As digital health expands its presence in our lives, healthcare and IT professionals should be simultaneously enthusiastic and cautious. Advances in healthcare IT have been astonishing. During the pandemic, those remarkable advances allowed healthcare providers to respond quickly in ways we could not have done just a few years ago. We expanded our bed capacities, added new venues, and enabled remote visits at unprecedented rates. Hurrah for the technology professionals who showed an appropriate sense of urgency, demonstrating remarkable agility and flexibility. It is ironic and disappointing, however, that being technologically connected has not necessarily improved person-to-person interactions.
Tweeting, texting, and email were the beginning of social distancing, and not just in healthcare. To counter this trend, the architects of digital health systems need to focus on meaningful communications between patients and providers. Our systems of connecting and communicating need to preserve and promote our humanity, to create opportunities to empathize and understand one another. Empathy and understanding are the keys to providing human-oriented care, not just disease or condition-oriented care.
I’ve had personal experience with some of the new digital processes. In January 2020, COVID-19 was emerging in Westchester, NY where I was working. On return to my home in Austin, I developed the typical COVID-19 symptoms of high fever and had difficulty breathing accompanied by a wicked cough. My wife was concerned I might be an early presumptive COVID-19 patient. Fortunately, at 6:00 p.m. on the Friday before Martin Luther King’s birthday holiday, my wife was able get online and via Google and find a 24×7 urgent care medical facility, log in to their website, get me an appointment for 6:30 p.m.
After examining me at the facility, the provider suspected pneumonia, but was unable to confirm or rule out the diagnosis because their on-site x-ray machine was broken. The provider made a phone call on my behalf and sent me home to wait until 8:15 p.m. for an x-ray technician. Just before 8:15, the x-ray technician rolled a 50-pound portable device into our living room where I had 2 chest x-rays. By 8:35, the images were transmitted wirelessly to a physician who was able to interpret the results, then send necessary medication orders to the nearest 24-hour pharmacy so I could begin treatment immediately. It was a great transactional experience.
The human interaction after the visit, however, was limited to a quick follow-up call to check on my fever and coughing. The call itself was an implicit expression of concern, but the caller never explicitly asked me about my emotional status or expressed concern about me as a person. Nor did she ask about my family’s sense of well-being. Fortunately for me, my beloved wife is a nurse where I got more than my fair share of empathy, compassion, and support. The digital health experience was great from a technology perspective but lacking in attention to my mental state and sense of well-being.
Most providers have little time and few reminders to focus on a patient’s sense of well-being and aspirations when they are trying to alleviate the immediate issues of pain and suffering. The increasing demand for services, the tyranny of urgent and emergent care, and the increasing burden of documentation all combine to mean less time with the patient and family, less time to explore and focus on their high touch needs. The documentation requirements often force a provider to look at a screen instead of the patient. There are some relatively simple solutions – repositioning the screen, stopping every few questions to face the patient, modifying the assessment and planning scripts to ask questions about sense of well-being and aspirations, using voice entry in lieu of keyboards, and employing scribes.
There are other general approaches that will work. Expand the notion of user-centered design to include actual patients who have been treated at your facilities. When you’re authoring your digitally enabled pathways, use patients in the design session discussions. With their participation, test your pathways to ensure the patient feels understood. Add aspirational questions to your assessments. Modify the computer “scripts” to remind providers to take time to look away from their screens and into the eyes of the patient. Many providers already do post-visit follow ups. Add questions to the scripts that test the patient and family for comprehension. Ask questions about their overall well-being.
Healthcare, as the words health and care imply, is not about consuming – it’s about restoring a patient’s health by providing the best care. Best care is based on empathy and understanding. My plea to architects and the people who deploy digital health services is to focus on the high-touch aspects of care. Use digital health to promote empathy and understanding, to optimize the care experience, to unite us, to improve the human condition one person at a time.
This blog is the 4th in a series. The first three are:
- Digital Health – Is Healthcare Ready? Are You and Your Organization Ready?
- Becoming a Digital Health System
- Digital Health – Governance in a Digital Health System