Healthcare has a change problem, or a drinking problem depending on whom you ask. On the one hand, well-intentioned health leaders are drinking from the wrong end of the Kool-Aid filled waterfall, stuck on the old medical model of provider-centered healthcare delivery. On the other hand, patients themselves are creating change by demanding more control, higher quality, and more access to their medical decisions—but not without potential ramifications. Meanwhile, advances in digital health innovation are disrupting the market for everyone. So while healthcare organizations and providers alike have embraced the upheaval in electronic records taking place, another seismic shift—one of epic digital proportions—is poised to push them aside as patients move from passive recipients to active consumers and central decision makers in their own care. This shift toward consumer healthcare could make patient engagement the blockbuster drug of the century—tested and proven, without needing FDA approval.
Patient engagement will fail, however, without old-fashioned communication skills like listening, and without innovation that allows for seamless collaboration. And unless providers recognize the democratization taking place, and until they evolve, they will become extinct as patients will just walk away. They’ll find their medicine online or from their smartphone, the same way they find music, movies, and shopping. Convenience and empowerment, especially among a younger generation, will lead patients to turn to tools like mobile health and telemedicine, bypassing providers altogether. But patients are not providers and providers will never be physically replaced—there will always be value in face-to-face interaction and physical examination.
Calibrating healthcare’s compass
“Nothing is permanent except change,” Heraclitus said, and today’s healthcare delivery model can evolve as fast as technology and organizations allow. That’s what our patients expect. But we’re holding them back—we’re holding ourselves back.
The provider-centric, hospital based model is dead, and patient-centered care is no longer good enough, which is why a shift to person-centered care is imminent to prevent healthcare from losing its moral (and fiscal) compass any further than it already has. Person-centered care means taking a holistic approach to support the individual’s lifelong health. It means empowering them through partnership, knowledge, wellness, and involvement of caregivers and family members. It means thinking of them as consumers, rather than what we once natively referred to as patients, and providing them with personalized healthcare delivery that suits them and their unique set of needs.
Tech-savvy innovators are ready to shift the needle in that direction. And smart organizations will recognize the value in focusing on the patient, with the right technology, processes, and workflow. This pivotal shift will leave the old guard on life support. The only cure is for healthcare to treat the patient as a highly desired consumer in a crowded, competitive, connected and social market—and utilize health data in a way that allows for more precision and stratification to improve outcomes and lower costs.
If there’s a missed message in healthcare, it’s providers’ and organizations’ ongoing impression that they can avoid change—that they are immune to shift and disruption. Sure, everyone learns their new EHR system when they have too, and upgrades to new platforms as needed, but in healthcare, almost more than any other industry, technological and environmental change is constant. And that’s good news, because change means improvement, and with it, the high-quality outcomes our patients expect. Change isn’t a stigma for our industry, but rather an enabler, and consumers want more of it, more frequently. And they want, and will have, more say in their own healthcare as the industry tide shifts in their favor in the wake of disruption.
Consumers and technology shift expectations
This shift to a new model of healthcare delivery will be defined by patient engagement, just as much as it will be defined by patient empowerment. And it will be driven by convenience as patient consumers set their own appointment times and ask for house calls—not just the traditional ones of yesteryear, but 21st-century ones made possible by real-time and asynchronous video. Why travel to a brick-and-mortar office when you can easily video your symptoms, right from your mobile device, and send it to your provider. In a sense, the balance of power in healthcare itself is shifting, at least in part, to a world in which the patient chooses to see you, as opposed to you, the provider, choosing to see the patient.
And in this person-centered healthcare era, patient consumers expect to have access to their health data and the availability of a full range of mobile health apps in the palm of their hands at all times on their phones or tablets—intermingled and connected by open APIs, set quite literally on FHIR (fire). Which is why the next era of healthcare delivery and technology interoperability should prove to be limitless through an “Internet of Things” type network in which patients, providers, payers, and organizations are all connected and all collaborate toward precise medicine.
