When Technology Understands What People Want From Healthcare, Our System Has A Chance

As a primary care doctor in San Francisco and Silicon Valley, I have been searching for the holy grail of patient engagement for over 15 years. My journey began with an alpha-numeric pager and a medical degree. I shared my pager number with my patients along with a pledge to call them back within 15-minutes, 24-hours a day. My communications evolved into email and texting, with the predicate that by enhancing communication, I could carefully guide my patients down the byzantine corridors of healthcare – with a high probability we could avoid mistakes – if they would agree to share the ownership of their treatment plan. My life’s work has been where the rubber meets the road; where doctors interface with patients: office, hospital or smartphone.

Technology has washed over almost every industry and transformed it, radically. Healthcare is on the precipice of destiny. The wave is here.

Over the past three decades healthcare has lurched from one existential crisis to another; often manifested by an acronym solution: HMO, ACO, PCMH, P4P, PQRS; each a valiant attempt to reign in costs and solve for aligning incentives. However, we can’t have hospitals, doctors, health systems and payers accountable to healthy outcomes if the 300,000,000 people are not paramount to the equation.

If you haven’t been paying close attention, ‘patient engagement’ is a white-hot topic in healthcare these days. It wasn’t sexy 5 years ago. In fact, in his keynote speech at HIMSS 13 (the national Health IT conference), thought-leader Dr. Eric Topol announced that the “The blockbuster drug of the 21st century is Patient Engagement”.

While the mantra is strong, the industry seems to conflate “patient engagement” with “consumer engagement”, which in my view are two distinctly different propositions. Consumer engagement is predicated on the fact that there is choice, a free market and low barriers. As consumers, we can swing by the Apple Store and pick-up a Jawbone bracelet to monitor our exercise activity and sleep patterns, perform an in-home ECG screening with AliveCor’s iPhone Heart Monitor, or self-assess symptoms and find an appropriate doctor using the iTriage website.

These products represent the innovative eye-candy that dominates the headlines, but I’m here to tell you that none of them are the killer app for patient engagement. They are all important pieces of the puzzle but the kernel of transformation lies in tapping into one of the most under-valued assets in health care, the doctor-patient relationship. Consumers, who strap on monitoring devices and crawl the web for solutions without the guidance of a doctor, are heading down a path towards anxiety – and likely more questionable consumption of healthcare resources. The always available Dr. Google enables anyone to self-diagnose, but what consumers don’t realize is that Dr. Google is an oncologist that often lists cancer as one of the possibilities….more anxiety.

Patients engaging with themselves are a noble aim, for sure, however coupling a patient to their doctor throughout their healthcare journey is simple, elegant, and necessary: essentially we need a Clinical CRM (or PRM – Patient Relationship Managment). On the surface this may seem like an improbable proposition, as many doctors are already suffering from Chronic EMR Fatigue Syndrome, overloaded schedules and diminishing payments. They don’t want yet anotherhttps://www.itriagehealth.com/ solution.

Taking human physiology as a metaphor for complex systems (in the spirit of biomimicry), excess sugar in our food supply causes metabolic syndrome and ultimately diabetes – which extracts a huge drag on the body in terms of aging and pathologic opportunities. Our healthcare system is no different; excess technology and proprietary solutions have caused a digital opacity syndrome and ultimately a health care system of balkanized cash vacuums*, people suffering unnecessarily and finger pointing. Healthcare is the diabetes of our GDP.

When technology understands what people want from healthcare, our system has a chance. This is not about what the system wants for itself and it’s not about what ‘consumers’ want for themselves; it’s what makes the most sense to achieve the ultimate outcome: a healthy population at the most efficient cost.

We need a new angle, a new dimension, something simple and human that provides demonstrable value; both in the short term and the long run. The good news is that we’re at a once-in-a-generation moment in time where great change is upon us….and where there is great change, there is great opportunity.

We need a new Healthcare Operating System; one that enables shared ownership between all parties and where innovative ideas fit together like Legos.

The four walls of medicine and the millions of telephones that occupy the space between doctors and patients must evolve. It has failed to scale. Grab the eraser and let’s start all over. Please.

I have a few ideas…perhaps the next blockbuster drug is physician engagement…(wait, what?)

Stay tuned for more Healthcare Musings from Dr. Shlain…

*See Time Magazine, Bitter Pill (the Cash Vacuum reference is the loud sound of hospitals sucking up money)

Dr. Shlain is physician and founder of Healthloop which uses technology to help physicians, health plans and self-insured employers connect with patients in a new way.  Healthloop has attracted top tier investors and is currently engaging with national health plans, health systems and self-insured employers as well as forward thinking doctors with an 80% patient opt-in rate. Dr. Shlain regularly speaks about the next evolution of healthcare including in to policymakers in Washington DC and is on the board of the Hope Street Group..  Upcoming engagements include the American University Executive Healthcare Policy forum as well as the 4th Annual ACO summit discussing Strategies and Technology for Innovative Payment Models. He can reached at @DrShlain.

