François-Marie Arouet, 18th century French author and iconoclast, better known as Voltaire, quipped that, "The art of medicine consists of amusing the patient while nature cures the disease." As the 21st century marches inexorably onwards, in the era of chronic disease, big data and mobile devices how prescient or outdated is Voltaire's assertion?
At the same time as Voltaire wrote in France, in the United Kingdom industrialization was taking the work of artisans and enshrining it in processes executed by humans and machines working in concert that were able to achieve greater productivity at higher quality and lower cost. I believe that in the 21st century, as vertiginous advances in computational processing, mobile devices and artificial intelligence collide with improved understanding of the genetic basis of disease and the interaction between genes and the environment, we are faced with the prospect of an "industrial revolution" in medicine. However at the same time, I believe that the art of medicine and of health IT remains, at least in part, to amuse the patient.
Over the festive season, as I had the pleasure of introducing my family and friends to our newborn daughter, I was also able to catch up on some clinical practice. It was good to be back in the saddle. The shared stories, the witnessing and investigating, even the perennial frustrations of tests gone missing and symptoms unexplained were old but new. "It's just like riding a bike," said a wizened physician who had previously taken a sabbatical. But this bike felt different. It was a little more difficult to steer at first, and then even as I became more familiar with it, a sense of curiosity with its mechanics remained. One new patient, an elderly man with puffy eyes and tough, squared hands said to me, at the end of a seemingly straightforward consultation, "whilst I am here doc..."
This classic refrain, familiar to clinicians everywhere, meant not only that I would now be running late but that I had passed the test of listening to, validating and sorting a teaser symptom and had been granted access to the inner sanctum -- the swirling world inside, with experiences felt but only partially understood. I feel that it is in this way that clinicians can uniquely add value. It seems that there is an enduring truth that the practice of medicine is about relationships, relationships are built on trust and trust is built on confidence. Or more mechanistically, in an ideal world, clinicians establish patients' confidence in their skills and humanity, on the foundation of this confidence they are able to build trust with patients and over time this fashions a therapeutic relationship that allows otherwise obscured problems to be revealed to diagnostic clarity and otherwise unacceptable perturbations to be willfully accepted by the patient and his or her family.
So, how, if at all, can technology help in building these therapeutic relationships? In spite of the aforementioned advances in medical science, the practice of medicine remains bespoke, reactive and notoriously costly. What this means is that individual clinicians, like artisans before the industrial revolution, create therapies de novo for each patient in response to that patient's individual complaints and largely through the medium of face-to-face consultation. On the one hand this is Cadillac care; however, the costs of practicing in this way are dizzying and the well-documented variability in quality and safety unacceptable. The recent incorporation of guidelines and process management into chronic disease care has improved quality and safety and enabled nurses, physician assistants and community health workers to join the chronic disease management workforce. However, all clinicians are still tasked with collecting, analyzing and imparting the information needed by an individual patient in a consultation as well as establishing and fostering therapeutic relationships. Due to resource constraints, even in the best performing centers, patients typically get one clinician contact per month.
It is important that technologists should work with clinicians to challenge this effective alienation of patients by the health care system. Low touch is simply not good enough for people who are in fragile situations, with complex needs, where the benefits of success and conversely the costs of failure are significant, who need daily and personalized support. The good news is that in clinical trials where mobile technology has been woven into the fabric of care delivery and used by clinicians themselves that patients respond and process efficiency and outcomes can improve.
In fact, a simple design principle emerges: Technology works best when it simplifies work that is not fun (such as medication adherence, disease monitoring and appointment scheduling) and enables human connections, which are. Simply put -- in a way that would hopefully make Voltaire blush, technology works when it amuses the patient and enables relationships: High tech works when it enables high touch.
Wellframe is a Boston-based Health IT company that has created a mobile platform for chronic disease management. This platform gives patients a GPS navigation system for their health that offers turn-by-turn guidance in order to empower patients to take control of chronic health conditions. Wellframe's Harvard and MIT trained team combines deep expertise in clinical medicine, consumer health technology and computer science. More information can be found at www.wellfra.me
Wellframe is one of the five Merck | Heritage Provider Network Innovation Challenge semi-finalists. The sponsors have called on entrepreneurs, data scientists, designers, health care providers, and big thinkers to create the products or services that will support patients with diabetes and/or heart disease in adhering to their care plans and ultimately improving health. Semi-finalists will be presenting their solutions at Demo Day on January 23rd in NYC. Check out their progress, watch their Demo Day presentations, and find additional open innovation challenges by visiting Health Data Challenges.
This blog series is produced in partnership with Health Data Challenges, creators of The Health Data Challenge Series, a formal initiative of the Health Data Consortium, powered by Luminary Labs. The platform seeks to foster the use of data to drive innovation that will ultimately transform health and healthcare through high-stakes innovation challenges. Learn more at www.healthdatachallenges.com.