Consider that in context: an estimated two billion people use smartphones globally, and if you include all mobile technology, the number swells to about five billion devices in use worldwide. The truth is that anywhere, anytime access already covers our personal and business communications (ever tried taking a vacation without checking your email?). We are defined by connectivity and convenience. Consumer confidence in mobile technology is ballooning, a trend demonstrated by online, mobile, shopping trends. Retail is the fasted growing segment of mobile use as of Q4 2014, leading the charge at 40 percent, which is up from 37 percent in the previous quarter, and from 32 percent in the same quarter last year.
So why should healthcare be any different? We’re already driven by double-digit, and even triple-digit growth in retail healthcare (think CVS MinuteClinic or Walgreens Walk-In Clinic) for the same reasons—quicker access and lower costs. Yet, in healthcare, we’re stuck, dragging our feet with digital and remote health—missing the virtual boat as empowered patient consumers’ steam on by at full throttle. But the level of continuity between patient and provider will be crucial to long-term success of this more ‘convenient’ delivery medicine.
Only nimble organizations will survive in this fast-moving, person-centered world. Desktop EHRs are on their way to obsolescence, soon to be replaced by apps, APIs and workflow tech, in what Eric Topol calls medicine’s democratization (The Patient Will See You Now, 2014). Smartphones and other digital devices will enable patient engagement on an unprecedented scale, converging patient consumers and providers through active care collaboration.
If you think you’ve got time to adapt, think again. Already, innovative companies like American Well (@AmericanWell), MDLive (@MDLIVEInc), and Teladoc (@Teladoc) have given us synchronous telemedicine and the ability to talk to a provider anytime, anywhere—leading forward-thinking institutions to start laying the groundwork for a new age of real-time encounters. Moreover, widely available consumer-grade wearables already monitor heart rate, and while providers may be loathe to utilize limited data from sensors, clearly we are on the way to a more connected healthcare world where we can collect, monitor and share temperature, blood pressure, heart sounds, glucose levels and other information right from our phones. And an emerging technology by way of asynchronous telemedicine, from companies like ReelDX (@ReelDX), means providers can capture and share discharge instructions with patients and their family members via HIPAA compliant video, just as patients can record and send video describing their physical symptoms at their worst prior to arriving for their appointment.
So for the healthcare industry, it’s shift—or get out of the way. Few consumers will go to a physician’s office when they can so easily have a virtual visit, especially millennials who’ve grown up with information at their fingertips. Flexible, nimble organizations, led by a new generation of connected providers who’ve grown up using smartphones, tablets, and other mobile technology, will step in with new medical paradigms based on text, chat, and all-access health data. As this paradigm becomes the new normal, costs will drop in what Topal calls a “bottom-up” transformation that upends the provider-centric model.
What’s old is new again in healthcare
But for all the change, let’s face it: some answers require a look back. That’s right—the old is new again in healthcare. House calls are back, whether they’re in-person or virtual. And since any medical model must consider the whole patient within the context of family, economics and population health, it makes sense that providers will also more resemble the family doctor of the past. Just as that family doctor knew what illnesses threatened the community, providers today have access to see widespread health patterns and are no longer limited by geography. And the new ‘family doctor’ will treat a global patient, as virtual house calls can take place when the patient lives thousands of miles away.
For the trillion-dollar (and growing) healthcare business, patients and third-party payers will demand accountability along with their demand for greater accessibility. The old model of patient billing, with mysterious codes, hidden costs, and no-questions-asked payment, no longer suffices. Patients demand transparency. Payers demand cost-efficiency. And everyone expects better care with improved outcomes at lower costs.
In the end, we must remember what it’s all about—the patient, the consumer. And whether in person or at light-speed, our ability to engage with the patient through old-fashioned communication skills like talking and listening, as well as through new ones like asynchronous video and virtual office visits, will determine our success or failure.
In the end, though, hype is just hype until we as an industry—a cohesive industry—quit daydreaming about change and actually start propelling the delivery of healthcare forward by pulling up our #pinksocks (@SockItToMeInc) and turning #GSD into action. And if you don’t know what that hashtag means, maybe you should give that flavor of Kool-Aid a try.