Technology’s Role in the Doctor-Patient Relationship

Technological advancements have drastically changed the way the healthcare industry operates. Significant breakthroughs in the acquisition of data, research tools, and treatments have given medical providers and physicians more effective tools, more ways to treat their patients, and new information with which they can practice medicine. Technology has made several aspects of life easier, both in real life and in the medical field. But when it comes to medicine, some professionals would also argue that some aspects of the job have become more difficult as computerization becomes more prevalent. With all the new apps and technology, what is the physician-patient relationship these days?

Deliver Patient Value Through Technology

“Patients and physicians alike are confused and disoriented by the new digital world, even while being empowered by the knowledge they can impart,” writes Kent Bottles, MD, the former Vice President and Chief Medical Officer of the Iowa Health System (now known as UnityPoint Health). “These cutting-edge technologies have the potential to improve a patient’s healthcare experience dramatically, but to get there, we first have to engage in some good old-fashioned talk.”

That conversation is one of balance. How can medical professionals utilize new technologies, research, and methods while still ensuring that the nature of care delivered is centered around patients and their needs?

The digital age has deeply changed the patient-medical staff relationship — in some ways for the better and some ways for the worse. Every day, people use the internet to Google their symptoms, self-diagnose, and learn about new treatment options or better ways to manage their ailments — sometimes to the chagrin of their doctors.

In the same vein, the internet has provided a means for healthcare providers to have access to the latest in medical research and treatments and have access to resources that can aid them in continuing their education, all at the click of a mouse.

Similarly, the internet can allow practitioners to better connect with and understand their patient base, from learning how to become more culturally competent, to understanding the refugee experience and how trauma affects health, to learn how to spot signs of emotional distress in minors that may make a difference in their treatment.

“When physicians understand the cultural backgrounds of their patients and themselves, they can engage patients more effectively and provide better care,” write researchers at the Alpert Medical School and School of Public Health at Brown University.

The internet is just one-way healthcare providers can access information to become more culturally aware of improving the doctor-patient relationship.

While internet-based technology has become a source of information for many, it has its limitations. The internet acts as an easily accessible library of sorts for patients and doctors alike, granting them access to data-driven information and research; the internet can also be a well of misinformation.

 

Medical Information Accuracy

“When it comes to medical information, inaccurate or irrelevant information could potentially have a major detrimental impact on our well-being,” Jalees Rehman writes in a piece for Scientific American.

His piece, which explored the accuracy of online search engine results, found that an alarming number of websites contained inaccurate information. When researching the accuracy of pages about Sudden Infant Death Syndrome, for example, “Only 43.5% of these 1300 websites contained recommendations that were in line with the AAP recommendations, while 28.1% contained inaccurate information and 28.4% of the websites were not medically relevant.”

Doctors and patients alike would do well to recognize that the internet is a tool that can help inform care and increase collaboration between patients and doctors. Today, patients are more literate and are ready to take charge of their care. But to combat misinformation, doctors can use disruptive technologies to help patients better understand and comprehend their conditions.

Patient Education With Voice

Researchers have recently discovered the enormous potential in digital recording, for example, to help prevent misinformation. While this technology has been available for anyone with access to a cell phone for quite some time, doctors have begun to transition to professionally produced recordings.

“A simple cellphone recording enables a patient to remember important information better or to share it with family members,” writes Dartmouth Institute researcher Glyn Elwyn, MD. Together with Paul Barr, Ph.D., and Sheri Piper, Elwyn wrote a research paper highlighting the potential of digital recording to improve healthcare. “Next-generation professionally produced recordings can be used to develop and further patient and family engagement, shared decision making, and research.”

Elwyn, Barr, and Piper also note that this technology could be a way to help combat physician burnout. When digital recordings are coded correctly, it will significantly reduce the amount of record-keeping that doctors must do, which typically accounts for over 50 percent of a practitioner’s time.

