Connected healthcare is not about technology, says a Partners HealthCare expert; changing physicians' culture, attitudes, and training could diminish burnout and enhance humanity.
For more than a quarter century, Joseph C. Kvedar, MD, vice president of Connected Health at Partners HealthCare in Boston, has led novel initiatives, testing and piloting new models of healthcare that involve emerging technologies. The organization he helms focuses on connected healthcare, which moves the point of care from the hospital or doctor’s office into the day-to-day lives of patients.
According to Kvedar, connected healthcare encompasses the following concepts:
- Delivers care that is independent of time and place to care for patients wherever they are located, including nontraditional settings, such as the home and workplace.
- Uses technology to empower patients to take better care of themselves.
- Enables a "one-to-many model of care," meaning that automation provides an opportunity for patients to interact with technology before a healthcare encounter to create system efficiencies.
Yet realizing the potential of connected healthcare does not rely on devices, he says. It is rooted in changing healthcare culture, along with physicians' attitudes and training.
With greater acceptance, this approach to care can help resolve challenges related to burnout, and surprisingly, the expert says, add a human dimension back into the practice of medicine.
Named after the concept, Partners Connected Health is developing a model of delivery that moves the point of care from the hospital or doctor’s office into the day-to-day lives of patients. The organization uses mobile phones, tablets, wearables, sensors, and remote health monitoring tools to help providers and patients better manage chronic conditions; maintain health and wellness; and improve adherence, engagement, and clinical outcomes and conducts research to test the effectiveness of these technologies in various clinical applications.
Kvedar is a board-certified dermatologist and professor of dermatology at Harvard Medical School, who still practices one day a week. He has written two books on the subject of connected healthcare, serves as cochair of the American Medical Association's Digital Medicine Payment Advisory Group, is a past president and board member of the ATA telehealth association, and past chair of the American Academy of Dermatology (AAD) Task Force on Telemedicine.
HealthLeaders recently spoke to Kvedar who shared five insights about the potential of connected healthcare and barriers to effective adoption.
1. It's a Mistake to Place Physician's Needs First
In most other industries, the customer's needs always come first. In healthcare the cultural milieu is quite different; the focal point has traditionally centered around physicians. "We need to have a long, hard look at why we think healthcare is different," says Kvedar.
Physicians have a distorted perception of their role in healthcare, he says. "It's complicated because of this relationship that we have with insurance [companies], the patient, and the staff. Everyone tends to layer praise on the doctor because … a doctor drives all the revenue; we're like the rainmaker."
"Nobody can get paid for anything" without the doctor's involvement, he says.
And, he points out, "I have the magic pen." Patients can't get a prescription without consulting with their doctor, he says. "So everyone's nice to us."
Yet patients often have to wait for months to get an appointment and perhaps for hours once they arrive, creating discord. "I have countless stories of patients who have been angry to the staff, they're mean to the nurse, and then they're sweet as pie to me," he says. "It happens all the time."
As a result, physicians "get lulled into the sense that we're incredibly important," says Kvedar. "We've got to wake up to the fact that other service delivery models don't tolerate that, and we can do better on behalf of our patients." The concept of connected healthcare helps shifts the focus to patients by factoring in their needs and convenience.
2. Physicians Attitudes Create Barriers to Connected Care
Although research has demonstrated the value of remote care, "There are still a fair number of practitioners who are skeptical about the quality of connected health," says Kvedar.
"There is, of course, no substitute for being together and the richness of that experience," he says. "My point is that not every single decision they make about care has to be done [face to face]."
Remotely monitoring a patient's blood pressure offers one example of how connected healthcare can work well. Patients check their blood pressure at home, and data is sent to the physician who can communicate instructions back to the patient via secure text, email, or a phone call without a patient having to schedule an appointment, he explains. "I don't need to drag you into my office for that. Many of the things we do are really by habit. That sort of thing doesn't need a visit, but that's how we think."
