Cisco on wireless health, alert fatigue and apple carts

By Brian Dolan
08:10 am
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Dr. Danny Sands"It is really not all about the technology," explained Dr. Daniel Sands, senior medical informatics director for Cisco Systems, during his keynote at the World Health Care Congress's Wireless Health event this week. "My talk is entitled 'It's not about the technology, confessions of a healthcare technologist.'"

"So it's a first," Sands said. "Everything we do is a first. So, we are excited by the fact that we are implementing technology, that's really exciting but you know what? So what. It's OK, it's cool, and it's great. That's as far as it goes. In fact, if we want to succeed at what it is that we are doing, we are going to have to do more than just be the first cool whiz bang thing. And that's really what we would focus on. Ultimately, it's this that we have got to think about -- if we have a technology, something that we are trying to do. It shouldn't be about the technology it should be about solving these problems. Thinking about all of the stakeholders in healthcare starting with the clinician and the patient in the center. Then, of course, the other people in the ecosystem: public health agencies, health authorities, hospital practices, life sciences and the payers. We need to think about how we are helping this whole ecosystem, not just how we are going to create widgets."

While he didn't use the word, Sands clearly believes there to be a lot of hype about wireless health. His keynote at the WiHealth event in Boston began with a rant against fetish-sizing technology for technology's sake but ended with a series of thoughtful challenges that face every company looking to gain a foothold in the emerging wireless health industry.

The doctor's apple cart

To make any technology initiative successful in healthcare, you need to think of the impact it will have on all of the stakeholders in the system, Sands explained. For doctors, the impact will be on their "apple cart." The doctor's life is best described as an apple cart that is full to the top and the last thing they want to do is add on more thing on top, because they are worried it will topple the whole thing over. We have got to be sensitive to that if we are going to implement something in the doctor's office, Sands said.

"Are we expecting our physicians our doctors to put yet another thing on their Batman belt?" Sands asked. "Yet another gizmo? How does this fit into their workflow?"

Alert fatigue is becoming a studied phenomenon

"Maybe we are asking them to respond to too many different things," Sands wondered. "We are overloaded with alerts. Alert fatigue is becoming a studied phenomenon. Whether it's the bells and ringing and beeping or whether it's the alerts being shown to us through our applications. Doctors aren't going to handle another thing being thrown at them," Sands concluded.

Time and money, time is money

"Scheduling is another problem," Sands said. "Doctors offices are highly scheduled... and they don't have slack time ...to follow something else that you are throwing at them."

If you expect a doctor to adopt some kind of remote care application, then that remote visit or consultation needs to be scheduled into the doctor's day. Not only scheduled, the visit needs to be reimbursed too, because if the service takes them away from visiting with patient face-to-face, they better well be getting paid for that, Sands said.

"If they are not going to see patients where they get money, then where is the money going to come from?" Sands asked.

Don't forget about training and support

What is your company's procedure for training your various customers -- doctors, nurses and patients? Training doctors is not easy, Sands said. Maybe it's because we don't understand doctors, he noted, 'we' as technologists. We need to understand the way they think and the way they learn, because it's actually going to be different from how you train nurses, Sands said, or from how you train patients. You have to have customized approaches for each of these groups. We need to think about customer support for these products and services early on, Sands said. We need to make it a simple point of contact and we need to make this simple.

Have we thought enough about liability?

"Have we really thought through the liability issues of this technology?" Sands asked. "Have we thought about - well, if something goes wrong who's problem is it? Is it a problem with the service provider or the software or devices? And is the doctor protected against this?" All those people out there creating these systems, we need to figure out who is regulating them.

Wireless health vs. face-to-face or A trusting relationship

"The last set of points has to do with relationships," Sands said. "It has to do with trust. There is something to be said for face-to-face. You lose something if you can't actually see people -- if you can't interact with them. If you don't have that face -- a person to connect with -- we, as humans, sort of recoil from that. We don't feel we can trust it."

Sands said he believes the question of the importance of in-person face-to-face visits is still an untapped opportunity, which may have a better solution. He suggested half-jokingly that perhaps interacting with a hologram image of a doctor is better, certainly better than a simple image of one or just the doctor's voice. And while there may be some better ways to accomplish this yet to be discovered, Sands said the bad ways are still very clear.

"Hello, I'm your new primary care physician your original HMO has been acquired by an insurance company that recently merged with a multi-national phone company specializing in interactive telecommunications. Drop your pants please," Sands said to a round of laughter.

"This is probably not the way to do this," he said.

Need to be considering these points all the time

"I don't mean to preach to the choir here," Sands explained by way of caveat early in his presentation. "I know that some of you get this, and I don't mean to imply that you don't. But some of you are not thinking about these things. We need to be thinking about these things all the time."

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