My friend Lisa Suennen recently wrote a thoughtful review of the Computer Electronic Show (#CES) http://www.venturevalkyrie.com/2014/01/11/people-who-need-people-a-ces-follow-up-report/5961. For those of you unfamiliar with the event, there were more than 2 million square feet of exhibits and roughly 150,000 people last week in Las Vegas. Digital Health is part of a broader offering covering all things tech. Amongst all these glittering objects, the of envy for any true geek, Lisa had several interesting observations. First, that many health entrepreneurs are (as she notes, wrongly) looking for ways technology can replace people, rather than enable people. There is a general sense that scale (a magic word for the investment community) requires fewer bodies. Second in her opinion, the ultimate goal should be a mash up, a convergence of IT, devices and services for true value. I couldn’t agree more.
My efforts focus on collaboration. Within health IT is what seems obsession with data, EMR’s and dashboards, but for me the future is about teams- getting the right people at the right time to come together. Without this opportunity for timely expertise and collaboration, the value of data decays. Information has trouble converting to knowledge. However, collaboration is messy. It requires thoughtful consider of how people and process interact with technology.
Replacing the Pager with a PDA.
For decades the pager has been the official form for medical communication. It is safe and secure. It is also limited, inflexible and a poor choice for collaboration. In response, many physicians have adopted texting as an alternative method of communication. However, as of September 2013, new federal mandates limit texting. There is a potential 50,000 penalty for texting a single instance of patient information being exposed in an standard text. The response by many vendors has been ….I have an app for that, to wrap messages in a secure technology. However, an effective solution needs to be far more nuanced.
In the consumer space, apps can go viral. However, the social fabric and supporting infrastructure for healthcare presents a number of obstacles. There is an assumption that all providers will have a PDA. However, PDAs at work are expressly forbidden by many nursing regulations. This means messaging must be cross platform. What if an individual doesn’t want their PDA to be leverage for work responsibilities; is the hospital required to provide a device? Many hospitals do not have have the necessary wireless/cellular infrastructure to support PDAs. Most hospitals do not have accurate information on their providers beyond pager numbers and an office address; snail mail remains the de facto form of communication.
For their part, physicians often do not want to be reach directly. In part this is a workflow issue. Imagine a physician is in surgery and receives a call telling a patient needs their attention immediately. Do they leave the surgery, or stop the surgery and call someone to cover? There are reasons for call centers. Practically, there needs to be permissions set by time of day, availability and role for the collaborative communication to be appropriately routed. This requires high level enrollment into a “service” identifying roles and managing preferences.
The result has been islands of communication. Groups have adopted apps for internal communication but no real holistic community of providers for collaboration. With the help of a vendor (disclosure- I have invested in the company, #Emerge.MD), St. Joseph’s has deployed a technology enabled service helping people to collaborate. This service enables provider collaboration by name (eg...Dr. Jones) or by role (neurosurgeon on call). It incorporates nursing requirements (for desktop messaging) as well as physician preferences. Via this service teams of people can be brought together text, voice or video. Importantly, there is sponsorship from a business owner, the hospital and more broadly the Accountable Care Organization. The executives have something to gain- more cost effective care (throughput issues, access to specialists, etc…). This solution is now spreading through Dignity Healthcare. However, this was not plug and play. It required extensive knowledge about the people and process rather than strictly technology.
Even replacing an archaic device, the pager, with a PDA is not about technology but rather about understanding and management of a constellation of social processes. At the end of the day, health and healthcare are personal. There are many processes that can be automated and improved upon via technology. But for my money, I am with Lisa. Transformation will be more about enabling rather than replacing people. And people require services, not technology.
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