Think fax machines are the only out-dated tech in healthcare? Sandeep Bansal, CEO of Medic Bleep makes the case that outdated internal phone-based paging systems used by hospitals need to go too. According to Sandeep, the UK’s NHS clocks 1 billion internal phone calls a year, with a full 23% of them solely made just to find the right number for the person they are really trying to call. What works better? Listen in to how Medic Bleep plans to provide a communication system for health system staffs that actually matches the way they work to deliver care.
Filmed at Webit Health in Sofia, Bulgaria, May 2019.
No one ever asks if you get along with the cashier at the grocery store or the barista at your neighborhood coffee shop.For most folks choosing a doctor means finding someone in your area who’s taking new patients with your insurance, which usually isn’t too many.
Simply getting an appointment is hard enough, so expecting a pleasant experience and a good relationship with the doctor seems to be an unreasonable request, like asking for a unicorn who also speaks fluent Spanish. Many people don’t think patient-physician relationship is particularly important; they’re looking to the doctor for medical advice, not to be a friend.In these days of electronic medical records and 15 minute appointments, many physicians simply don’t have the time to get to know patients and find out their motivations, goals and fears.It’s even harder for patients with language and cultural barriers; for example, physicians talk more and listen less to black patients than to white patients.
EMR adoption is skyrocketing, in no small part due to government incentives. The office of the national coordinator lauds this hockey-stick curve as a success. Advocates promise electronic records will improve patient care, reduce mistakes, and save healthcare costs. At the same time, doctors love to complain about implementation cost and poor usability. How can we reconcile these differing opinions? The truth is they are describing very different technologies. EMRs, the way they are implemented now, will not accomplish these goals. In fact, early adopters can become stuck at a rudimentary level of functionality, and the extensive feature lists described by meaningful use criteria fail to address the most basic needs for patient care.
I have been at medical institutions at different levels of technological development. Each has a different attitude toward the EMR; for some its loathing, others longing. Some devote resources to try to improve it, but others give up. I realized the parallels with Maslow’s Hierarchy of Needs, people are motivated to attain something only after their very basic needs have been fulfilled. So are EMRs good or bad? Well, it depends on where you are on the hierarchy.
The figure above describes the steps to building a technology infrastructure that will lead to improved patient care. Yes, incentives help us achieve some very basic needs, but the problem is that decisions and investments we make now will determine the ceiling as well.
From childhood most of us remember the sage parental advice on how to deal with bullies–“sticks and stones can break my bones, but words can never hurt me”.
Of course, we all know that words do hurt, maybe not physically, but they certainly take a toll on our psyche.
These days in planning meetings at my own company, in articles I read on the web and at various tech industry conferences, I come across words and language that I know feel hurtful, or are at least disrespectful, to the health industry and the people who work there. I hear cavalier talk about the need to disrupt the healthcare industry.
Some thought leaders even say we will creatively destruct the healthcare industry. Consumers armed with technology will rise up, they say, and disrupt everything about the current state of healthcare.
Now imagine for a minute that you are a hospital executive, a doctor, a nurse or other clinician and you hear people who work outside your industry talking about disrupting or destructing it.
Imagine being told that consumers, patients, and tech companies will rise up and destroy your business.
There you are doing the best you can to make it through each day keeping your hospital or practice economically sound, dealing with the barrage of patients at your door, staying one step ahead of ever-increasing rules, regulations and rising costs, while those who’ve never worked a day in your world tell you they are going to disrupt and/or destroy it.
Even if there is a need to disrupt healthcare (and even many who work in the health industry might agree), nobody appreciates being told by some outsider that they know your business better than you do.
I don’t imagine my colleagues who work at Microsoft (or Google, or Apple, or Amazon) would appreciate being told by a hospital administrator or a doctor that they knew better how to run a tech company, or what ails the tech industry.
Nor do I think that most patients and consumers can really appreciate the amazing complexity of our healthcare system or the unbelievable pressures under which it operates these days.
A recent case taught me a lot about how people perceive their medicines.
I was trying to help a 92-year-old man get off some of his medicine. I can’t go into the details, but suffice to say, there was much opportunity to trim a long list of drugs, many of which were threatening his existence and impairing his quality of life.
As I was discussing stopping many of the meds, the patient said (with a quite sincere tone):
“You doctors these days just want us old people to go off and die.”
That was a zinger, a real punch in the gut. I was trying to do the opposite–allow him to live a longer and better life–but the patient perceived me as a mini-death panel.
I’ve been thinking a lot about this case. Why was this man “attached” to his meds? Why had he associated his longevity with chemicals that now threatened his existence?
The answer, I believe, is a knowledge gap. He, like many people, doctors included, fell into the trap of association and causation. He associated his health with his medicines; he overestimated their benefits. He thought the pills were keeping him alive. They were not. He lived despite his medicines.
What I tried to explain to this patient was that benefits from medicines do not continue indefinitely. Things change in the elderly, and, what is for younger patients may not be in the aged.
Take the case of preventing stroke in the elderly. Simple drugs, such as high blood pressure medicines and statins, may no longer offer a net benefit to the patient over the age of 80. Really. It is true.
Let me tell you about a recent commentary in the journal Evidence Based Medicine (from BMJ).
Dr Kit Byatt is a doctor in the UK who specializes in Geriatric Medicine. He wrote this refreshingly concise summaryoutlining four reasons why the medical community should reconsider its overenthusiastic views of stroke reduction in patients over the age of 80. In the title, Dr. Byatt asks whether we are being disingenuous to ourselves and to our elderly patients.