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“Hey doctor, what do you think about this product/solution/service?”

These days, I look at a lot of websites describing some kind of product or solution related to the healthcare of older adults. Sometimes it’s because I have a clinical problem I’m trying to solve. (Can any of these sleep gadgets provide data — sleep latency, nighttime awakenings, total sleep time — on my elderly patient’s sleep complaints?)

In other cases, it’s because a family caregiver asks me if they should purchase some gizmo or sensor system they heard about. (“Do you think this will help keep my mom safe at home?”)

And increasingly, it’s because an entrepreneur asks me to check out his or her product.

So far, it’s been a bit of a bear to try to check out products. Part of it is that there are often too many choices, and there’s not yet a lot of help sifting through them. (And research has shown that choices create anxiety, decision-fatigue, and dissatisfaction with one’s ultimate pick.)

But even when I’m just considering a single product and trying to decide what to think of it, I find myself a bit stumped by most websites. And let’s face it, if I visit a website and it doesn’t speak to my needs and concerns fairly quickly, I’m going to bail. (Only in exceptional cases will I call or email for more information.)

So I thought it might be interesting to try to articulate what would help me more thoughtfully consider a product or service that is related to the healthcare of older adults.

My questions when considering a new technology

To begin with, here are the questions that I think about when considering a new technology:

Does it help me do something I’m already trying to do for clinical reasons? Examples include tracking the kind of practical data I describe here (sleep, pain, falls, etc), helping patient keep track of — and take — medications, helping caregivers monitor symptoms, coordinating with other providers…my list goes on and on, although I’ll admit that I prioritize management of medical conditions, with issues like social optimization being secondary. (Social optimization is crucial, it’s just not what physicians are best at, although I certainly weigh in on how an elder’s dementia or arthritis might affect their social options.)

What evidence is there that using it will improve the health and wellbeing of an older adult (or of a caregiver)? Granted, the vast majority of interesting new tech tools will not have been rigorously tested in of themselves. Still, there is often related and relevant published evidence that can be considered. For instance, studies have generally found that there’s no clear clinical benefit in having non-insulin dependent Type 2 diabetics regularly self-monitor blood glucose. (And it is certainly burdensome for older people with lots of medical problems.) Hence I would be a bit skeptical of a new technology whose purpose is to make it easier for older adults to track their blood sugar daily, unless it were targeted towards elders on insulin or otherwise at high risk for hypoglycemia.

How does the data gathering compare to the gold standard? Many new tech tools gather data about a person. If we are to use this information for clinical purposes, then we clinicians need to know how this data gathering compares to the gold standard, or at least to a commonly used standard. For instance, if it’s a consumer wrist device to measure sleep, how does it compare in accuracy to observation in a sleep lab? Or to the actigraphy used in peer-reviewed sleep research? If it’s a sensor system to monitor gait, how does it compare to the gait evaluation of a physical therapist? If it’s the Scanadu Scout Tricorder, which measures pulse transit time as a proxy for systolic blood pressure, where is data validating that pulse transit time as measured by this device accurately reflects blood pressure? (BTW I can’t take such a tricorder seriously if it doesn’t provide a blood pressure estimate that I can have confidence in; blood pressure is essential in internal medicine.)

How exactly does it work? Especially when it comes to claims that the product will help with clinical care, or with healthcare, I want to know exactly how that might work. In particular, I want to know how the service loops in the clinician, or will facilitate the work the clinician and patient are collaborating on.

How easy is it to use? Tools and technologies need to be easy to use. Users of interest to me include older adults, caregivers, and the clinician that they’ll be interfacing with. BTW, all those med management apps that require users to laboriously enter in long drug names are NOT easy to use in my book.

How easy is it to try? Let’s assume a new technology is proposing a service to the patient (or to me) that offers plausible benefits, either because it’s a tech delivery of a clinically validated service, or because it passes my own internal common sense filters. How easy is it to actually set up and try? I’m certainly more inclined to explore a tool that doesn’t require a large financial investment, or training investment.

How cost-effective is using this technology? I’m interested both in cost-effectiveness for the patient & family, and also for the healthcare system. Sometimes we have simpler and cheaper ways to get the job done almost as well.

Can this technology provide multiple services to the patient? My patients are all medically complex, and have lots going on. Products that can provide multiple services (such as socializing with family off-site AND monitoring symptoms), or that can coordinate with another product — perhaps by allowing other services to import/export data — are a big plus.

Does this technology work well for someone who has lots of medical complexity? I always want to know if the product is robust enough to be usable by someone who has a dozen chronic conditions and at least 15 medications.

What I’d like to see on the websites

These days, a website is the generally the place to start when looking into a product or service.

It’s a great help to me when a product’s website addresses the questions I list above. Specifically, I find it very helpful when websites:

Have a section formatted for clinicians in particular. I’m afraid I don’t have much time for gauzy promises of fostering a happier old age. I just want to know how this will help me help my patients. Specific examples are very very helpful.

