Where Secure Text Messaging, Social Media, and EHR Converge
Nuclear fission is when an atom’s nucleus has too many protons or neutrons, becomes unstable, and splits. Fission is a good metaphor for what has happened to the technology used by physicians and patients in healthcare over the last few years.
Let’s consider technology available to the general public as protons, and technology available to care providers as neutrons. There has been an explosion of consumer health and communication technologies over the last few years—lots of protons. Many patients have adopted these technologies. By contrast, the development and adoption of medical applications has been slower—not so many neutrons. This has caused the nucleus of healthcare apps to split and evolve into two separate worlds.
Here is a patient’s world: An active social media user, a patient uses apps regularly on her smartphone. She posts a video to her Twitter feed. She mentions a few friends to notify them all simultaneously and also hashtags a couple of topics to share the video with people around the world. Next, she quickly toggles to the Health app on her smartphone and uploads data to the cloud, which tracks her diet and overall health, while her smartwatch collects data about her daily activities, charting her personal health trends over time.
Here’s the hospital’s world: A patient is waiting to be admitted to the hospital. A nurse calls the operator to page an admitting physician then waits for a call back. The admitting hospitalist is caring for another patient and returns the page after minutes or an hour to discusses the case and approve the admission. The ED physician is now occupied with a patient and unable to attend the call. The admitting physician either wastes time waiting on the line, or hangs up to and the cycle of phone tag continues.
Today, patients and physicians live in very different worlds. Physicians live in the cumbersome world of electronic health records (EHRs) and complicated clinical monitoring systems. Most patients live in the agile world of consumer mobile apps. Consider that a consumer can now press a button on a $5 device the size of a key fob to order just about anything on the Internet, while hospitals spend hundreds of thousands of dollars to implement and integrate nurse call systems. Somehow it seems like the typical consumer lives in a superior world. So, why the disconnect?
When World's Converge
Consumer health and social media apps have transformed our daily lives by connecting us to the world around us. Like it or not, most of us interact with our mobile devices more than any other object or person. This constant connection between most consumers and the mobile device provides an unprecedented opportunity for personal and public health—an opportunity that many healthcare organizations are struggling to even begin taking advantage of. The future of technology in healthcare will be marked by a convergence between the world of the patient and the world of the clinician.
An Institute of Medicine report, written more than 15 years ago, already attempted to predict a better future which we haven’t yet fully achieved in healthcare. The report included 10 rules for healthcare redesign. One rule stated that: “Knowledge is shared and information flows freely. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.” Another states: “Cooperation among clinicians is a priority. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.”
The future of messaging will hold an interconnected network of health solutions and a collaborative platform where patients and care providers can share information. The experience for the patient in the hospital will simply be a continuation of their experience with technology at home. As Preetha Reddy, managing director of Apollo Hospitals said in a PricewaterhouseCoopers Global CEO Survey: “There has to be a consistent acknowledgement of what technology can do in terms of healthcare delivery. We have to invest in it and find ways and means to be extremely cost-effective in taking the point of care from within the hospital system to the doorstep of the consumer.”
The Center of the Universe
The patient needs to become the center of the universe in healthcare. Unlike traditional healthcare workflows and technology, which revolved around the physician, new(er) systems are being designed to revolve around the patient. This more recent view of the universe within healthcare requires a shift in the way technology is implemented and used to communicate with patients. As discussed in an article published in the Journal of General Internal Medicine envisioning primary care in 2020, “Patient-centered care is a key component of a health system that ensures that all patients have access to the kind of care that works for them.”
Putting the patient at the center of healthcare means fundamentally changing core processes, workflows, and technologies. Healthcare messaging systems of the future must be adapted to a patient-centered environment. Instead of architecting systems that enable care providers to look one another up and send point-to-point messages, systems should be architected to enable care providers to look up patients and post status updates to a collaborative feed. For example, such a system would let care providers open an app on a mobile device, look up a patient, and post status updates to a patient feed (like a Facebook® wall) with a few physician tags to notify them, and hashtag drugs or diagnoses to trigger actions in the EHR system. Patients would be able to post to or read from the feed directly. Wireless devices like pulse oximeters and nurse call buttons would also trigger posts to the feed. The feed would contain a holistic view of the patient’s personal status timeline, which could be accessed anytime and/or fed into the EHR.
Let’s consider another hypothetical scenario: It’s a few years down the road and you are a patient in a local hospital with a heart condition. Wireless devices collect data from you and automatically post it to your patient feed, so your care providers can see updates regarding your status. A nurse receives a notification on her tablet. She sees some readings in your feed that concern her, so she tags a physician who gets notified and can take a look at the readings and other recent status updates in real time. The physician sees nothing alarming, but mentions you in a message to check in. He also hashtags medication for the nurse to administer and goes on evaluating the patient he is currently with. A few days later you go home and open up the Health app on your device where you find instructions from your doctor. You take a reading from your wireless pulse oximeter and upload it to your feed. You go about your day as your device continues to collect data and upload it to your physician in real time.
This kind of integrated collaboration between the patient and the care provider isn't far away. The patient already lives in this world, and the next few years will bring the physician into the world of the patient. Technologies like consumer health apps and social media are re-defining how we look at communication in healthcare. The future of messaging technology in healthcare will be all about putting the patient at the nucleus of every conversation and making sure relevant communications remain undivided.
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