Connected Health: Technology First or People?

For some reason of late, I’ve noticed the tagline of the automobile insurance company, Esurance. In case you haven’t seen it, it goes like this:  “Technology when you want it, people when you don’t.” When I first heard this, I thought it would be a good tagline for connected health.  Then I pondered further and wondered if in healthcare, the goal should really be “People when you want them and technology when you don’t.”  The premise here would be that in healthcare we are different and that the human relationships are sacrosanct.

In a way, the tagline as they’ve stated it, is emblematic of how many service industries have transformed. We happily do our own travel planning online, pump our own gas, buy groceries with automated systems, check ourselves in online or at the airport and draw cash out of machines. However, when something goes wrong with any of these processes, we want to talk to a person at our convenience.  Think calling your telephone service provider for tech support and being frustrated as you navigate phone menus.

We haven’t really gone that way in healthcare (though I did check myself in by Kiosk when I went to my PCP for a visit recently).  Is it because healthcare really is different and the human interaction is critical to success?  It is not so simple.

My favorite mind bender example of why not comes from my friend and colleague Tim Bickmore who is a professor at Northeastern University and works on relational agents (  We collaborated with Tim to show that a relational agent coach was powerful in terms of sustaining improved walking behavior in an experimental cohort. He has also shown that patients who are preparing for discharge from the hospital prefer getting their discharge instructions from a computerized agent as opposed to a person.  The reasons cited are that the patient never feels stupid in front of the computerized agent and that the patient doesn’t feel time pressure. They can ask the same question over and over until they learn the answer.  This is at least one well-documented case where technology is preferred over people.  However, I’m guessing that if you asked the next 100 folks you bumped into if they’d prefer a human interaction for their healthcare vs. technology, they would default to the human interaction.

This conversation has come up recently in a well-written book by MIT professor Sherry Turkle (Alone Together) as well as other discussions by the likes of Dr. Jerome Groopman and Sustainability by Design Author, John Ehrenfeld.  In different ways, all three do some hand wringing over what, to many, is a troubling concept – that we might be forced to substitute technologies such as caring robots for people in healthcare’s future.

There seems to be a gulf between what people worry about and what they prefer.

This brings me to an important point.  There is a difference between what people say that want/need and how they behave.  My favorite example of this comes from an article written by Steven Lohr in The New York Times.  He refers to the unveiling of the iPad in 2010 and a journalist asking Steve Jobs what consumer research was done to aid in its development.  “None,” Mr. Jobs replied. “It isn’t the consumers’ job to know what they want.”  This is such a critical concept for true innovators to grasp.  At least half of their job is to show the market what the market did not appreciate it needed.

The truth of the matter is that we don’t have enough healthcare providers to meet the demand for services that exists today.  The demand continues to go up and we are not training more providers.  Also of note, is that for most healthcare installations, human resources represent between 60-70% of costs, so increasing the human resource burden, even if we could, would not be a viable solution.

I think the right healthcare slogan should be the same as Esurance, “technology when you want it, people when you don’t.”  But our charge as connected health entrepreneurs is to create solutions that offer our patients such a compelling experience that they choose technology over people, whenever it makes sense.

Examples of this beyond Tim Bickmore’s work include our experiences at the Center for Connected Health with blood pressure self management. where we showed that folks on a 6  month blood pressure home management program with automated web-based coaching had improved blood pressure compared to a control group.  This concept was taken by the talented team at Healthrageous to a whole new level using machine learning to create a unique experience for the healthcare user that draws them into their care and keeps health top of mind.

I hope you are all on board for this incredible task. The overwhelming sense of both providers and the average patient is that human beings are required to do everything in healthcare. If we’re going to solve the $2.3 trillion problem and keep the quality of care high, we have to show them a different way and use technology to substitute for some tasks where we now use humans.