He suggests that physicians consider whether they need to see patients in their office for each situation, and whether the same exchange could occur remotely or asynchronously—with a transaction that doesn't occur in real time, such as texting.
3. We're 'Training Creativity Out' of a New Generation of Physicians
Seemingly, millennial physicians would be more open to adoption of technology, but that's not necessarily the case, says Kvedar.
Although most millennials grew up as digital natives, the newest generation of physicians seems to have adopted the habits of previous generations, with a preference for in-person visits, he says. "They can't get out of this prison we have them in of having to see [their patients] in person in the office. We're really stuck on that, and it's holding us back."
The American Well survey demonstrates some support for this phenomenon. "Interestingly, newer physicians (aged 25-34) were somewhat less willing [74%] to use telehealth compared to [77% of] other young physicians (aged 35-44)," according to the report. The authors speculated this factor might be "because these physicians are still learning their craft and thus less confident about new technology."
Kvedar has a corollary theory. "We've trained the creativity out of them, and it's sad," he says.
As a result, Kvedar is working with the Association of American Medical Colleges (AAMC) Committee on Telehealth to change this dynamic by inculcating virtual care training into the medical school curriculum.
"We're putting together a set of competencies that will become embedded in the way we teach medical students and residents to prepare them for this kind of care delivery being part of their mainstream practice in the near term," he reports.
4. Connected Healthcare Offers a Solution to Physician Burnout
The healthcare industry is plagued by physician burnout and it's getting worse. A recent study by the Massachusetts General Hospital Physicians Organization showed physician exhaustion increased by almost five percentage points between 2014 and 2017 from 52.9% in 2014 to 57.7% in 2017.
"A lot of what we currently call physician or clinician burnout is really about a supply-and-demand mismatch," says Kvedar. "It's the pressure that we feel to see more and more patients and in only one way, which is [an office visit]. If we were able to redirect and rethink our care delivery models to use more technology, we could take some of that pressure off."
Changing demographics and a shrinking physician workforce may force physicians to consider practicing differently.
"We are literally running out of young people to take care of old people," he says.
5. Using Technology Can Enhance Humanity in Healthcare
As counterintuitive as it may seem, technology can help humanize healthcare in numerous ways, including using artificial intelligence and machine learning to help make clinical decisions, as well as chatbots to interact with patients before or instead of encounters with clinicians.
"People are now quite afraid of automation across the board," says Kvedar. "As a patient, you might feel shortchanged, but clinicians also feel nervous about how we introduce automation. I would say that if we do it right, it enables us to be more human."
Computers strip away bias, he explains, and deliver predictive results for physicians to apply judgment and act upon.
"We should be delegating more tasks to computers that computers do well," he continues. "They sift through lots of information; they call out patterns. There are things that computers do infinitely better than we do."
"If it happens really quickly," Kvedar says, "I get to be a human being [during our visit] and care for you, which we've kind of lost now. We don't do much caring anymore cause we're busy either documenting in the record or looking at the computer screen while you're in the room. "
Chatbots that query patients about their history and current symptoms are another emerging form of technology in healthcare. These tools also create efficiencies, but must be carefully deployed, he says. Some of these tools are so sophisticated, it is difficult to determine whether one is interacting online with a computer or a person. Yet healthcare presents interpersonal challenges that are different from purchasing a phone, for example.
"We have to give you that experience at the right point in your care," says Kvedar. "If you [want] a person, you should get a person, but you don't always need a person. It's sometimes going to be more efficient and pleasant for you to interact with software. That's going to be really powerful. We've got to figure all that out, and I look forward to it."
Mandy Roth is the innovations editor at HealthLeaders.
Patients' needs, not physicians need to come first.
Physicians’ resistance to change creates barriers to delivering healthcare in a new way.
Connected healthcare offers a solution to physician burnout.
Technology can add humanity back into the healthcare equation.