Bill Bunting

Passionate about innovative healthcare tech that improve patient outcomes. Follow @WTBunting

Patient EngagementMobile technology puts access to nearly everything in the palm of a hand. Whether we’re buying or selling, browsing or tracking, this appetite for anywhere, anytime access defines our time, regardless of age demographic or race. We customize shopping; we customize retail sales; we customize entertainment delivery. Algorithms act as mind readers to deliver content and purchasing suggestions. Even personalized advertising based on our browsing history and social media engagement appears whenever we log in. The Internet knows us, and tailors our clicking experience to our interests and needs, much like our mobile devices themselves do. So why should healthcare be any different? And while the Internet of Things (IoT) or the Internet of Everything (IoE)—or even the more aptly named, ‘Internet of Healthcare Things’—will bring with it a sense of industry disruption, it will be the ‘Internet of Me’ in the midst of empowered consumers that will redefine healthcare delivery and patient engagement with staggering implications.

That shift, toward a highly personal, customizable real-time online experience, must take place in healthcare—albeit, while still maintaining continuity of care—or organizations and providers will find themselves up shift’s creek. Patients accustomed to light-speed searches and access to TV and movies, shopping and communication, want on-demand healthcare that’s personalized and proven (evidence-based), in keeping with the national initiative for precision medicine. Yet as an industry, healthcare lacks the preparation to deliver on these patient demands in a time when patients will no longer see us, but rather providers will come to see them (#PWSYN), as Eric Topol so eloquently puts it.

Patient ParticipationThis Internet-empowered, mobile-driven patient-as-consumer has turned the tables, disrupting the traditional provider relationship, in which the doctor or other provider possessed all the knowledge, offered restricted appointment windows, rarely disclosed complete information, and frankly, at times, failed to incorporate the patient’s concerns and wishes for treatment. That model is gone, replaced by the “Healthcare of Me” powered by active participation and an expectation of connectivity and any time, any place accessibility to care and information—in a way placing the future of medicine in the hands of the patient.

Who is driving this change? Certainly Millennials, with a population of about 80 million, outnumber baby boomers. This diverse population grew up with technology. For them, on-demand is a way of life. But here’s the thing—digital health knows no boundaries, and another large demographic group—baby boomers themselves—are also demanding convenience and accessibility.

Without a Paddle
Healthcare’s ability to keep up with patient demands and deliver improved outcomes at reduced costs rests on its ability to be connected and accessible, and while that shift is taking place all around, healthcare has found itself without a paddle. To catch up, organizations and providers need to start looking forward—and backward—to develop patient care delivery channels that are both technologically advanced and highly personal, while making them more affordable and more efficient. It’s been said many times that when the industry moved bottom-line results front and center, with the accompanying emphasis on codes and billable treatments, healthcare lost its moral compass. Instead of allowing time to listen and document the full circumstances surrounding a patient’s Healthcare Cant Shift Without a Paddlecondition, providers and organizations packed their schedules to satisfy revenue demands. These revenue-centered approaches emerged when smaller practices faced higher expenses and increased competition, yet this process focus put a chill on engagement as patients seemingly lost their voice—and became passive receivers of care instead of active participants. Diagnosis-centered appointments overlooked the complex conditions that created a patient’s healthcare status. Missed opportunities abounded. While focusing on the hypertension, the obesity went untreated; focusing on heart failure, respiratory illness worsened; recurrent ED visits left patients’ underlying problems to worsen. Instead of working with the patient’s constellation of symptoms the industry coded for the appointment and moved on. The results were acute patients with increased morbidity, and higher costs that drove up overall expenses without increasing positive outcomes—and the trend we see today, in which 5 percent of patients account for up to 50 percent of healthcare spending in the U.S., was born.

Back to the Future
The remedy is looking back—and ahead—at the same time. Looking back to healthcare basics, family-doctor style, by listening, engaging, and questioning—and through constant prevention and adherence so that patients stay healthier longer and problems don’t metastasize into chronic conditions. Looking ahead to new models—moving beyond patient-centered care, to person-centered care—there needs to be a re-emphasis on continuity of care and an added focus on not only the patient as a while, but the family as a whole so that an individual’s lifelong health and well-being can be supported through holistic care. We need to start re-delivering healthcare that works, healthcare that is safe and high-quality, and healthcare that, quite simply, leaves no one behind. But it also takes recognizing that healthcare is going to be much more personalized in the future than it has been in the past, as well as more connected, more mobile, and more collaborative. And the adoption of new technologies will be crucial to allowing the industry to redefine the delivery of patient care and improving how we—collectively providers, patients and payers—securely communicate and share information.

