It’s time to embrace new technologies to improve patient care Sheilagh Foley
NOTNobody likes change. When the first Sumerian pulled out a wheel, I’m sure most people thought “Oh for Babylon’s sake, would you look at your man’s yoke with the sandals on after you’ve rolled”. Guess we all have to have one by now! Flippin ‘lula with the hula.’
But change is essential to evolution. Although I dread the day when my daughter will let go of my hand and dodge my public embrace, it’s inevitable and a healthy progression. If we’re still “hand in hand” as she climbs through the teenage hellmouth, God help us all. The future is fast and fluid – so get your hoop out before a teenager tells you to.
I recently learned that being a “futurist” is a job. In an age where peer pressure skills can land you million dollar influencer deals, I wasn’t completely surprised to learn that choosing to follow in the frightening footsteps of one Ghosts of Scrooge was a respectable career choice. Futurists collect signal data and predict plausible futures. At a time when generations are scattered across the spectrum, futurists can help companies predict which way the needle (or digital gauge) might swing.
Futurists predict that our health and wellbeing will go digital, and that it will move faster than an 800mph electrically levitating hyperloop train from San Francisco to Los Angeles (they also predict). I may struggle with change, but I don’t want to be left behind. I plan to come on board, are you?
Leaving aside, for a moment, the world of wearables, from your smartwatch to your connected toilets (it’s a thing), my concern is the doctor and patient journey. In twenty years, maybe even ten years, will we still pick up a phone and make an appointment with a GP with the [insert description of choice] Secretary? Are we going to patiently wait for a phone call/letter to let us know that the Gods of the Lists have finally ripped our name off the anonymity sheets and called us in for the long-awaited procedure? Are we going to rely on a badminton game of letters from Doctor X to tell Doctor Y that Doctor Z has the ABC on our 123 at the old infirmary?
Or will we jump, jump and jump (broken legs and all) in the world of online medicine where Dr. Al Gorithm reigns supreme. The doctor’s receptionist is a portal; a bodily cacophony of his character where test results, reports, appointment information, medical history, medication list, illness history, hospitalizations, doctors consulted, etc. are all just a click away.
I first experienced patient portals in America when I registered my daughter with a pediatrician. Along with filling out swaths of information in triplicate, I was also handed a piece of paper with a web link and password (God forbid they email it to me, I also used the word “web link” so maybe they thought I was gently aged). I initially ignored it for weeks, as I do most slips of paper handed to me, but when my due date came around, I dug it up.
When I entered this portal, my mind was blown, especially because I used it as an excuse to say the word “portal” out loud several times. I felt like I was embarking on an adventure through time. The information was pretty basic, probably because my daughter hadn’t been born yet, but over the years it was quickly filled in – immunization records, her milestones noted, and past illnesses (when she had pneumonia and I had to take him to the hospital, brings me an old lump in my throat).
As my phone became an important member of my family, the portal became an app and multiplied. I diversified my portfolio of health issues and collected applications for various hospitals. The letters were drying up, everything was now electronic. Because I have kept a large dinosaur foot in the past, I often asked for the results to be sent to me by letter. It somehow feels more official, more real. Of course, forms had to be filled out, in triplicate. In an ironic suicide/murder pact, paperwork will be the death of paper.
On my return to Ireland, I registered with various doctors, always asking for portals or apps, only to be met with blank stares and suspicion. A secretary quickly replied, ‘A portal? He’s a medical doctor, not a Dr Who! I felt like a Sumerian, shamefully hiding the steering wheel behind my back.
I understand that it can be expensive to implement new technology and difficult to educate an older population on a new way of doing things. But I’m afraid the HSE is like the lumberjack in the woods chopping the log with a dull saw. As the story progresses, a lady appears and suggests he sharpen the saw to speed up the work, but the woodcutter says he “can’t stop now because it would take time for the cut”.
Progress can still be made. St James’s Hospital was the first to introduce electronic patient records; they will never return to Manila madness. Level up St James’s and submit an application.
I’m afraid healthcare is following the path of banking, where the dinosaurs failed to invest in technology in time and where the ‘new kids on the block’ crypto banks rushed in with fandangle apps and sophisticated financial technologies. Don’t let private money and Big Tech dictate what happens next in healthcare. I appreciate by its very nature and the demands placed on it that HSE is not a nimble and nimble operation, change is not easy, but it will happen – whether we like it or not.
On a recent visit to the UK, I discovered, to my surprise, that NHS Digital has taken the UK masses by storm and is shoving its way into a digital No-Man’s Land. I am being cared for by a hospital in London for one of my old cancers, so I had the pleasure of going straight to the NHS patient portal. In my experience, it works well. Prior to the portal, appointment changes were common, letters notifying me of the change would get lost, arrive late, or not arrive at all. Now whenever something changes in my portal, I get a notification email. I have all my notes handy for easy reference.
There are significant benefits beyond the ability to book an appointment. This online presence can also identify people designated as “extremely vulnerable” to Covid or the flu. This can facilitate a smooth and equitable deployment of vaccines. It could be used in a call for cancer screenings, given that in the modern mobile world, people may no longer live at the address where their appointment letter for a three-year Pap test arrives. Getting an SMS, email, app notification (and postal letter) seems more common. Perhaps the next leap in technology is to sync your wearable devices with your doctor/hospital’s app, a well-honed algorithm could alert you that it’s time for a doctor’s visit.
However, not everyone falls in love with the digital switchover and their reasons are understandable. An English parent has pointed out that his NHS GP has switched to ‘online services’, so to book an appointment he has to fill in an online form with 51 questions! From the vague ‘Are you in pain?’ to the annoying ‘Do you have pain elsewhere?’ to the somewhat Benny Hill question: “Do you have numbness in your buttocks?” ending with the ironic and accusatory tone ‘Is there anything else you would like to tell us?’ post-scripted with a final, ending ‘Do you take drugs?’
Speaking of numb buttocks, I found myself the center of a post-Christmas family roundtable on virtual medicine. I was the only promoter. One of the feelings was the loss of the personal touch – replaced by a series of automated text messages, links and messages to search emails and fill in this and that online, all of which could perhaps be captured and handled via phone call or in-person chat. Let’s not overlook the importance of humanity and relationships.
I am strongly in favor of in-person medical appointments and the connection and familiarity they can encourage, which is valuable for both parties. But an accessible digital file is also beneficial. I think it can level the playing field between the patients themselves, allowing the quieter cohort to pull a chair up to the table that’s usually reserved for frequent travelers. In addition, it can relieve the doctor, especially in this period of “personal responsibility”.
I agree that we’ve all become immune to emails and texts, engulfed in boredom as excitement continually presses against our phone screens distorted into smiley faces and party hats. But despite hacks and global pandemics, progress continues. As an old Sumerian said, “If you’re not behind the wheel, you’re in front.”