At best, technology supports and improves human life; at its worst, it alienates, isolates, distorts and destroys. -- John Naisbitt, author of High Tech, High Touch
We live and practice in an increasingly technology-driven society. Email and texting are default methods of communication, and our patients request that we friend them on Facebook and follow health advice delivered in brief 140-character bursts on Twitter. In a 2008 survey conducted by the Commonwealth Fund, nearly 90 percent of respondents indicated they wanted their physicians to communicate electronically. Patients want high-tech doctors. But they also want more face-to-face time, more personal connections; let's call it "high-touch" care. The 21st century buzzword is patient-centered care (PCC), defined by the Institute of Medicine as "care that is respectful of and responsive to individual patient preferences, needs and values." PCC reaffirms the doctor-patient relationship as a key to improving both clinical outcomes and cost-efficiency. There exists a common perception, dating back at least as far back as the Industrial Revolution, that the increasing reliance of society on technology necessarily furthers human disconnection. In the evermore complex world we inhabit, how do we reconcile our high-touch values with our high-tech realities?
I am convinced we can have it both ways, but only if we heed Naisbitt's warning. Technology is neither bad nor good. It is how we use the tools we develop that determine this outcome. In no industry is this more evident than medicine. Preliminary research suggests a high-touch, patient-centered medical home model leads to better health at lower cost. More encouraging data is in the pipeline, too, as the Patient-Centered Outcomes Research Institute (PCORI, funded through the Patient Protection and Affordable Care Act of 2010) is actively supporting work to elucidate which models are most promising. Can technology enhance patient-centered care? Yes, by facilitating communication and connection, the keys to promoting healing relationships. Let's examine several innovative high-tech/high-touch initiatives.
1. Patient portal: athenaCommunicator (athenahealth)
I've been a huge fan of athenahealth since 2008, when I decided to go with their cloud-based practice management/EHR solution for my new practice, the Whole Child Center. At the time, I was really impressed by athenahealth's ability to improve my clinical and administrative efficiency so I could spend more time doing what matters: being with patients. But with the subsequent addition of athenaCommunicator, their superb web portal product, patient-centered care took center stage. Patients can now update health and demographic information, request appointments and prescriptions, receive test results, and communicate via secure messaging. Greater access has led to more efficient communication and more satisfied patients. I find emails preferable to phone calls; the conversation is more fluid and continuous. Office visits are much more enjoyable, as I can simply be present, not feeling pressured. We review what is happening now as opposed to everything that's happened since the last visit. My relationships with my patients are enhanced by the ability to communicate more efficiently.
2. Clinical tool: emWave2 (Heartmath)
In primary care medicine, most of the tools we have at our disposal are for diagnostic purposes. I've got some cool stuff to check eyes and ears and even a new-fangled electronic stethoscope. But my favorite gadget by far is about the size of an iPod and more powerful therapeutically than most pharmaceuticals I prescribe. It's called the emWave2, and it's a handheld biofeedback device that monitors heart rate variability (HRV) simply by placing your thumb on the device or by attaching an earlobe probe. HRV is a biological reflection of how our heart rate changes from beat to beat in sync with our breathing. The more in sync, the more "coherent" our HRV. Higher coherence is associated with more effective stress coping. I use the emWave2 to teach patients with conditions like irritable bowel syndrome and chronic headaches how to be aware of when they're stressed (different colored lights reflect better or worse HRV) and learn tools (e.g., yoga, meditation) to improve HRV. One of the central tenets of PCC is empowering patients to make sustainable changes in behavior, leading to better health outcomes. Mind-body strategies like biofeedback are among the safest and most effective methods to give back patients control over their health.
The rise of social networks like Facebook and Twitter highlights our society's desire to reconnect and share stories and information in new and interesting ways. A 2011 QuantiaMD survey found that 87 percent of physicians use social media personally, while 67 percent use it professionally. Practitioners who have embraced this technology are now able to address not only the individual information needs of a single patient but can deliver messages instantaneously to an entire community. I maintain an active Facebook page linked to my Twitter account. Recent posts/tweets include notices of interviews/articles related to my book, health news about vitamin D, a video on how to make a DIY natural hand sanitizer, and a request for baby supplies for victims of Hurricane Sandy. The opportunities for connection -- and for action -- are endless in this new world of doctor-patient communication. Social media should be interactive and participatory. While I do not give specific health advice publicly, I welcome posts by patients wishing to share information, resources and events. We've created a virtual community with far greater reach than my brick-and-mortar practice ever could.
The new media have caught on for a reason. Knowledge is increasing exponentially; human brainpower and waking hours are not. Fortunately, the Internet and information technologies are helping us manage, search and retrieve our collective intellectual output at different scales, from Twitter and previews to e-books and online encyclopedias. Far from making us stupid, these technologies are the only things that will keep us smart. -- Dr. Steven Pinker, Professor of Psychology at Harvard University
Lucky for me, Dr. Pinker was my undergrad advisor at MIT. I learned from him and my other mentors there that technological advances must be tempered by humanism. With this in mind, I have chosen to profile scientific solutions that facilitate, not hinder, connection between doctors and patients. As we are challenged to make the most of the time we spend together, our relationships -- powerful healing tools in and of themselves -- can be deepened through the selective use of high-tech solutions to support PCC initiatives. The Agency for Healthcare Research and Quality June 2012 report, "Enabling Patient-Centered Care Through Health Information Technology," that "significant evidence exists confirming the positive impact of PCC-related health IT applications on health care outcomes." The future of health care is in fact dependent on reemphasizing time-tested, old-school values inherent in PCC through the use of modern communication tools. If we are to move forward, it must towards a hybrid high-tech, high-touch system that does not shun the use of technology but instead embraces the challenge of mindfully utilizing our best new technologies to optimize health care.
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