As a primary care doctor in San Francisco and Silicon Valley, I have been searching for the holy grail of patient engagement for more than 15 years. My journey began with an alpha-numeric pager and a medical degree. I shared my pager number with my patients along with a pledge to call them back within 15 minutes, 24 hours a day. My communications evolved into email and texting, with the predicate that by enhancing communication, I could carefully guide my patients down the byzantine corridors of health care -- with a high probability we could avoid mistakes -- if they would agree to share the ownership of their treatment plan. My life's work has been where the rubber meets the road, where doctors interface with patients: office, hospital or smartphone.
Technology has washed over almost every industry and transformed it radically. Health care is on the precipice of destiny. The wave is here.
Over the past three decades, health care has lurched from one existential crisis to another, often manifested by an acronym solution: HMO, ACO, PCMH, P4P, PQRS. Each a valiant attempt to reign in costs and solve for aligning incentives. However, we can't have hospitals, doctors, health systems and payers accountable to healthy outcomes if the 300 million people are not paramount to the equation.
If you haven't been paying close attention, "patient engagement" is a white-hot topic in health care these days. It wasn't sexy five years ago. In fact, in his keynote speech at HIMSS 13 (the national health IT conference), thought leader Dr. Eric Topol announced that: "The blockbuster drug of the 21st century is patient engagement."
While the mantra is strong, the industry seems to conflate "patient engagement" with "consumer engagement," which in my view are two distinctly different propositions. Consumer engagement is predicated on the fact that there is choice, a free market and low barriers. As consumers, we can pick up a Fitbit bracelet to monitor our exercise activity and sleep patterns, perform an in-home ECG screening with AliveCor's iPhone Heart Monitor, or self-assess symptoms and find an appropriate doctor using the iTriage website.
These products represent the innovative eye candy that dominates the headlines, but I'm here to tell you that none of them are the killer app for patient engagement. They are all-important pieces of the puzzle, but the kernel of transformation lies in tapping into one of the most undervalued assets in health care: the doctor-patient relationship. Consumers who strap on monitoring devices and crawl the web for solutions without the guidance of a doctor are heading down a path toward anxiety -- and likely more questionable consumption of health care resources. The always-available Dr. Google enables anyone to self-diagnose, but what consumers don't realize is that Dr. Google is an oncologist that often lists cancer as one of the possibilities... more anxiety.
Patients engaging with themselves are a noble aim, for sure; however, coupling a patient to their doctor throughout their health care journey is simple, elegant, and necessary. Essentially, we need a clinical CRM (or PRM -- patient relationship management). On the surface, this may seem like an improbable proposition, as many doctors are already suffering from chronic EMR fatigue syndrome, overloaded schedules and diminishing payments. They don't want yet another solution.
Taking human physiology as a metaphor for complex systems (in the spirit of biomimicry), excess sugar in our food supply can cause metabolic syndrome and ultimately diabetes -- which extracts a huge drag on the body in terms of aging and pathologic opportunities. Our health care system is no different; excess technology and proprietary solutions have caused a digital opacity syndrome and ultimately a health care system of balkanized cash vacuums, people suffering unnecessarily and finger pointing. Health care is the diabetes of our GDP.
When technology understands what people want from health care, our system has a chance. This is not about what the system wants for itself, and it's not about what "consumers" want for themselves; it's what makes the most sense to achieve the ultimate outcome: a healthy population at the most efficient cost.
We need a new angle, a new dimension, something simple and human that provides demonstrable value, both in the short term and the long run. The good news is that we're at a once-in-a-generation moment in time where great change is upon us... and where there is great change, there is great opportunity.
We need a new health care operating system, one that enables shared ownership between all parties and where innovative ideas fit together like Legos. The four walls of medicine and the millions of telephones that occupy the space between doctors and patients must evolve. It has failed to scale. Grab the eraser and let's start all over. Please.
I have a few ideas. Perhaps the next blockbuster drug of the 21st century is physician engagement (wait, what?).
Stay tuned for the next blog on physician engagement.
Dr. Jordan Shlain is physician and founder of Healthloop, which uses technology to help physicians, health plans and self-insured employers connect with patients in a new way. They have an 80 percent patient "opt in" rate. He has been active in the digital health community for many years as an advisor and investor. Dr. Shlain regularly speaks about the next evolution of healthcare including in to policymakers in Washington, D.C. He is a board member of the bi-partisan Hope Street Group and will be speaking in Washington next week at the American University Executive Healthcare Policy forum as well as the 4th Annual ACO summit discussing Strategies and Technology for Innovative Payment Models. He can be reached at @DrShlain.
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