Healthcare is becoming more decentralized every day thanks to new technologies and a growing emphasis on consumer-focused services, according to presentations at the Patient Engagement and Experience Summit in Boston today. But even as telehealth, wearables, virtual reality, and other technologies disrupt familiar models of health care delivery, a greater shift in culture and policy will be necessary to transform care.
“Innovation really has to be in the DNA of an organization,” Tim Walston, assistant vice president of Interactive Marketing at MedStar Health, said during a session. “Sometimes it’s a challenge because it’s not only at the provider level, but sometimes it’s the management that needs to understand. … It’s all about perseverance, because you’re not going to change everyone overnight.”
New delivery strategies, new mindsets
Walston illustrated the growing shift in health care delivery by pointing to the retail industry: just as malls are being usurped by online sellers, so too is the centralized management of healthcare in large hospitals giving way to a landscape of smaller clinics and telecommunications. The latter, he said, is emblematic of the “disruptive technologies” transforming care that will need to be leveraged by health care systems.
“The current state of digital health is really being impacted by telehealth — we can see that this trend is growing throughout the world [and] we estimate up to 30 million users using telehealth [by 2020],” Walston said. “In southern Maryland, we have saved millions of dollars on our transportation costs not having to medevac stroke patients from southern Maryland to the hospital center, because we now have empowered our physicians to talk to our stroke experts and, in real-time, assess whether the patient needs a helicopter ride to D.C.”
Walston ran down a number of other mobile health technologies that his own system is currently employing — such as telehealth and medical wearables — and many that may exist in pilot programs but could become more prolific over time, including machine learning, augmented or virtual reality-based therapy, receptionist robots, clinical decision crowdsourcing, and automation.
“It’s really [trending] toward force multiplying; doing more with less,” Walston said. “That’s the focus, and also to use technology to meet customers on their terms, … to be sensitive to large trends, to keep our ear to the ground, and to make sure we understand how to use the technology to find solutions that actually accommodate their lifestyle.”
The major challenge for the industry will be embracing these technologies and the reorganizations they herald. Walston said that an organizational culture that is more entrepreneurial and open to experimentation might be best achieved with an injection of new lifeblood into the organization.
"When it comes to some other areas … sometimes you have to bring [those qualities] into your organization based on your hiring strategy. I’ve only been in healthcare now for three years, and I’ve been bringing in folks, some that have healthcare [experience] and some that don’t. They bring in a fresh perspective."
Technologies blurring the lines of care
Juhan Sonin, director of user interface and application design firm Involution Studios and a lecturer at MIT, envisions a more radical future for healthcare — one where devices and household appliances capture health data automatically, and conversations with physicians occur frequently thanks to patients’ smartphones.
“I imagine … my data is going to be captured beautifully, without me being involved, and when I have to do it, the coefficient of friction is very, very low,” Sonin said during a presentation. “[Like Uber], I want this on my phone. I want to talk to a virtual doc, and hopefully over time it just becomes part of my daily activities.”
Sonin called for an intertwining of daily life and healthcare, a shift that he envisions will come from a renewed focus on data collection. By increasing the number of devices passively collecting health data, as well as standardizing health data records across providers, Sonin argued that healthcare may someday be able to blur the lines between treatment and everyday life, all the while providing truly preventative care. Those devices could include smart versions of everyday objects, such as a bathroom sink capable of collecting and scanning discarded hair follicles.
“My hope is that we’re seeing things earlier and earlier in the cycle,” he said. “The little ‘doctor bots’ in my pocket, in my house, in my home, in my bathroom are picking up on goodies and … saying to me ‘Hey, this is going to happen to you in a couple of days, we’re seeing the signs. Go to Walgreens and get your little personalized flu treat.’”
Although these ideas are not the current reality of care, the seeds for such a future are currently available in mobile technologies. Clinical data collection and video conferencing between patients and physicians using everyday devices is becoming more commonplace — although Sonin hopes that the latter will eventually comprise 70 percent of patients’ interactions with primary care physicians. Daily internet connections are available to nearly the entire population, he said, and could become the foundation of patient-owned care and universal primary care.
However, much like Walston, Sonin said that continued advocacy and open-mindedness will be necessary to achieve these goals. Certain roadblocks — such as the availability of telehealth or other technologies to low-income patients — could require changes to policy, and will need persistent, concerted efforts to overcome.
“Culture and policy are the two biggest, hardest things to change,” Sonin said. “It’s easy on the design side, where you can flitter around the periphery of things. It moves really fast — like fashion, it changes all the time. Policy is where it has legs. That, to me, is where you can have the biggest impact, where you can shift financial biases and then thus shift culture biases … but be prepared for it to be a multi-year extravaganza.”