I’ve just watched this interesting video of Lucien Engelen sharing his ideas at last months TEDxMaastricht and I can’t help think the problem is more fundamental than he suggests. Rather than just creating more data I think the task we have is how we begin to use and understand it properly. Here’s a few things the talk got me thinking about:
> The importance of listening to patients:
I really like this message and appointing a Chief Listening Officer is a great idea for healthcare providers. But the model of meeting someone in the Hospital who’s got a cup of tea or coffee and is interested in knowing “what’s up? how can we help you?” seems so typical of a healthcare process to me: Reactive to problems, potentially limited to the energy/availability of an individual, requiring the patient to feel confident enough to speak out about their care, etc.
Surely it’s better to use tools that enable us to start the process of listening before we even encounter the patient? A document that provides patients (their families and all their other carers) with their own written record documenting everything that’s been said and what’s been done about it?
Sure I can see mapped lists of AED’s that are accessible by an iPhone App or Microsoft Smartphone and leverage crowd submitted locations being cool but actually it’s real world contribution to our health today is uncertain for me. Instead of firing up an app what’s wrong with making a 911/112/999 call to emergency services? Here in Ireland/UK the emergency medical despatchers who manage these calls not only have this data on thousands of in-commuity and publicly located devices but they also have access to the reliable service records of these devices (no good going looking for a device that’s been removed or isn’t charged), are calmer and have clearer thought processes than the average citizen responding to a medical emergency, and have access to the contact details of responders who have devices and know how to use them.
> I’m not confident that patients are going to have the same confidence sharing their health data as publicly as Lucien:
Ignoring the potential privacy issues of public sharing of medical information I really wonder if we’d all find public comments conducive. What if my weight went up by 7lbs over the weekend and my ex-husband retweeted it to all his friends. What does that mean? What if my boss over looked me for promotion at a time when my weight was going north. What does that mean?
I find this is another classic case of technology not being the limiting factor. Back in 2005 the Nokia Wellness Diary could be used by patients owning basic mobiles to submit the readings from the screens of their medical devices to an EHR. Okay so a WiFi blood pressure cuff and weighing scale from Withings may be cooler and easier to use (once set up) but there’s little evidence that there’s wider patient interest or healthcare provider support for this.
From my experience I can’t help but think that the step change is so significant that there is a huge opportunity for a whole new layer of health coach services that remote providers like us will be well placed to serve.
> eHealth will continue to fail so long as it’s reactive:
In Lucien’s video the patient story (seen in reverse in the video) actually starts with the young lady collapsing with a heart attack. I think the real opportunity started a long time before this and technology has an important role in helping us start this story earlier by showing patients the information and charts that they need to truly be “captains of their own ship”. Unlike Ship Captains, who ensure routine services and maintenance are taken care of before setting out on journeys, patients are typically just reacting to situations that more than likely started developing a long time ago.
I’m confident that Technology provides a key to a lot of this and by next year presenters at events like this will be demonstrating CardioNet style solutions that move the timing of the incident back by several hours. In 2013 we’ll probably have presenters demonstrating predictive health monitoring services that move the timing of the “incident” back by a weeks and months. Then it gets really exciting.
This is key to why I think the future is mHealth and not eHealth. For considered, behaviour modifying preventative strategies patients need to start engaging long before it all starts looking like a healthcare service.