There’s a video featuring the Kaiser Foundation that I found one day when I was perusing YouTube for insight on how the vision of the hospital has morphed over time. The video, which projects a 1950’s glimpse of the "ultra-modern hospital" offers the promise of all things streamlined and expedited, and includes amenities ranging from advanced lighting fixtures that promise no shadows during surgery to sliding baby drawers that provide mothers with easy access to their newborns (an idea ahead of its time as far as maternal-infant bonding benefits were concerned).
When you watch this video now, more than 60 years later, there’s something comical about the predictions provided. Still, at that time, I can imagine how this vision would have seemed Earth shattering. In the 1950s, the first color televisions and McDonald’s appeared so it’s not surprising that things like remote control doors could really "wow" the general public.
Let’s fast forward to where we are today, however. As a chief medical information officer and clinician, I’m tasked with keeping my finger on the pulse of what’s happening both in health care and in the real world as it relates to advancements in technology. Now, more than ever, these two worlds are colliding. The consumerization of health care has begun and the idea of doctor as driver and patient as bystander is nothing short of archaic. Today, the clearly demarcated lines between patient and caregiver are becoming blurred as patients are tasked with stepping up to the plate and actively engaging in their own health and well-being.
As we catapult into this new era of health care, I’ve been thinking a lot about what the massive shift to value-based care—or care that’s focused on quality, efficiency and outcomes vs. volume—will mean for physicians and patients. More so, I’ve been reimagining patient care. In an effort to focus and share my vision, I’m offering my thoughts on the hospital of the future and the top three transformations that will drive the next generation of patient-centric care.
Issues surrounding the usability of electronic health records (EHR) continue to surface despite federal mandates that clearly state that this transition isn’t really optional. To demonstrate how mainstream these EHR frustrations have become one only needs to take a brief jaunt to Twitter and search #EHRbacklash. Part of the frustration rests in the fact that doctors are forced to fit their patient data into drop down menus and point-and-click options. There’s clearly something missing within that approach to documenting a patient story. Moreover, EHRs and the typing that goes along with them, act as a barrier between the patient and doctor. Instead of encouraging interaction and engagement, technology has become a concrete wall between patient and caregiver.
So what’s the solution? It involves taking a page out of the consumer technology world. The idea being that mobile virtual assistants, like Siri, but built with medical-specific speech recognition, language understanding and artificial intelligence could shoulder the burden of these usability frustrations for physicians. In essence, streamlining how physicians interact and navigate the EHR at the point of care, while also simplifying access to data within the layers of information hidden in the system. Perhaps most importantly, this type of intelligent virtual assistant could allow physicians to turn away from the computer or tablet and engage the patient in the creation of their own record through a conversational user interface that listens, captures and creates the digital record in a natural, human way.
The Internet has put vast amounts of data into the hands of today’s generation and it’s given us the ability to access data anytime, anywhere. As a result, patients waiting for surgery are likely consuming videos and advice via YouTube and Facebook before their doctor has even taken the time to walk them through the surgery, related recovery and what they’ll need to do to get their life back to normal.
So what does this mean for hospitals? It means they need to find a way to be more relevant and integrate web-based patient education and social media in a more cohesive fashion. As a result of this need, I think we’ll see more hospitals embracing everyday consumer technology advancements that you and I have come to expect – from text-message reminders about medication best practices to easy access to digital portals that allow patients to own their health information, ask questions and actively participate as part of their own care team.
Moreover, the move to the quantified self (we all know someone with a Fitbit or FuelBand) and the rapid uptick in mHealth app adoption will further encourage patient ownership of their own health which will, over time, likely eradicate some pressure and cost from our health care system. In essence, the consumerization of health care will shift more responsibility to the patient. This will force hospitals and the doctors who work in them to find new, more social ways to educate and engage their patients in order to ensure they have the information and tools needed to make smart decisions that ultimately impact their own lives.
Part of this movement to shift responsibility to the patient means hospitals, which have for years measured financial success based on the number of filled beds, will have to adjust to a new health care system that values empty beds and healthier patients. I know, this seems backward, and it is, which is why the government is driving change through the Affordable Care Act.
As a result of this massive overhaul in the approach to how hospitals get paid, I’m seeing an interest in new approaches to care that focus on keeping patients out of the hospital. One company driving this approach is Sense.ly, an avatar-based telehealth platform that enables continuity of care for chronic diseases, leading to improved patient outcomes and reduced costs.
According to the Centers for Disease Control and Prevention, chronic diseases contribute to seven out of 10 deaths every year in the United States. Data also shows that the largest volume of readmissions occurs among patients with chronic disease and more than 75% of health care costs are in fact attributed to chronic illness. Sense.ly helps address these systemic issues by enabling patients to manage their chronic diseases through a telehealth platform offering access to home-based behavior and medication services and consultation. The telehealth market, which is slated to impact 1.8 million patients worldwide by 2017, compared to 308,000 today, offers a glimpse into what the most profitable hospitals of the future might look like—empty.
When I think about where health care is today and how hospitals look and feel in this day and age, I think back on the 1950’s "sliding baby drawer" mentioned earlier. Mostly, I know that someday, someone in my same CMIO and MD shoes will think how silly it was that doctors actually hand-typed patient notes; that consumers didn’t know the number of steps they walked in a day or how much it actually cost to get hip surgery; and that people actually drove to see a doctor face-to-face vs. simply speaking to them over the television or computer. When I think about all of these things and the tumultuous changes impacting patient care, I can’t help but wonder what our generation’s version of the sliding baby drawer might be.