For decades, our society's approach to addressing health care has been highly focused on the acute response to advanced stages of disease and exacerbations of chronic illnesses.
Frequently quoted in scholarly articles and the popular press are the exorbitant national expenditure levels on healthcare and the poor ranking of the United States in areas such as life expectancy and health outcomes. Our teams of clinicians, administrators and support staff work tirelessly to act in the best interest of the patient, yet our progress as a society is limited when taking into account the volume of expenditures in aggregate and the care environments in which those dollars are spent. How is it that a country of immense wealth and talent finds itself in this current situation and moreover what does the future hold for existing infrastructure in better addressing the problem?
In revamping our healthcare system to a primary care-centric model that tackles chronic disease earlier in its lifecycle, we must not only work on issues such as patient access, but also focus on social determinants of health. According to the Kaiser Family Foundation, health and well being are affected by a number of factors including genetics (30%), individual behaviors (40%), social and environmental factors (20%) and access to health care (10%). While genetics can be more complex to address, the other factors combined are responsible for about 70% of our ability to avoid the risk of premature death. With payment models evolving to a system predicated on value-based care delivery and data analytics enabling more efficient disease management efforts, the role of technology as a platform for change is both necessary and evident.
Envision the ability for clinicians to focus their efforts based on health indicators delivered via a dashboard on mobile devices versus the workflow associated with in-office patient care. Technology would allow teams to be proactive in patient management and engage patients based on a variety of organically collected inputs, such as exercise logs and grocery shopping habits. Helping patients understand how to better prepare meals and stay motivated to make healthier choices will be a core aspect of the technology, making it easier to support these goals. For example, the pre-diabetic who is diagnosed in clinic today is likely encountering a fog of advice about how to prevent progression to full-blown diabetes. Certainly a level of follow-up is inherent in our primary care system. But all too often, the focus is on reactive measures such as monitoring through periodic bloodwork rather than proactive measures that better define the steps the patient needs to take to avoid progression (and the importance of doing so).
The days of handing a patient a brochure and hoping they will comply are gone. Through technology, we can engage patients in real-time from anywhere in the world, then utilize algorithms, aggregation of data and mobile devices to help encourage healthy behaviors – and facilitate targeted interventions such as home visits and exercise with care team members when needed. It can be as simple as a patient taking a photo of a meal, or purchasing groceries with a smart phone.
In addition to the real-time passive data collection from patient activity and active interpretation by clinicians and care teams, technology also has the power to improve the convenience of accessing care. Obtaining the support one needs to achieve better health can be as easy as withdrawing cash from an ATM or booking a flight. Technologies that allow patients to choose how and when they access care, whether in person or virtually, are already proving useful. Some hospital systems are reporting goals of greater than 50% of outpatient care to be delivered via telemedicine modalities alone. However, the true value of technologies like telemedicine will be realized when care teams are able to achieve greater awareness of the home setting and provide interventions that solve real problems patients are facing. One example today is Care Lab, an initiative by Sidewalk Labs, which is an Alphabet company that is focused on addressing social determinants of health in urban environments.
A central part of the journey toward this new comprehensive management of patient health is the integration of data silos and different electronic medical records (EMRs) to create a single patient record at the top level. Avoiding redundancy in care delivery and improving accountability for outcomes across the system are the most basic initiatives that will enhance the benefits of new technology platforms. Yet this is only the first step in how technology will be an effective mechanism for improving factors such as food security, environment, poverty, language and many other social determinants proven to affect health outcomes. We will need to track and understand these factors before they can be adequately addressed – with flexibility to continue to adjust as data is attained.
A recent article in JAMA highlighted the issue of language and how it correlates to medication adherence in diabetics. Despite utilization of translation services provided by an interpreter or the clinician, adherence was lower in the non-English speaking group than either the English-speaking Latino or white patient groups. With technology, issues such as this can be far more easily addressed and adjusted to constantly better meet the needs of patients – regardless of language.
With issues such as trust and comprehension being centrally important in achieving patient compliance and engagement, technology stands to serve a role in creating care teams that are broader in composition than they have been historically. This includes an arriving era of borderless and constant care. While the treating clinician must remain a licensed provider of record, technology platforms that connect patients to clinicians in their home country can also prove valuable in overcoming barriers to health literacy among non-English speaking populations. Messaging and audiovisual applications will give patients greater access to culturally sensitive providers. It will mean health coaches and educators that are familiar with cultural traditions, food sources, and other unique factors exclusive to a patient's origin.
Beyond the barrier of language, we can now interject solutions to address other social determinants of health. For example, in communities where access to fresh, whole food is limited, technology can enable meal delivery to help address issues of food security and diet. Use of financial assistance could be done entirely digitally – where patients are able to receive treatment and care without opening their wallet or leaving their home.
Integration with the primary care team's goals is facilitated through a common portal and allows a new age of care coordination that serves to truly address the social determinants we need to solve. Barriers within patient populations of the past can be lowered through a range of very easy to use software applications and devices that are familiar to patients. Technology can now enable health care providers to intervene more efficiently and effectively across all the determinants that can affect health.
The critical factor that hospitals, health care providers, and technologists must be cognizant of and agree to is the need to develop these solutions with patient factors in mind from the start. A common issue among health care technology today is a lack of communication and collaboration between the various industries involved. Design must not be centered on the web/mobile savvy consumer alone, but also consider those who may not have owned a smart phone in the past, or who may need to rely on mobile connectivity due to lack of internet access in the home. Language, age, dexterity and other considerations must equally be involved, foremost between which is patient choice with respect to the user interface and how the patient will engage with the technology solution.
Ultimately there is incredible potential to more positively impact the health of our patients through the use of technology and greater awareness of the factors affecting health outcomes. With multiple stakeholders achieving greater alignment of incentives than ever before in our healthcare system, the future holds great promise and will be a time of substantial advancement in our ability to prevent disease progression.
By Vikram D. Bakhru, Physician, Serial Entrepreneur and Senior Healthcare Executive
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.