Context Is Everything

A few weeks ago, I had the opportunity to talk with an innovative company about a new product.  I make it a policy not to endorse any particular company or product on this blog, so this is not an endorsement.  Rather it is a fascinating story that tells us lots about human nature and gives us clues on how we should design healthcare programs, apps, etc. as we move into the world of patient engagement and accountability.  And we are moving there. Whether your focus is achieving meaningful use of your EMR (increasingly we’re going to be graded on how we engage our patients in this regard), the journey to becoming an Accountable Care Organization (as we enter an environment where we’re compensated for quality and efficiency, patient engagement becomes key) or simply that you realize that we don’t have enough healthcare providers to take care of all those folks who need it (in this case, patient engagement becomes a tool to give patients the opportunity to be their own providers, taking work off of our beleaguered primary care workforce), patient engagement is all the rage.

Right out of the gate, we health care providers have a big hill to climb.  We are the ones who remind you that you are sick. Who wants to be engaged with that?  Once patients get into the mindset of being sick, the context becomes pain, suffering, inconvenience, depression, time out of work, rehabilitation, and on and on. It’s no wonder that patients don’t engage much (other than the occasional masochist among us).  And the conversation immediately gravitates to whether insurance will pay or not. We’ve observed patients in our connected health programs who are happy to go to the sporting goods store to fork over their own money for a heart rate monitor so they can watch their heart rate during a work out, but baulk at paying for a blood pressure monitor to be part of a hypertension program.  After all, fitness is your own business, but when we’re talking about sickness your insurer owes you ….

A little while back, some airports introduced those whole body scanners – the ones where you stand with your hands over your head and the machine takes an image of your body to rule out the presence of weapons, explosives, etc. Given all of the threats from shoe bombers to liquid bombers that have made it through traditional metal detectors, I thought this was a good idea.  More monitoring to insure my safety is a good thing.  But the outcry from the libertarians and the privacy crowd was deafening.  It was newsworthy for weeks.  All kinds of concerns about TSA agents peaking at one’s body profile, etc.

So imagine my surprise when I talked on the phone the other day with folks from Unique solutions.  They use the exact same technology in the shopping mall to allow consumers to create a clothing size template that is unique to them.  Armed with that scan information, you can go to certain merchants to buy highly customized clothing of a fit that is unique to you.  When I heard about this, I wondered how widespread it is, but right after the phone call I saw one of these in a mall near my home.  Consumers are flocking, apparently.  No complaints from the privacy crowd on this one.  Who’d a thunk it?  Essentially the same scan.  Same risks best I can tell (couldn’t an errant employee view your scan?). But no outcry.

This is fascinating.  There are two angles to think about here. One is the psychology and the other is the health application for this technology.

I’m motivated to think about how many ways we can re-invent how we engage patients about their illness.  By way of analogy, I’d say that we as healthcare providers are like the TSA with the airport scanners.  The alternative therapy, fitness industry is like the mall-based solution.  Two ways of viewing the same challenge. What this tells me is that we have to think hard about how we communicate with patients and develop ways to be less serious, less dour and more hopeful. I don’t mean to say healthcare should become a joke, but there is a long way between comedy and the way we talk to our patients now.

The applications for this technology in health are interesting to ponder.  Overweight is not one uniform problem.  Abdominal fat has more dire health consequences than other types of fat.  There are other examples of where body habitus can help predict health outcomes.  People who engage in serious exercise programs can add muscle mass as they lose fat, obscuring the value of BMI as a reporting tool.  I could imagine a new metric beyond BMI which would use one’s unique body scan as a tool to predict future health state and to track response to weight loss or diet initiatives.  Add a wireless weight scale and a smart pedometer and things start to look very interesting.

Tell me what you think about this.  Why do people raise a fuss about a technology in one location but embrace it as hip when presented in a different context. Does that give us clues as to how we should design our communication tools and patient engagement initiatives?  Do you see health care applications for this type of scanner? Let me know.

Dr. Joseph Kvedar is the Director of the Center for Connected Health at Partners Healthcare. He blogs regularly at THCB and also at the cHealth Blog.

5 replies »

  1. I think you raise 2 good issues in your post.

    One is how we look at things, our paradigm, and how that affects whether we react positively or negatively to something like a scan. The second is whether there is a role for less-heavy (more comedic?) communications in the world of healthcare.

    I’m not sure about how or whether to do the second, but I certainly agree that context makes a big difference in how we perceive something, and therefore how we feel and behave!

  2. What I actually think of Accountable Care Organization is it aims to raise the level of accountability for health care providers, decentralized accountability that is. But I don’t think it is that essential, we have seen and proved in the past that performance-based reimbursement did not improve quality. Although health care providers have a huge chance now. It’s a matter of competencies being challenged, with bonuses and penalty payments involved.

  3. “Why do people raise a fuss about a technology in one location but embrace it as hip when presented in a different context.”

    Uhmmmh … how about the simple fact that the airport scanner was considered, by many and probably not without reason, somewhat coercive (intense patdowns, combined with ex- or implicit disapproval by TSA personnel, being the alternative choice), while the other one is a consumer choice?