Telehealth evangelist, Joseph C. Kvedar, MD, is creating and deploying a digitally-enhanced model of healthcare to streamline quality patient care outside of traditional medical settings. He is Senior Advisor, Virtual Care at Mass General Brigham, Editor-in-Chief of npj Digital Medicine, Professor of Dermatology at the Harvard Medical School, author of “The Internet of Healthy Things” and “The New Mobile Age: How Technology Will Extend the Healthspan and Optimize the Lifespan”. Let’s talk about the vision and reality of connected health.
Dr. Kvedar, you are involved in developing a new model of healthcare delivery in order to move care from the hospital or doctor’s office into the day-to-day lives of patients and their homes. Could you please explain how connected health should look like in practice?
The ultimate goal is an integrated experience for the consumer or patient where digital touch points intersect logically with in-person interactions. If you, as a patient, need a healthcare service, you should reflexively reach first for your mobile device.
There you will probably connect with a chatbot, but that bot will be informed by all of your clinical data as well as consumer data from your phone, activity tracker, etc. The bot can sense if you need a person and, if not, will guide you through a process to get to the right care for you, whether it be in-person, virtual video, urgent care, etc. Other features would be integrated, such as way-finding and publishing wait times for urgent fare centers.
Within the Partners Connected Health, you have also launched numerous innovative digital health programs, and you’ve seen what works and what doesn’t. Would you please share some initiatives or case studies that could be used as a blueprint in other health ecosystems?
Two things are key, to oversimplify. One is ease of use of technology. Consumers expect easy-to-use technology and when it comes to health, any excuse to NOT engage with the technology will be taken. The second one is engagement. We’ve learned that engagement has to be exceptionally well-done in the digital health space.
People often compare to apps such as Facebook or Candy Crush—it turns out, once again, that engaging patients around their health is much harder than engaging consumers around a game or shopping experience. Some of the tools that we’ve discovered are successful in terms of patient engagement include personalization, making it about life (rather than sickness), social connections, using unpredictable rewards, subliminal messaging and the sentinel effect.
In your latest book “The New Mobile Age: How Technology Will Extend the Healthspan and Optimize the Lifespan,” you claim that “health tech innovations will create a better and more responsive healthcare system for everyone.” How can tech help fix broken healthcare? And why can’t we achieve better care using classical interventions? Finally – what can technology and people do better when they team up?
Tech can help fix broken healthcare chiefly through enabling “one to many” care models. If we design the system right, your first interaction with the system will be with a bot or symptom checker. Based on remote monitoring data coming in from all corners about you, systems will proactively reach out to keep you on a healthy path enabling providers to intervene only when the situation is complex enough to require human intervention.
“We must free up technology to do what it does well – capture and analyze data – and enable healthcare providers to focus on the human elements: caring, emotional intelligence and judgment.”Dr. Joseph Kvedar
You also describe how artificial intelligence, vocal biomarkers, facial decoding and social robots will analyze emotion, anticipate health problems, improve quality of life and enable better relationships with healthcare providers. Do you think it’s what people want? Will new generations be more ready for more health monitoring and control and – as a result – less privacy?
This is a matter of how we design the system. If we create it so that people feel that their privacy is invaded and they get nothing in return, that will not be well-received. However, if we design it – as the online retailers have – so that when you give up private information you get caring, convenience and good health in return, people will be willing to make that trade-off.
During one of your TEDx speeches, you called to create integrated care supported by the internet of healthy things to be more like Uber as we conduct patient care. What do you mean by that?
I like the analogy of Uber vs. traditional taxis when applied to healthcare. For decades, we assumed that a taxi was the only choice we had. Drivers became complacent with their hold on transportation and service quality eroded. They used different tools to keep us hooked on their platform like unions, monopolies, etc. Then, along came Uber and Lyft and – with a combination of digital technologies and attention to convenience/service – upended that industry.
Healthcare has lots of parallels. Providers take their market for granted. Our attention to customer service/patient experience is nil. Thus we are ripe for disruption as the taxi drivers were.
The tools to create a “one to many” model of care are already here: wearables, EHRs, health apps, telecare, robots, AI, etc. However, they rather offer fragmented support instead of a continuum of care. How to create a new seamless care experience?
This is a critical question. All of the data generated from your phone/wearables, etc. is not normalized or standardized. This is an important step. The second step is the AI algorithms to process it and generate predictions you need to stay healthy. The third step is understanding what motivates you as an individual and using those levers to encourage you to stay healthy.
Digitalization in healthcare differs from digitalization in other industries. It’s about embedding empathy, emotions, ethics, closeness, communication, support on every stage of care, whether we talk about patients with chronic diseases or the elderly. Do you think telecare, powered by automation, can offer a better experience than on-site visits, which have different dynamics?
Yes, with caveats. If the care required is complex and has high emotional intelligence requirements, in person is probably better. On the other hand, if it is routine, simple decisions and the patient has a long-standing relationship with the provider, “digital-first” is probably better.
What are the projects that have been absorbing you in the recent months?
I’ve been working with my colleagues at the American Telemedicine Association to insure that the gains we made in telehealth adoption during the first phase of the pandemic stick. This is mostly about policy, advocacy and education to all stakeholders here in the US.
What is the “call to action” that you would like to address?
If you are a provider, allow yourself to embrace new ways of caring for your patients that involve digital tools. If you are a supplier, innovate to help us achieve the “one to many” care model. Finally, if you are a patient, stand up for your rights—demand access, quality and convenience as well as continued multi-channel healthcare delivery.
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