is an achiever; she is an active angel investor in a variety of start-ups, for-profit and otherwise, around the world.  And, she seems to be having fun with just about everything she does.  I love that she has already published her epitaph on her business website EDventure “I wasn't done yet! There is still more to learn and to fix.”  Oh, and she has written a book (on my to-read list) Release 2.0 A Design for Living in the Digital Age.   

Regina Holliday – artist, advocate and brilliant visionary. What an incredible person, such an inspiration. Here is a link to  Regina Holliday's Medical Advocacy Blog.  If you haven’t heard of Regina, please do yourself a favour and read her blog then follow her on twitter @ReginaHolliday.  Regina is the brainchild behind The Walking Gallery (I hesitate to summarize this project for fear of not doing her work justice).  She creates beautiful works of art that represent the patient experience in healthcare or an aspect of ‘The System’ that would benefit from discussion and she reproduces them on the backs of business jackets and gives them to notable attendees at medical conferences.  The jackets stimulate discussion and beautifully illustrate how difficult it is to turn your back on the patient when their voice is always present.  Her personal story is vividly described in her blog and depicted in her own jacket, I leave that with you to experience. 

Jessie Gruman - author, epatient (4 time cancer survivor) and founder of the Centre for Advancing Health.  The Institute provides pragmatic resources to encourage all consumers to be a Prepared Patient.  She has authored a few books, check out After Shock.  What to do When the Doctor Gives You a Devastating Diagnosis.  Jessie tweets @jessiegruman and is a knowledgeable voice bridging the personal experience with her extensive understanding of healthcare and policy. 

Michelle Petersen – journalist and champion of innovation of health in pharma.  Michelle is founder of Health Innovations – A Platform to Enable All Sectors Within the Health Industry.  She is a prolific tweeter and brings a wealth of information on clinical trials and news from the pharmaceutical side of the industry.  Her blog is Health Innovations.  Follow her on twitter @shelleypetersen.   

Dr. Leslie Saxon – Lelsie works in the coolest place, the USC Centre for Body Computing – The CBC (not the Canadian Broadcasting Corporation) believes that technology solutions are not the problem (or the drivers of our terrific and ever rising health care costs), they are the solutions, and they represent the very best achievements in modern society.  The CBC is an innovation incubation center that commercializes wireless health products that will transcend policy and politics in the future.  She gave a great Ted Talk in 2010 on the need for technology in healthcare and provides a plain-speak explanation of why we shouldn't put patients in ‘information purgatory’.  Leslie is working in this rapidly emerging environment and her tweets highlight how quickly technology is driving the future of healthcare.  Follow her @DrLeslieSaxon. 

Jane Sarasohn-Kahn  - Healthy thinker – Jane is a health economist who works at the intersection of health and technology (my favourite corner).  In her most recent blog The future of sensors in health care – passive, designed, integrated, she explores how sensors will help consumers monitor and manage their health conditions.  Love the infographic too.  You can follow Jane @healthythinker or check out her website Health Populi . 

As my final shout-out in honour of International Women’s Day, I would like recognize the recently launched project, Chime for Change.   Despite the glossy celebrity endorsements, I’m optimistic that some awareness and good work may emerge from the effort.  The six women that I've highlighted are all North American women (Esther is Swiss born but a native of NYC now) a fact that does not escape me and I believe highlights the global aspect of gender inequality in science and technology.  We are so fortunate to live in a time and space where the contributions of women in science and technology are celebrated and their voices are heard, but not all women and girls have the same opportunities.  View the video, and if you see value in the effort, give them a follow @chimeforchange.  

As Hillary Clinton said  “It is past time for women to take their rightful place, side by side with men, in the rooms where the fates of peoples, where their children's and grandchildren's fates, are decided.”

It’s your health.  It’s your health information.  Manage it well.