Have a “how it works” section with screenshots and concise text. Personally, I have limited tolerance for video (videos can’t be skimmed the way text and pictures can) and find it a little frustrating when most information is in videos. Note that it’s probably best to have separate “how it works” sections for clinicians and for patients/caregivers.

Provide a downloadable brochure for patients/families, and another for clinicians. Although it’s annoying when information is presented ONLY in a pdf brochure, I’ve discovered that I quite like having the option of a brochure. Brochures are much easier to read than websites, in that you don’t have mentally decide how to navigate them, or search through them in quite the way you do with websites. Also, brochures can be conveniently emailed to colleagues or patients, which is nice when you want to suggest that your patient try something new.

Include information regarding the relevant evidence-base supporting use of the product. It’s nice to not have to go digging through the literature myself, to see if this is likely to help my patients.

Include information on how valid/accurate the data collection is compared to conventional clinical practice. And make it easy to find. I just tried looking for such information at www.myzeo.com and it took way too long to find, in part because they don’t seem to have a section meant to help a clinician who is asked “Can I use this device, doc?”

Offer a free 30 day trial. Especially when people have a lot of choices, or have other psychological hurdles to clear (like figuring out exactly how will this work), it’s nice to get the option to try something for free at the beginning.

Summarize how the product is different or better than similar available products. Often there are several companies offering a product for a given need (caregiver coordination, med management, etc). It’s nice to be able to quickly figure out what is unique or better about a particular product.

Summing it up

I’ve found it fairly tiring to look into new technologies, because it usually requires a lot of effort to figure out whether this technology is likely to help my older patients, and how exactly it might work to try the technology.

In general, if companies want clinicians to easily engage with their product, they may want to consider creating a section of their website, designed specifically to answer the concerns of clinicians.

Leslie Kernisan, MD, MPH, has been practicing geriatrics since 2006, and is board-certified in Internal Medicine and in Geriatric Medicine. She blogs at GeriTech.

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18 Responses for “How Doctors Think About New Technologies”

  1. John Ballard says:

    Terrific message. After spending the last ten years working in senior care I found myself saying “Amen” every few paragraphs. I had no idea what a wellspring of entrepreneurial talent could look like until I moved from a career in the food business into a “medical” environment. (I’m a non-medical caregiver through an agency in my post-retirement life.)

    In the private sector my only awareness of anything medical was through group medical insurance or workers compensation. In both cases that awareness was infrequent (thank goodness) since most people are well more than they are sick and careful not to have work-related injuries. Besides, in both instances costs were corporate, not personal, since WC claims are a business expense and group insurance is both subsidized and tax-advantaged.

    Now, mostly as an observer, I see how medical concerns, especially costs, are NOT infrequent in the lives of people as they age. The older we are the more often we have contact (and expenses) resulting from medical problems. No longer is the population “more well than sick” or less likely to be injured. For older people the odds are reversed. Getting old usually meansgetting sick or hurt and the costs become personal, not corporate and not tax-advantaged.

    The only additions I would suggest to your list are
    1) How much does the new technology cost?
    2) Who’s gonna pay?
    3)
    Is the new technology intended to make someone better (and thus make itself obsolete) or will future costs go down (not up) as economies of scale and recovery of R&D expenses are taken into account.?

    My observation is that new technologies aim more at sales than remediation of medical problems. Elaborate communication systems designed to track dementia, weight and BP can be used by spouses or other caregivers instead of patients. Data can be accidentally or deliberately incorrect which defeats the purpose. Mail offers for endless supplies of test strips, catheters or other disposables “at no cost to you” are becoming more common, inviting waste while driving sales more than the actual needs of end users. (No puns intended) And every time I see another of those commercials for scooters (“FREE! Medicare and my insurance paid for it!”) I want to throw something at the TV.

    Sorry to get on a tangent. I could go on like this for pages. Bu thanks for the good post and thanks for reading.

  2. Mighty Casey says:

    This is a great guide to assessing value for *any* tech product or service, particularly the call for a trial to see how/if it works as promised, and is an effective tool for the customer. I wonder if the lack of understanding of basic tech sales process is caused by the gold rush that is the stimulus payments for EHR? Not that apps are necessarily folded into EHR tech and attached incentives, but in some cases they may be.

    I also like John’s comments about the lack of “who’s paying for this” intel. He also shares a POV that I think is at the heart of why healthcare is such a skewed system:

    “my only awareness of anything medical was through group medical insurance or workers compensation. In both cases that awareness was infrequent (thank goodness) since most people are well more than they are sick and careful not to have work-related injuries. Besides, in both instances costs were corporate, not personal, since WC claims are a business expense and group insurance is both subsidized and tax-advantaged.”

