One of the opportunities presented by healthtech is the chance to significantly change the relationship between the patient and their care ecosystem. We say ecosystem because patients have very different relationships with each care provider (carer, general practitioner, consultant etc.), and those providers also have different motivations and pressures. The result of applying tech will differ in each case.
Furthermore, even though technologies are specifically designed to bring patients and physicians closer together, the result can be the exact opposite. Here’s an example of where it goes wrong. Put simply, one of the key complaints about primary care here in the UK is this: “Why does my doctor never look at me? He’s always too busy looking at the computer!”
Equally, sometimes the claimed ill effects of tech are blown out of proportion. For example, some commentators have noted that forums and communities are leading to highly informed and motivated patients who – embarrassingly – know more than their care providers. Well, this has always happened. A doctor in general practice is by definition a generalist: that’s why we refer up the chain to specialists. And patient representation groups have existed for many years; often in the third sector. Patient power isn’t new; the online world has just oiled the wheels of communication. Most importantly, the professionals welcome it. In a recent phone call, we put the patient/professional question to Roni Zeiger, TedMED speaker and founder of SmartPatients, and he was unequivocal: clinical professionals have an ingrained desire for more knowledge of the lived patient experience, and welcome informed patient interaction with open arms.
What medical professionals do universally suffer, though, is time pressure. In the UK, moves are afoot to cancel the already meagre 10-minute consultation period. And, as this presentation from Deloitte shows, one of the effects of an ageing population is a striking 33% increase in demand for consultations among the elderly.
A raft of emerging healthtech tools is therefore popping up to allow specialists to either maximise their time or extend their reach with patients; connecting and managing treatment pathways beyond the clinic.
Seattle/Vancouver-based Wellpepper, for example, is a video-rich app which allows physiotherapists to define a set of exercises, and support patients in ‘sticking to the program’ beyond the clinic. On the face of it, this is an adherence product (and it’s rich in neat engagement ideas: the video you watch to see how to do an exercise is not a musclebound hunk from Palm Beach, it’s a video of yourself from the clinic!)
But it also buys time for physicians. CEO Anne Weiler says that by solving problems and reviewing results between visits, many hurdles which would take face-time to resolve can be reduced (risk is also reduced – a key issue with physio is ‘bad’ exercise causing more problems). “Ultimately, fewer visits are required, and both patient and clinician can make effective use of that crucial face-to-face time”. Live video catch-ups are also possible, and – let’s be honest– without the tech enablement, these intermediate conversations simply wouldn’t happen at all. Plus, Weiler points out, “The clinical relationship is not separate to an adherence program, it’s fundamental to it.” Adherence tech will only work if patients feel connected by it, rather than fobbed off with it.
Similar logic is used by UK venture My Clinical Outcomes (MCO), which uses clinically validated questionnaires to maintain a connection with patients – this time those suffering with LTCs. MCO is evidence oriented rather than experience oriented: the questionnaire data is shared with caregivers and allows for more proactive management of the condition and in many cases an opportunity to flag up issues which would otherwise go unnoticed until the next appointment date. Again, these contacts simply would not happen without the technology layer, and MCO adds value to face-to-face contact when it does occur.
Indeed, CEO (and ex-doctor) Tim Williams goes even further. “The cold hard reality is, depending on the condition, the patient may not get that follow up appointment any more. The British Orthopaedic Association, for example, says that patients should be followed up at one, three and five years. Many Commissioning Groups just aren’t going to be able to find the cash to honour that commitment.”
The data gleaned, meanwhile, can be used for scorecarding and primary/secondary/public health applications, too. Indeed, MCO originated specifically in the world of orthopaedics, where (in the UK) Patient Reported Outcome Measures (PROMs) for hip and knee replacements are a recognised benchmark of care provision.
Perhaps the key take-home from these (and many more similar options) is that the worlds of telecare and Health 2.0 are colliding. After all, video consultations of various sorts (including strange camera cubicles on remote islands) have been around for almost two decades now. If we were forced to unpick some sort of distinction between the two, it would be that telecare has approached health from a tech angle, whereas the new kid on the block uses lessons from online social tools, branding, open standards and more to build tech around the patient. As Matthew Holt, Co-Chair of Health 2.0 says, “The potential is that tech fades into the background; becomes easier and more automatic. Then we can get on with what we really want to do, which is build empathy between caregivers and their patients.”