Bedside Education

Doctors are also embracing the idea of changing the ways that patient bedside education functions overall. For decades, patients were given brochures or told about their conditions through hurried bedside conversations. It’s an education system that many argue has less than ideal outcomes.

“The bedside education that is given in the paper is usually not consumed by the patient–they’re either throwing it away, or they just forget about it,” argues Nick Patel, MD, medical director of clinical informatics and medical director of Midland Internal Medicine, Palmetto Health-USC Medical Group. Together with Ben Schooley, assistant professor of health IT at the University of South Carolina’s College of Engineering and computing, Patel is studying the effectiveness of patient education and working on ways that technology can deepen and improve the patient experience.

“We want to look at the next generation of education at the bedside that’s more consumer-friendly and see if we can improve outcomes and reduce readmissions, and, more importantly, really just improve adherence to their medical regimen,” Patel continued.

In this study, Patel and Schooley aim to provide their patients with touch-enabled devices that run Patient Nexus software. From there, patients and educators will be surveyed about the implementation and whether or not the effort improves the quality of patient care.

“We want to close that gap when it comes to the time they spend with a physician and with a whole care team,” Patel said. “Physicians, with the time they have going in and out of rooms every 15, 20 minutes, they’re not able to sit beside and give this content as they would like to. I think it empowers the resident care team to take a bigger part in providing that education and extending what the physician might have already started a conversation on.”

It’s a practice that Dr. Richard Milani, chief clinical transformation officer, and cardiologist at Ochsner Health System in Louisiana, has implemented in his hospital.

At Ochsner, where Milani practices, for example, patients are given iPads that allow them to see who their care staff is, which medicines they are being prescribed, their schedule for the day, and test results as they happen in real-time. They are also permitted to use their iPads to record conversations with doctors that can be played back later to family members or help them remember.

While he doesn’t believe that these new advancements should be viewed as quick fixes, he thinks that this technology, in particular, can radically improve the patient experience.

“Technology is not the answer,” Milani said in a recent panel about the role of technology in the patient experience.  “Technology is an enabler towards a better patient experience and better patient engagement.”

Doctors and medical professionals must center the human element of healthcare to improve the patient experience. Technology can be a tool used to make the patient experience easier.

For the best patient outcomes, doctors must balance using these disruptive technologies to increase good outcomes and maintain a meaningful and trusting relationship with their patients.

Technology’s Effect on Clinical Efficiency

Though the intent of the EHR was almost certainly to increase transparency and promote efficiency, computerization and government oversight have increased the amount of “busy work” that medical staff must attend to, rather than focusing on information that is the most meaningful. It can also sometimes prevent patients from receiving quality care.

“A senior colleague who was hospitalized for a longer spell, a person whose scientific and technological discoveries have helped transform care in virtually every hospital, told me with some chagrin that during his stay, the only people who got to know him as an individual human being were the nursing assistant and the housekeeper,” Abraham Verghese wrote for The New York Times. “The nurses, through no fault of theirs, were tethered to the COWs — Computers on Wheels — into which they entered data about him.”

Verghese went on to ponder what might happen if the opposite were the case. What if the technology was used to give nurses a big picture? What if the bedside informatics were used in a succinct and summarized way for the medical staff to use so they could focus on the holistic aspects of the patient?

AI usage in Modern Healthcare

With the use of AI, doctors may be able to overcome the cumbersome aspects of the EHR in a way that benefits both the caregiving staff and the patient.

Artificial intelligence technology can help automate processes using speech recognition during a visit, allowing doctors to record each detail that the physician and the patient communicate about. From there, the AI will feed them directly into the EMR, freeing up a large chunk of time for hospital staff.

This technology affects data collection and can also be fed into an algorithm that will ultimately improve the quality of care in some ways. For example, doctors can use predictive analytics to treat high-cost and life-threatening conditions.

