Welltok's CTO on designing healthcare technology to feel like it isn't there

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In a sense, healthcare has been playing catch up for the entire modern era of medicine, focusing on diagnosing and treating retroactively instead of anticipating illness and fighting it off before symptoms appear. But it's not just physicians who dream of prescribing tools that proffer prevention rather than cure, it's also those that design the technology underlying the patient experience.

What if instead of solving problems for high-risk patients after they become high-risk, providers could work with patients before they became-high risk in the first place? That's the question that crystallized for Brian Garcia, chief technology officer of Denver-based Welltok, after he analyzed the mountains of healthcare metrics collected in today's patient-physician interactions.

"Many want to turn it around — change healthcare from a largely episodic-oriented system that tends to be highly paternalistic to something that empowers individuals to invest in their own health," Mr. Garcia says. "If we could do that, it would create sustainability for patients' personal health and reduce the amount of people that become high-risk."

A big contributor to that game of catch up is lagging technology — not news for anyone steeped in the logistical care delivery issues plaguing the post-millennium industry. Where other sectors have surged forward with intuitive platforms, programs and applications, healthcare largely flounders, unsure of how to increase adoption among hospitals and physicians as well as the patient population. One reason is the limited role healthcare technology was initially designed to play. EHRs, although widely used in hospitals, are viewed by some as nothing more than a glorified billing system and by others as the most powerful tool to come on the scene so far. They are an ideal example of a tool developed to work within the system, but not to assist the people working in that system.

"EHRs are very good about codifying an encounter with a patient, but they tend to be less good with actually helping care for the patient," Mr. Garcia says. "[They were] designed to integrate with the system, but not designed to respect the human-to-human connection that is really important in healthcare. Technology can't intrude on that relationship, it needs to enable it, then fade into the background."

Beyond technologies implemented on the provider side like EHRs, many hospitals have a difficult time getting patients to download apps or use other forms of mobile health tools that could help with engagement. Mr. Garcia says putting such a heavy focus on adoption, rather than the ability of a technology to improve the patient experience, may be preventing healthcare from reaching its full potential.

And it's not just about what technology looks like from the patient perspective, but how it makes patients feel about their own health. Healthcare data is often used as a way to personalize an experience, but Mr. Garcia says that's troubling for a couple of reasons.

Firstly, patients are not their conditions, and overloading them with data about their conditions doesn't define who they are. Secondly, so much of that data is generated by a system that tells patients, what to do, when to do it, and often how and where to do it.

"What I think is important in the personalization world is how we understand the personal characteristics of an individual, which are often derived from family relationships, the things I like to do, where I live — those things actually drive my behavior, not healthcare characteristics," Mr. Garcia says.

Using the human perspective to drive changes in personalized care is everything from thinking critically about where to put the computer that runs an EHR in the exam room, to asking patients what is important to them in the long-term and designing technology to work more invisibly toward those specific goals. Even though many providers feel at the whim of the technology they're forced to use, patients still opt to seek care from the physician that looks them in the eye and has a conversation with them rather than the one who reads questions off of a screen.

Mr. Garcia uses the analogy of a concierge in a hotel someone might frequently visit as technology's role in a physician's visit. As soon as the guest walks in, the concierge knows who they are, what they like to eat or which paper they like to read, and the concierge is facilitating all of that, making it happen without the guest even knowing.

For drivers, this type of experience exists with apps like Google Maps, which routes around traffic and accidents without even notifying the driver that it's happening.

"I use those apps going home from work. It's technology that helps me achieve the goal of getting home quickly to my family — that's the highlight of my day," he says. "I think if we can take that same design principle in the healthcare space we will have an opportunity to change quite a bit." 

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