The humanity in health technology

Innovative technology is integral to clinical medicine and yet healthcare has traditionally lagged in its adoption of technology into patient, operational and business intelligence spaces.

In some locations we have stubbornly continued to build 100-year-old hospitals with little in the way of technological nervous systems and we are left with staff and patients who use technology more effectively at home than they do in our hospitals. Inevitably then, healthcare workers are constrained in their ability to deliver safe, timely and consistent care and patients are unable to engage effectively with their own health journey.

One of our great strengths in healthcare is in our highly intelligent, educated and motivated workforce and so when the system fails to deliver technological solutions, our clinicians will initiate solutions of their own. The result is often a fragmented mix of non-integrated niche systems that dangerously complicate the patient journey.

Adding urgency to the conversation is the rapidly changing consumer population. Baby boomers traditionally presented to health providers to find a solution to their health challenges, but this model is evolving. The millennials are driving their own health outcomes from an early age, for instance, many are deciding how they will eat, exercise and work towards their health goals, and conversely, they are informed as to how they will proceed if illness strikes. This group seeks to partner with their providers and has clear expectations of maintaining control of all healthcare decisions, with advice from expert clinicians. This will significantly alter how they seek to connect with their physical health environment through technology.

Younger patients are now demanding connectivity within the hospital on a par with what they experience outside. Electronic patient portals enable consumers to feel in control and informed with the ability to schedule appointments, complete patient education or interact with their health record.

To this point, the biggest piece of health technology with which patients have had to contend is the upside-down call button. An article by Dr Val Jones, MD, the president and CEO of Better Health, ranked the upside-down patient call button in the top 10 hospital design features most disliked by patients¹; few would disagree.

The classic and largely unpopular 'upside-down hospital call button'.

But as we integrate technology into hospital design, we must be mindful of maintaining the balance between the natural and comforting environment that evidence suggests is best for healing, with the more high-tech and potentially sterile environment that we sometimes see depicted as the hospital we will inhabit in 25 years.

Depiction of the 'Patient Room 2020' from design collaborative from NXT Health. Are consumers and clinicians really ready for this?

Clinician involvement

There has been an industry built advising on the topic of clinician engagement; how do we make clinicians care about great ideas and systems we have paternalistically designed for them? The answer lies within the question; clinical staff should co-design their own solutions and then the need to retrospectively engage dissipates. Yet too often clinicians and patients are an afterthought in the system design process as we build them a new database or radiology system; build it and they will adapt... they will whine, but they will adapt.

At times technology can lie uncomfortably with the art of medicine where decisions don’t always follow neat algorithms. Many early clinical review and prescribing systems were unable to tolerate this intuitive dimension of medicine. Clinical technology must be programmed to accommodate flexibility and at times ambiguity in order to still deliver a human health experience.

More than just stakeholders need to be consulted; it is patients and clinicians who will inhabit and breathe life into a health system and will ensure its success or expensive failure. The decades of collective corporate intelligence held within staff allow for the avoidance of pitfalls and for the discovery of innovations not imagined by engineers. Clinicians must become co-creators of the design and the supporting models of care thereby ensuring the sense of engagement and ownership critical to integrating technology into the human side of healthcare.

Primarily, health technology must contribute to the healing of our patients and it must be intuitive and kind to our staff; it must facilitate the humanity of healthcare. If this is our primary objective and is facilitated through our staff and patients then other desired safety, reliability and efficiency gains will inevitably follow.

References

Jones V. The Ten Worst Hospital Design Features: A family member’s perspective. July 21 2012. Better Health. http://getbetterhealth.com/the-ten-worst-hospital-design-features-a-family-members-perspective/2012.07.21

Dr Victoria Atkinson is a cardiothoracic surgeon and the Chief Medical Officer and Group General Manager Clinical Governance at St Vincent's Health Australia. Victoria also has EDAC certification in evidence-based design from the Center for Healthcare Design and is interested in the role of hospital design in influencing measurable clinical outcomes.