This has practical benefits. Recently, doctors at the University of California, San Francisco, were able to use AI analytics extracted from EMRs to help treat Clostridium difficile infections.

Similarly, a team of researchers from the John Radcliffe Hospital in Oxford, England, developed  Ultromics, an Ai diagnostics system that is more accurate than doctors diagnosing heart disease.

Not only do these new technologies improve patient care and diagnosis, but they also help the hospital’s bottom line.  

“These AI diagnostics systems save lives by providing an earlier diagnosis of heart problems and lung cancer. They could also save money that could then be put toward anything from hiring more doctors, nurses, and hospital staff to new equipment,” writes Kyree Leary, a journalist at Futurism.

Timor Kadir, chief science and technology officer of medical tech startup Optellum, agrees that his company alone could cut healthcare costs by nearly $13.5 billion. In Europe, he believes that his program could help to save the NHS by cutting costs by nearly 50 percent.

There are positive and negative aspects of the EHR. Though the EHR can drastically change the way scientists and researchers treat disease, it also has a dramatic impact on the patient and doctor experience. It will be necessary for medical staff to find more meaningful ways to use this information which puts the patient at the center, without overburdening an already busy hospital staff.

Technology Outside the Clinical Environment

Wearable technology is a trend that has experienced tremendous growth in the past few years. According to an IHS Technology report, the worldwide market is expected to sell nearly 466 million mobile sensors by 2019. It’s a trend that medical professionals ought to embrace.

Mobile sensors provide a wide range of uses, such as monitoring medication dosage, analyzing heart rate and blood pressure, reading glucose levels, and measuring diet, exercise, and sleep patterns. Though these are all possible to track without technology, mobile technology allows the user to consistently and acutely monitor and take charge of their health.

“Mobile apps for smartphones are changing the way doctors and their patients approach medicine and health issues,” writes Vincent DeRobertis, Senior Vice President of Global Healthcare at Research Now. “Patients with heart disease can send information about their heart rate straight to their doctors, accessories allow diabetics to monitor their blood glucose levels by sending results straight to their smartphone, and nutritionists can see trends in patients’ caloric intake and exercise patterns.”

Understanding this, many patients and healthcare professionals have turned to technology to help monitor their health and maintain a healthy lifestyle or track unhealthy patterns between checkups.

In fact, according to Mobi Health News, many doctors view mobile apps in a positive light, believing that they will make their patients more informed, more healthy, and more empowered to make medical decisions:

• 86 percent of healthcare professionals believe mobile apps will increase their knowledge of patient conditions.
• 76 percent believe apps and trackers will help patients with chronic diseases.
• 72 percent believe mobile apps will encourage patients to take responsibility for their health.
• 61 percent believe they will help those at risk of developing preventable diseases.
• 55 percent believe they will help patients who are already healthy maintain their health.
• 50 percent believe mobile technology increases the efficiency of patient treatment.
• 48 percent believe they can help patients who are recently discharged from the hospital.
• And 46 believe that apps have the potential to help them improve their relationships with their patients.

Self-Collected Patient Data

Patients are gathering data about their conditions. DeRobertis continued, which allows them to improve their health ultimately, and may help reduce the number of times they need to make return visits to their physician. Overall, he argues, there are real health benefits of wearable technology that can improve patients’ quality of life.

While wearables and health-related technology have a reputation for being used by athletes and people who are generally healthy, new technology is being adapted and created all the time to help people no matter their level of health. Many of them are highly specialized.

For those suffering from extreme allergies, for example, doctors may choose to recommend investing in devices that help to detect traces of gluten or peanuts in their patient’s foods.

Other forms of tech can be used to detect diseases before they get out of hand potentially. Cyrcadia Health recently released a device called the iTBra. This device–worn as a bra insert– monitors circadian metabolic changes in heat that correlate to accelerated cellular activities common in breast tumors. This data is then sent to a PC or mobile device that can be easily shared with physicians. Not only does this impact individuals who are concerned about developing cancer, but it can also be a tool for cancer survivors to detect abnormal growth.

