For all our collective, breathless enthusiasm toward a technology-driven revolution in healthcare, it seems we are at risk for letting digital possibilities run away with us without solving more analog problems. Chief among them: How we communicate in and around clinical settings.
The preventative care technology market is anticipated to reach more than $432 billion over the next eight years. What does that mean?
More tools, more toys, more devices, digitization and augmenting.
The biggest boosters to this market are on the cutting edge of connected care, which utilizes mobile communications, wearables, and telehealth systems to link patients with their doctors and systems well beyond the clinical environment. This mobility, in turn, operates through digital Health Information Exchanges (HIE), anchored to electronic health records, connecting both patients and providers with more data, more of the time, so both are able to make better decisions, understand health and care issues, and communicate more readily. Of course, this data is leading us toward healthcare personalization, which takes all of the above and layers it with genomic testing, custom metrics, and individualized treatment plans and even medications and devices.
We are offloading much documentation, analysis, and even record-sharing to increasingly “smart” devices, without pausing long enough to assess how we communicate with said devices, the information they provide, or with one another. Sure, we could use the information we generate to facilitate better patient engagement and clinical communication, but the success of the technology does not inherently depend on us doing so.
Is “disruption” enough?
Leaps forward in what technology promises to deliver—soon, always very soon—are leading toward its integration in clinical systems today, as the tech proves itself. In a sense, “high technology” in the medical sector has become linked to the idea of disruption: shaking up systems and expectations with bold claims of potential. Anything that can be labeled a “disruptive” innovation in healthcare is driven by rounds of financing and marketed to patients and health systems alike as the sine qua non of next-generation preventative care technology. Yet, the systemic status quo seems invulnerable to disruption by technology.
Recent history has shown that it is a lot sexier for investors to throw money at “disruption” because that is Silicon Valley’s brand. Disruption was the core selling point for Theranos and its blood-testing technology, both of which have become more cautionary tale than a catalyst for a revolution. The inflection point for massive change brought about by high technology doesn’t seem to put much stock in broader, less ostentatious ways to bolster preventative care.
For example, hospitalized patients need to sleep but seldom do. So too, for that matter, do hospital staff, like doctors and nurses. Our training system can’t seem to balance respect for the natural, healthy limits of human endurance with care coordination. So, we face an artificial trade-off: Sufficient breaks and shorter shifts, or continuity of care without the risk of handoffs compromising continuity of care.
Care coordination, it turns out, has some role to play in the sleep—or lack thereof—that patients get in the hospital. The better we coordinate handoffs and care teams, the better off patients and providers alike will be.
Is this systemic weakness ripe for technological disruption, or might we improve handoffs, coordination, and accommodate caregivers’ need for sleep, with more low-tech reforms?
High tech doesn’t replace basic communication
One thing that no amount or fashion of technology seems apt to replace is the need for basic communication. At the heart of care coordination is communication. Underlying the need for HIEs and any utilization of patient-generated data is communication. Impeding the advance of EHR interoperability and improvements to user experience is a lack of communication. Even Theranos managed to dig its own grave, in part because of the opacity it preserved over every element of its devices and operations; it had, in essence, a failure to communicate.
Perhaps new high-tech innovations can enhance our ability to communicate or influence our habits of communication. What it cannot do is substitute for a will to engage. Among caregivers, with patients, with IT staff, with administrators—communication starts with the individual, not the system. The system operates on the strength of the engagement between and among the people it comprises, not the tools and resources they utilize.
Whether we want to disrupt the system, address its weakness piecemeal, or take advantage of the latest and greatest devices, everything has to build on a foundation of engagement, of solid communication skills. High technology may thrill us from time to time with promises, but it is the low technology of interpersonal connections, of speaking, listening, and sharing, that keeps us all going.
The system resists disruption; it is up to us—as early adopters, innovators, leaders, and users—to make room for new tech. By the same token, the system does not oblige us to coordinate more, communicate better, or keep humanistic considerations front and center. It is up to us to design systemic incentives to do that. Embracing the high tech as well as the old-fashioned comes to the same thing. The choice is ours to make, every day.