    In short, no one thinks about healthcare until they get sick. Healthcare should be an ADL – we should be aware of, and managing, our own health outcomes *before* we wind up with “a thing.” That approach could help us avoid many “things.” It could even help us enter our elder years in better shape, and less likely to need a freakin’ scooter. Just sayin’ …

  3. John Ballard says:

    Thanks for your comment.
    Your mention of EHR is to the point. At first I was excited about the idea, but as you say it has turned into a gold rush as a multitude of proprietary systems compete for sales profits.

    As a patient I had a vision of being able to walk into an office and hand someone my EHR access card and not spend another half hour of my life filling out a pile of papers — for the umpteenth time — with my name, vital stats and medical history. Silly me. I actually imagined that since the people who sell me gas by credit card never miss a penny on my bill, that some kind of universal ID system might be adopted to manage health care information. Instead we still watch TV ads that include “Tell your doctor if yadda, yadda, yadda….” It’s one thing to tell your barber how you want your hair to be styled, but it shouldn’t be necessary to tell a mechanic how to repair your car.

    Going back to the title of this post, I really want doctors to think about the costs of new technologies as much as their efficacy or how user-friendly they are to professionals. I can’t escape the suspicion, however, that as long as costs can are passed on to whoever pays the bill that consideration will be way down on the list of concerns. Even on Dr. Kernisan’s excellent, comprehensive list of questions, the mention of costs is short and perfunctory.

  4. Alex Fair says:

    Well done Leslie! This is exactly how we coach our MedStartrs (people with healthcare solutions, getting them crowdfunded by Patients, Doctors, Partners, and investors) to enable their pitch. If they can explain the value proposition and address the far too many pain points in being a Physician these days, then they have a home run. Just look at Dave Chase’s Avado or Fred Trotter’s DocGraph both did this quite well, getting funded online and off as well as picking up hundreds of new clients and partners – not to mention endless press. And it all starts with convincing Doctors and Patients of the benefits of the new idea, just like you describe. Thanks for explaining it so well.

  5. Thanks for these comments.

    Re cost, it’s very important. But I find it impossible to interpret cost without first understanding what a product or service DOES. If what it does seems likely to benefit my patients, then I look into cost.

  6. Alexa Jone says:

    Thank Leslie Kernisan. It’s true that this is a great guide to assessing value for Service. I am a medical technologist and my only awareness of anything medical was through group medical insurance. As a patient i had a vision of being able to work into EHR access card and not spend another. I actually imagined that since the people who sell me gas by credit card never miss a penny on my bill. If they can explain the value proposition and address the for too many pain patients in being a physician these days.Here is all to know

  7. Whatsen Williams says:

    Why would the vendors care about the oncerns of clinicians? Many technologies are forced upon the clinicians by others.

    • John Ballard says:

      Many technologies are forced upon the clinicians by others.

      Good point. Like many transactions, the customer is not the end user, in this case the patient and clinician, but the purchasing agent for the clinic or hospital. That’s who gets the sales pitch. And anyone who has ever bought anything knows how that works.

      The same dynamic is at work with group insurance. The contract is between the company and a TPA. The end users — employees who access the system — are not part of the arrangement until someone gets sick or hurt. Experienced employees know that resolving problems about their coverage works better by going through the company HR department than to the insurance company directly. When the insurance company deals with a patient, their mission is to keep costs in line one way or another, even if that fails to satisfy the employee. But when the insurance company gets a call from the HR department a public relations variable kicks in. Rather than risk making an employee unhappy, the insurance company will be more responsive to HR than the individual raising the issue (typically about coverage or costs in some form.)

  8. Chen Sirkis says:

    Great article! I wrote about it and quoted exentsively from it in our medical marcom blog http://goo.gl/8rUwg

  9. James Watson says:

    New-technology has turned the medical care group a lot more successful throughout the last several years, even though savoring a few facets of the area is far more complex, as outlined by medical care employment and technology specialists.

  10. Technologies are being used in health care and medical care systems since from decades; therefore doctors are worried about using of technology in medical systems as technology gives more effective results and helps health experts to deals with tough circumstances.

  11. grass says:

    Technology is the term now used everywhere not only in medical and got success. Technology helps you to go with fast access which is really helpful in medical terms.

  12. A. D. Wilson says:

    The criteria used by product manufacturers in designing new technologies should be based on the collective needs of doctors and clinicians (for specific applications) with the goal of improving efficiency and effectiveness of hospital and clinical tasks.

    http://www.mdpi.com/1424-8220/11/1/1105/pdf

  13. Hello, I believe your site might be having internet browser compatibility issues. When I take a look at your web site in Safari, it looks fine but when opening in IE, it’s got some overlapping issues. I simply wanted to give you a quick heads up! Apart from that, fantastic blog!

  14. Having read this I thought it was very enlightening. I appreciate you spending some time and energy to put this informative article together. I once again find myself personally spending way too much time both reading and commenting. But so what, it was still worthwhile!

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  16. Buyer beware. The only place to get alot of the information you think doctors need to choose technology is the company website. If you look at the DaVinci robot website you’d think the device was heaven-sent. It’s very difficult to find real information on how devices will actually benefit patients

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