Similarly, these devices can be used to track heart health. KardiaMobile recently created a device that helps to track atrial fibrillation in patients. Traditionally, tracking atrial fibrillation required a trip to the emergency room for an electrocardiogram. Still, this new mobile technology allows patients to place a small set of finger pads near their phone, which will then take a 30-second reading. From there, it announces whether the heartbeat is normal or whether a patient might be experiencing atrial fibrillation and can send those results to physicians. This technology is a diagnostic alternative to the traditional method, which requires patients to wear a vest monitor worn at all hours of the day for weeks at a time.

As apps and technology improve, healthcare professionals will look at data regularly rather than once a year. Overall, wearables can affect a paradigm shift in medicine, transforming the patient-doctor experience from one that is based on an encounter to one that is continuous and focuses on the patients’ overall well-being.

Technology and Access in Rural Areas

 

In rural areas of the United States, finding accessible healthcare can be a challenge. Economic factors, cultural and social differences, educational barriers, and distance make rural healthcare more difficult to access and promote.

In many rural areas, there are also fewer doctors and fewer hospitals that are readily available. And in an age where there are already physician and nursing shortages, these areas are hit the hardest. In Mississippi, for example, there are just 186 physicians for every 100,000 individuals.

At the same time, rural hospitals are in trouble. Between 2010 and 2016, more than 48 rural hospitals closed, and since then, an additional 283 can potentially meet the same fate.

Technology and specifically the advent of telehealth and mobile health, is helping to bridge that gap.

A 2012 report by the Institute of Medicine for the National Academies found that “telehealth drives volume, increases the quality of care, and reduces costs by reducing readmissions and unnecessary emergency department visits for rural communities.”

By utilizing telemedicine, these rural hospitals can more effectively serve their rural patients at lower costs while at the same time helping to cut down on the time it takes for rural patients to receive care. This is especially important for rural patients who require specialized treatment.  

In using telemedicine, rather than waiting for a healthcare professional to travel to a remote area or requiring a patient to travel what can amount to hundreds of miles round trip, this practice allows for remote consultations far more efficient than a traditional appointment.

Whether these appointments are annual checkups, following up on regular conditions and symptoms, or asking their physicians questions, remote consultations can drastically improve the patient experience while also ensuring that hospitals remain profitable.

“Patients also save money—and time—on transportation. Between 2012 and 2015, UPMC Northwest in Seneca, Pa., did about 2,000 telemedicine visits, saving patients about $233,000 in travel expenses,” writes Rachel Z. Arndt, a contributor at Modern Healthcare.

Remote Monitoring and Telehealth

Telehealth companies like Teladoc, American Well, MDLIVE, Doctor On Demand, and others have existed for quite some time, but recent updates in technology have made telehealth more accessible. Those technologies include:

• Healthcare apps
• Healthcare websites and portals
• Wearable technology
• Camera and smartphone technology
• Digital ophthalmoscopes
• Digital stethoscopes
• Digital otoscopes
• Wearable biosensors
• Other monitoring devices

This kind of technology also expands opportunities for individuals who need highly specialized care to receive treatment from the physicians most equipped to do the job.

Telemedicine helps bridge gaps in healthcare that prevent Americans from living their best and most healthy lives and ensures that doctors and hospitals are receiving financial benefits. It’s one of many ways to focus on the patient’s needs, and use technology to provide that care can make medicine more effective and better for both the doctor and the patient.

Technology is an aspect of medicine that is here to stay. Over the past few decades, advancements in medical technology have led to medical breakthroughs that have ultimately saved millions of lives. But that’s not to say that there aren’t still challenges to overcome. By finding a balance between technology and patient-centered care, medical professionals can continue to innovate while still placing the patient and the practice first.

Image credit thanks to Pexels.