Direct Primary CareTo do so, organizations must integrate the patient fully into the larger healthcare landscape, and that means accessible providers, accessible records, and accessible treatments. The family doctor’s ‘black bag’ needs new tools—mobile tools—that are available anywhere, any time. And while some will balk at that thought, it is inevitable that we will move beyond traditional monitors and fixed systems to smartphones and tablets, because the same devices that play music in our everyday lives will soon measure vitals and perform basic point of care labs, such as blood sugar, not to be constrained by a physical provider location. The sophistication of your average smartphone is pushing the industry—however reluctantly—toward mHealth and digital healthcare delivery.

With the ability to securely and compliantly transmit health data, providers, hospitals, and health-affiliated organizations can collect and share a full range of information about patients such as geographic location, travel and activities; vitals and other readings; even proclivity to falls and accidents. In a larger sense, mHealth and digital health can lead to increased adherence, for instance, with medication reminders and follow-up information exchange, and virtual, real-time, or asynchronous discharge instructions, follow-ups, and home checks. Already this trend is under way via a new age of telemedicine and telehealth: a 2014 report estimated 100 million telemedicine visits would take place worldwide in 2015, and 158 million by 2020. Those figures will be up drastically from the approximate 19.7 consultations in 2014. Not only is that care more accessible, but it is less expensive, reducing costs by $5 billion when compared with an in-person office.

The tools are available. And where they have gaps, innovation is running rampant in that space. So why is healthcare up shift’s creek—why are we continually laggards? As long as old ways direct delivery, patients will increasingly get their healthcare from flexible, consumer-driven organizations that place them front and center. Healthcare at present cannot deliver on patient demands for access to care, to records, to follow ups, to prescriptions—that is, access to the convenience that defines today’s connected climate. We’re going to need more transparency, value and rationality to survive. And, along with their empowerment, they’re demanding accountability. Which is why patients will tire of having patience with organizations and providers who remain stuck in old ways, and as Topol would put it, gets at why we are in need of not only an industry transformation, but also a democratization of the now.

Ready or not, technology like smartphones, tablets, sensors, and other portable devices are taking us away from a centralized, location-specific delivery to a system that is decentralized and networked. In healthcare, if technology initially created barriers to engagement, it can—and must—now enable a closer relationship with the patient while extending provider care opportunities and capabilities.

For instance, asynchronous (store and forward) video could increase engagement for families separated by distance. Older patients receiving discharge instructions could share them with family members many miles—or states—away. Likewise, other caregivers, at retirement homes or step-down units, can attend appointments virtually. And the list goes on.

Shifting Patient CareWhile these innovations increase patient engagement and satisfaction, they take us back to the future in a sense, to a time when putting the patient at the center of care wasn’t just a ‘thing’—carrying us forward to the person-centered future, with care provided by a 2.0 era of the family doctor. The benefits accrue in a triple bottom line (or aim) of healthier patients, better outcomes, and increased value for service. This shift is the only way healthcare will get paddling in the right direction. But it will require consolidating data to allow analysis and clinical decision support—integrated without access barriers and optimized for workflows—and it will take sharing information with one another without fear of losing a competitive advantage.

Shifting—Not Just Simply Talking
Therein lies the problem, however. Healthcare’s greatest challenge is getting out of its own way—coming out from the shadow of fear and casting new light on  new methods, new ways, new technologies. No longer can it afford to simply talk about change, but rather it must embrace it. Right or wrong, success or failure—we will never know the outcome if we don’t try. And if we aren’t failing at times when deploying some of the new we all fear, then we aren’t succeeding.

The light is at the end of the tunnel—patients see it, and they are demanding it—we just have to roll the dice and take a chance on being viewed as genius rather than risk becoming extinct. Genius is, after all, ‘knowing what the collective consciousness wants [or needs] 10 minutes before they know they want [or need] it.’ (@HeedYourCall)

That’s where healthcare’s future success will in lie, and we need to be relentlessly seeking the unexpected to drive healthcare forward (@JohnNosta). Just don’t wait until the last episode, like in Seinfeld, to realize that it’s already real, and it’s spectacular—just grab hold and go.

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Bill Bunting

Passionate about innovative healthcare tech that improve patient outcomes. Follow @WTBunting
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  1. Excellent article I liked the Continuity Emphasis

  2. Marc Braman says:

    Yes! Many great thoughts. And yes many of the forces you speak of are true and happening and moving this direction.
    The challenge is that government and vested big business hold the reigns. We can do all the cool technology we want, but until healthcare becomes “of the people, by the people, and for the people” we aren’t going to change the system. A bigger force than those presently in control has to come into being — patients united to change things to what works for us. We need “patient-directed healthcare” (#pdhc). Patients decided what flies and what doesn’t. Patients hiring/firing the system admins. Etc. Why we are launching Would invite you to join the movement. 🙂 We need tech in the center of the process.

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