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Societal Impediments To Connected Health

November 29, 2010

Two news pieces I read over the weekend reminded me of the societal challenges we face implementing connected health. Through our work at the Center for Connected Health, as well as the good work of others, we now have enough proof of concept to know that connected health can be a powerful strategy to improve self care as well as just-in-time care when a provider needs to be engaged.  Yes, there are still some technological hurdles to overcome, particularly in the ‘ease of use’ category, but with the increasing adoption of smart phones as well as the ubiquity of low cost, powerful, miniature sensors, the technology hurdles are all but solved.  Likewise, I used to worry about provider reimbursement as a hurdle, but the boulder of payment reform is now rolling down the hill. Everyone knows it is a matter of when, not if, we move to a provider payment system based on quality and outcomes.  This should pave the way for connected health adoption.  So what is left?

Two, things, best I can tell. One has to do with our instincts that somehow we’re better off being served by a person than a machine. It seems quite deep rooted.  This was called to mind when I read a piece in Saturday’s Wall Street Journal called, “Self-Service Nation Ends at Garden State Gas Pumps.”  This article recalls the days when gas was pumped by a service station attendant.  Remember that?  I can, vaguely.  I’ve long since converted to the convenience of pumping my own. Pull up, slip in your credit card, pump and away you go. Convenient and easy.  The same has happened in the airline industry (when is the last time an attendant checked you in for your flight?) and of course in banking with ATMs.  It turns out there are still a handful of states that prohibit self-pumping of gas, assuring that filling station attendants still have a job.

The WSJ article does a nice job of compare and contrast with the high touch attendant model vs. the convenient pump your own model.  I’ve often said that healthcare delivery would be improved if we could empower patients in the same way they are at the gas pump (in the majority of states), the airline check in or the ATM machine. In each case, you can find a human being to interact with if you want. But the vast majority of us feel liberated with the choice that self-service brings and do not resent doing the work that was once done for us by others.

We already have several examples demonstrating that patients bonding with a computerized relational agent can lead to improved health. I call this emotional automation.

In a connected health world you could do your own blood pressure check (maybe even adjust your own medication), as well as a handful of other tasks now reserved for a visit to the doctor’s office.  As I hear rumblings that some states are trying to assert their individuality and not adhere to the Obama healthcare reform plan, I’m conjuring up an image of the equivalent of the filling station attendant in New Jersey, except he’s wearing a white lab coat insisting that you come to the office for even the most mundane of transactions because it is a state law.  Not an inspiring image, to be sure.

The second roadblock is much more insidious and has to do with our libertarian roots.  In Sunday’s New York Times Magazine, Judith Warner writes about the challenges of fixing childhood obesity in a piece called “Junking Junk Food.”  Here the theme is how the far right, represented by Sarah Palin and Glenn Beck, insist it is our right to consume as many calories as we like and any infringement of that right is an example of too much government and too little choice.

To quote Beck, “the choice architects” of the Obama administration, believe “you’re incapable of making decisions. . . . Left to your own devices, you’re going to eat too much, you’re going to be a big fat fatty.”  This is disconcerting.

A big part of the success of connected health is engaging people about their illness with measurable data and holding them accountable to improved health goals.  Our experience at the Center for Connected Health suggests that those libertarians who are unhealthy know it, believe it is their choice and want you to stay out of their lives. They will have worse health outcomes and cost the system more.

The logical conclusion of the choice architects would be to insist they pay more of their own health care bills. Think they’d go for it when they are stricken by sugar diabetes or recovering from their first heart attack or stroke?

One news story that just wouldn’t go away this week was the brouhaha over airport screenings.  Again, the theme was ‘you can’t make me.’  It is an invasion of privacy to keep the population safe.  The theme here is the same.  As a society, we feel the right to personal freedom trumps our obligations to society as a whole.  In the case of health, that mantra would go something like, ”I have the right to mistreat myself even if it is going to cost society more to pay for my health care bills as my health deteriorates.”

This may be the toughest nut to crack for connected health.

10 Comments leave one →
  1. November 29, 2010 10:17 pm

    Interesting take on the second point. I don’t know that being unhealthy is strictly a Libertarian viewpoint… but I’ll bite. 😉

    I’m a big fan of connected health, but it isn’t a panacea because it will never cure the indifference that a percentage of the population (Libertarian or otherwise) will always have toward taking care of themselves. I’m with you on finding that to be a horrible reason to not progress, but I also think that it’s OK. Our job right now is to find the early adopters and then iterate until connected health reaches the mainstream. Not to solve everybody’s problems out of the gate. 🙂

    Finding the initial audience, of some scale, is job number one. And it’s heartening to know that there are examples out there today that have made millions of people healthier.

