Two news pieces I read over the weekend reminded me of the societal challenges we face implementing connected health. Through our work at the Center for Connected Health, as well as the good work of others, we now have enough proof of concept to know that connected health can be a powerful strategy to improve self care as well as just-in-time care when a provider needs to be engaged. Yes, there are still some technological hurdles to overcome, particularly in the ‘ease of use’ category, but with the increasing adoption of smart phones as well as the ubiquity of low cost, powerful, miniature sensors, the technology hurdles are all but solved. Likewise, I used to worry about provider reimbursement as a hurdle, but the boulder of payment reform is now rolling down the hill. Everyone knows it is a matter of when, not if, we move to a provider payment system based on quality and outcomes. This should pave the way for connected health adoption. So what is left?
Two, things, best I can tell. One has to do with our instincts that somehow we’re better off being served by a person than a machine. It seems quite deep rooted. This was called to mind when I read a piece in Saturday’s Wall Street Journal called, “Self-Service Nation Ends at Garden State Gas Pumps.” This article recalls the days when gas was pumped by a service station attendant. Remember that? I can, vaguely. I’ve long since converted to the convenience of pumping my own. Pull up, slip in your credit card, pump and away you go. Convenient and easy. The same has happened in the airline industry (when is the last time an attendant checked you in for your flight?) and of course in banking with ATMs. It turns out there are still a handful of states that prohibit self-pumping of gas, assuring that filling station attendants still have a job.
The WSJ article does a nice job of compare and contrast with the high touch attendant model vs. the convenient pump your own model. I’ve often said that healthcare delivery would be improved if we could empower patients in the same way they are at the gas pump (in the majority of states), the airline check in or the ATM machine. In each case, you can find a human being to interact with if you want. But the vast majority of us feel liberated with the choice that self-service brings and do not resent doing the work that was once done for us by others.
We already have several examples demonstrating that patients bonding with a computerized relational agent can lead to improved health. I call this emotional automation.
In a connected health world you could do your own blood pressure check (maybe even adjust your own medication), as well as a handful of other tasks now reserved for a visit to the doctor’s office. As I hear rumblings that some states are trying to assert their individuality and not adhere to the Obama healthcare reform plan, I’m conjuring up an image of the equivalent of the filling station attendant in New Jersey, except he’s wearing a white lab coat insisting that you come to the office for even the most mundane of transactions because it is a state law. Not an inspiring image, to be sure.
The second roadblock is much more insidious and has to do with our libertarian roots. In Sunday’s New York Times Magazine, Judith Warner writes about the challenges of fixing childhood obesity in a piece called “Junking Junk Food.” Here the theme is how the far right, represented by Sarah Palin and Glenn Beck, insist it is our right to consume as many calories as we like and any infringement of that right is an example of too much government and too little choice.
To quote Beck, “the choice architects” of the Obama administration, believe “you’re incapable of making decisions. . . . Left to your own devices, you’re going to eat too much, you’re going to be a big fat fatty.” This is disconcerting.
A big part of the success of connected health is engaging people about their illness with measurable data and holding them accountable to improved health goals. Our experience at the Center for Connected Health suggests that those libertarians who are unhealthy know it, believe it is their choice and want you to stay out of their lives. They will have worse health outcomes and cost the system more.
The logical conclusion of the choice architects would be to insist they pay more of their own health care bills. Think they’d go for it when they are stricken by sugar diabetes or recovering from their first heart attack or stroke?
One news story that just wouldn’t go away this week was the brouhaha over airport screenings. Again, the theme was ‘you can’t make me.’ It is an invasion of privacy to keep the population safe. The theme here is the same. As a society, we feel the right to personal freedom trumps our obligations to society as a whole. In the case of health, that mantra would go something like, ”I have the right to mistreat myself even if it is going to cost society more to pay for my health care bills as my health deteriorates.”
This may be the toughest nut to crack for connected health.