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Can’t We All Just Communicate?

A colleague of mine, Jonathan P. Weiner, Dr.P.H., was kind enough to forward an article he wrote which was recently published in the Israel Journal of Health Policy Research. Jonathan is a Professor of Health Policy and Management and of Health Informatics as well as the Director of the Center for Population Health Information Technology at the Johns Hopkins Bloomberg School of Public Health. His piece reviews some interesting survey results of Israeli citizens and healthcare professionals from other articles within the same issue of the journal, describes a graphic model of the “digital practice milieu,” and poses some important questions that should be asked and answered even as the “digitalization process” is underway.

A fascinating disconnect between the communication preferences of consumers/patients and doctors emerges from the data reviewed in the article:

  • 88% of patients believe that access to their doctor’s personal cell phone number would improve the patient-physician relationship… but only 2% of the doctors are willing to provide their number;
  • 71% of patients would like the physician’s personal email… but only 3% of the physicians are willing to provide direct access to their email account;
  • If reimbursement and/or organizational structure were changed, a majority of physicians indicated a willingness to adopt these “new” communication tools;
  • 74% of the patients surveyed accessed e-health tools through the Internet, but only 19% shared that fact with their physicians, though 78% wanted their doctor to provide guidance about how to use the Internet to help improve their health.

If communication is about connecting, the preceding statistics would suggest that physicians and consumers in Israel are not close — and the Israeli health system evidently isn’t providing the appropriate motivation for healthcare professionals to consider changing. While changes to the health system and reimbursement might accelerate such consideration — as we’ve seen here in the United States with HITECH — some health professionals might harbor some reluctance because of concerns about the unintended consequences of technology implementation. The following quote is attributed to Bill Gates:

The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.

Effective communication with patients/consumers/families/caregivers is critical to providing good healthcare — but it is fairly complex even before applying new modes of communication. We know all too well that with regard to basic office procedures and processes, many clinicians and their teams don’t give enough thought to redesigning workflows to leverage new technology. If we don’t fully understand the needs and preferences of the parties involved in communicating, have a health system that adequately supports new models of communication, and can anticipate how technology might affect communication, we may be in danger of achieving Mr. Gates’s second rule of technology.

A recent article in JAMA a few weeks ago by Elizabeth Toll provides additional caution. The article includes a drawing by a six-year old patient of her visit to the doctor. I encourage you to take a look at this young person’s honest and disturbing perception of the encounter.

Dr. Weiner precedes his list of “critical challenges and knowledge gaps” with the following statement:

Given that clinician/consumer communication and interaction is at the center of most e-health and HIT activities, before new technology can become fully ingrained within our health care systems, we must delineate, understand, and resolve many issues that surround this nexus.

Here is a brief recap of some of the 10 challenges and knowledge gaps Dr. Weiner encourages us to address:

  1. How will e-health impact traditional communication and interactions between clinical professionals, healthcare systems, consumers, caregivers, and communities?
  2. How can we shift from the past medical model of the 15 minute face-to-face, one clinician/one “patient” interaction, towards the concept of population health and wellness support in place 365 days a year, 24/7?
  3. How can we ensure that the disparities associated with a “digital divide” can be surmounted in order to target the benefits of e-health to those with the greatest need (who currently may have the least access)?
  4. In an e-health environment, how can the “inter-personal” human-to-human connection be maintained or even enhanced?

The full article is freely accessible online.

What do you think are the “challenges and knowledge gaps” that health systems researchers, clinicians, patients/consumers, and other healthcare professionals should be evaluating in the United States? Will Meaningful Use objectives related to patient engagement help or hinder progress in this area?

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.


One response to "Can’t We All Just Communicate?"
  • September 18, 2012
    Michael S. Barr, MD, MBA, FACP

    iHealthBeat today included an article summarizing the results of a Harris Interactive survey which showed the disconnect between the preferences of patients/consumers for web-based health care services and the lack of availability of such support.

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