  2. Kamran permalink
    November 30, 2010 1:13 pm

    A huge nut to crack are the interest groups that want you to eat more sugar, lots of dairy products (since it’s good for you no matter how much you consume), lots of fruit juice (same reason), etc. It is very difficult to combat the continuous barrage of advertisements that in essence tell you to keep eating and eating. Wouldn’t it be great if all subsidies from the all government were cut for sugar, cheese, etc and redirected to education on healthy diets …

    • December 3, 2010 5:56 pm

      nice to hear from you, Kam. i was in Spain this week so out of touch and responding late

  3. December 2, 2010 6:11 pm

    Let’s leave reimbursement and licensing to future discussions and look at acceptance and adoption. Any change is met with resistance. Your example of the airport screening process is a good one illustrating how we react when someone suddenly forces something upon us that we don’t understand. However, the predicted cahos over the Thanksgiving holiday never materialized once the public better understood the reasoning for it, not to mention the fact that most people were motivated to get to their destination as soon as possible.

    As advocates for the new technologies neglecting education for those who will be most affected by them is a serious oversight. Speak to those not favoring change and it becomes apparent that this is a major issue for most providers. Costs are a significant factor, but so are the disruptions to routine necessitated by a different approach.

    What do we ask when one seeks to sell us new products or services? Will it make money? Save money? Save time? Improve efficiency? Make the job easier? Offer protection re legal and regulatory issues? Greater outreach to providers at all levels and in the environment in which they operate can hasten the change we seek.

    Recipients, i.e. patients, have generally been positive to technology changes, as noted in many studies over the past couple of decades. It saves them time, effort and money, so what’s not to like? By and large we don’t see the same provider for all of our health needs, so that’s become much les of a barrier.

    Changing lifestyle habits presents an entirly different challenge. How many decades did it take to effect a significant reduction in the smoking population and to change the perception of smoking from being a socially acceptable habit to an unacceptable one in most locales? Still a significant number of folks stand out in the cold and rain just so they can indulge their smoking habit/addiction. The healthy diet and regular exercise required for one’s own benefit is general knowledge. However,following this advice comes with greater difficulty.

    Patience and reward over haste and punishment will carry the day in the long run.

  4. Nut Jobs permalink
    December 7, 2010 11:27 pm

    A huge nut to crack are all the nut jobs in Partners’ hospitals waiting to degrade you and deny you care. I would recommend spending money on training doctors and taking patient complaints seriously, rather than “getting connected”. Who would want to connect with one of your abusers? Social media is just another malignant marketing device to distract consumers from the huge profits and bad outcomes of our malignant medical system.

    • December 8, 2010 11:42 am

      In the spirit of transparency, balanced reporting and the first amendment, I am keeping this comment as posted. Of course I disagree and believe there is a great deal of evidence to contradict your assertions. But as they say, it is important to embrace diversity of opinion.

      • April 25, 2011 10:07 am

        Walking in the presence of giants here. Cool tnhkinig all around!

  5. December 8, 2010 1:51 pm

    Slinging mud on the wall is kid stuff, making it stick is something else. Therefore if a negative comment has merit, it would be helpful for its author to render the details leading to their conclusion.

    Open discussion on the pros and cons as we insert new ways of offering patient care benefits everyone. Surely not every new approach will be as positive as originally thought, but suggetions for modifying a process, device etc. is how we grow. Slams without explanatory details produce little value.

  6. Michael McGarry permalink
    December 8, 2010 5:36 pm

    Self serve systems seem to work well when the need is urgent and the choices are simple. My car is on empty and I have three choices for gasoline (none of which are “wrong” choices, except diesel perhaps) – perfect setup for self serve. If; however, the customer was asked what percent octane they need in their fuel from a range of 5 to 100 and filling your tank with the wrong octane level had serious consequences for your engine I think we would see the number of self pumpers decline dramatically. Same thing for ATMs – good for taking out and depositing money, but you don’t see much demand estate planning at the ATM machine.

    In healthcare, it seems the view of the typical user is that most questions are complex. Of course the helathcare community is partly to blame for this, but I don’t believe we can underestimate the value of education in overcoming this myth. I am continually surprised by the healthcare consumer that has taken very little time to understand or improve their health yet expects a low cost and convenient health care system to address their issues. Individuals must be more accountable for understanding and managing their own health. Without a doubt a “connected” health system can empower the individual by providing decision support and user specific information at the time of decision.

    A second challenge I see is different from, yet related to the first. Because of the latency between poor health outcomes and poor health behavior it is very easy for people to put off to tomorrow what they might do today. In a society that seems to prioritize daily activities based on the level of urgency; smart health decisions usually fall to the bottom of the list. Again, I don’t think the typical consumer is fully to blame here. Considering the relative ease of finding “4 out of 5 experts” to recommend just about anything how can we realistically expect the right choice to be made? I would agree with those that strongly favor personal choice above all else that individuals should be responsible for their own decisions/actions. Yet this only works if the person making the decision has honest information and a solid understanding of the consequences. Unfortunately, in the capitalist/consumer society we live not all product companies are providing the whole truth and nothing but the truth about their products/services. So the consumer needs to be better informed about the decisions they need to make, and yes, a connected health system can provide tremendous support in this area as well.

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