13 replies »

  1. Thank you, Sir. I am a big fan of Jesse D who I believe works with you.

    There is a need for experience to inform evidence!

    Rock on!

  2. Dr. Shlain,

    Sumit Nagpal (the CEO of Alere Accountable Care Solutions) saw the vision of this about 20 years ago and began building the exact system that you are envisioning, which is already currently being implemented.

    Alere Accountable Care Solutions works with biometric monitoring devices that a patient has in their home – such as blood glucose monitoring devices, blood oxygen level monitors, etc. and alerts the patient’s care providers when necessary. Otherwise, the information is simply stored in the patient’s electronic chart. Thus, creating the ‘Clinical Patient Relationship Management’ you spoke about in your blog.

    As a side note, this system also takes information from multiple other platforms of EHR’s, allowing it to get the complete picture of the patient’s medical background. It also has one of the largest evidence-based rules dictionary to allow that data to be meaningful to the physician, delivering suggestions and alerts regarding patients in order to reduce error.

    We, also, believe that patient engagement is one of the key factors in the future of healthcare. Only true patient engagement will allow for pro-active patients that believe in maintaining their health with the assistance of their providers. In the end, this will lead to less re-admittance of patients as well as reduced costs for healthcare providers and, of course, healthier patients!

    We’d love to show you our product! Please feel free to reach out to me and I can schedule a demonstration at your convenience, I can assure you that this is exactly what you and the rest of the physicians at ‘Discover Health’ have been waiting for.


  3. Right on all counts, Dr. Shlain.

    You are not alone.

    Lybba, the nonprofit I run, developing a concept that’s quite similar in nature. OPENHealth Central is a web- and mobile-enabled care-management system that 1) triggers care-provider action and 2) collects data that drives evidence-based improvement in patient care, population health, and healthcare costs. OPENHealth Central aims to help clinicians and patients plan for visits more effectively, track experiences between visits, boost the quality of care and self-care, and provide the psychological support that comes from a rich human feedback loop. Once built, OPENHealth Central will have the following qualities:
    A well-designed ‘care layer’ on top of/adjacent to EMRs
    Support for case managers and health coaches
    Screening tools that identify people in the community who need help
    Transformation of patient data into meaning insights for all
    Evidence-based care guidance that makes sense to patients and their families
    Ways to link patients to health-related community assistance programs
    Ways to drive change of clinical practice with evidence
    Support for multiple levels of EMR integration
    Growth through an open-source app model
    A case study for clinical quality-improvement initiatives

    With good fortune we’ll make progress toward our common objectives.

  4. Paying physicians for their time spent with patients rather than CPT codes would be a good start. Patient-centered care starts with a conversation.

  5. Dr. Kernisan,

    Glad you agree….collaboration is critical….however, if we’re not all on the same page at the same time we can fall into a time-trap….that is, making decisions only after the ‘thing’ happened….

  6. Well done. I especially like the analogy between technology and sugar…we can definitely have too much of a good thing.

    Also agree that clinician engagement is key. People will need good collaborative relationships with clinicians, and the Medicare population will especially need good PCPs.

    Look forward to hearing your ideas on how to make this happen.

  7. I believe we have to live in a future where we all participate…healthcare is existential….it engenders anxiety and if there are way to anticipate and share decisions, we all win

  8. Roy – great points…i’m all about transparency and enabling everyone to have all the info at their fingertips…healthcare decisions are often complex and require trust…..let’s make it happen.

  9. Dr. Shlain,
    You have addressed an important issue of engaging patients in relationships with their providers and share responsibilities for patients’ health. When some patients know more about their conditions, know how they could improve or simply live a good life, they become more involved in the care.
    I am also fascinated with availability and convenience of using new technologies. Thank you for creating an electronic system for communication between a provider and a patient. I hope I could use anything similar in my practice.

  10. Just thinking about what Roy the patient wants…from technology: a decision tree matrix showing the process my doc has gone through to arrive at a diagnosis…a chance to question that process…an opportunity to place a confidence factor to that decision process.

    I would like to see a non-gibberish, complete electronic medical record, over the course of my life.

    I would like to see my physician’s: CV, litigation record, and some kind of rating in terms of patient outcomes, board certifications, all continuing education courses with dates, and a history of any disciplinary actions.

    Another great concept would be and ISO approach to patient complaints! Full disclosure of all patient complaints and the responses and corrective actions taken by the physician.

    I would also like to know every person that has access to my medical record (every person who has the ability to access my record).

    That is just a start…