With the pervasive use of keyboards and monitors during office visits these days, most patients and doctors would not look to technology to strengthen their ties. But mobile health adds and apps (what I call “add-appters”), wearable sensors, remote patient monitoring and telemedicine consults can markedly facilitate the physician-patient relationship. It’s beyond improving communications between doctors and patients — which has already been proven by studies at Kaiser Permanente with email, phone and video connections and through the Open Notes project of sharing office notes.
This is about patient-generated data. For the first time, patients are seeing their own physiologic data on their smartphones via wearable sensors or add-appters. Not only are data such as blood pressure or heart rhythm being gathered by the patient, but it’s up to the individual when or whether to share it with his or her physician. This is the beginning of a radically different patient-doctor relationship, where the patient is activated, engaged and driving the care process.
Even before the data are shared with a physician via a dashboard screenshot, it can be analyzed by computer algorithms. For example, one of the smartphone electrocardiogram sensors has embedded software to immediately tell the user whether the heart rhythm tracing obtained is normal or abnormal. When it is normal, that can provide marked reassurance to the patient and can pre-empt an emergency department visit — which already has happened many times in my practice. We already know that computer readings of ECGs are routine in hospitals and are remarkably accurate — it’s just a matter of taking this software processing into mobile apps. This is just one of hundreds of examples that are forthcoming. You might quickly get the impression that this takes the place of physician contact, saving the valuable “coupon” for when it’s needed. Of course, such algorithms have to be fully validated, but ultimately they will or won’t survive.
And it’s not just about patient-generated data. It’s about the office visits that will go virtual. The majority will be conducted via secure video encounters with patient-generated data sent beforehand, utilizing the capability of smartphone add-apters like the otoscope or vital sign metric devices to get all the information collected just as it would occur in the traditional, physical face-to-face visit. But the doctor and patient will be face-to-face and review together data that the patient gathered, along with real-time data.
Take it another step further into the not so distant future where consumers will be able to do most of their lab tests using devices attached to their smartphones. Such lab testing like liver function, kidney function or potassium levels can be analyzed readily by software with the results and interpretation immediately provided to the patient. Also, apps should be able to translate complex medical data into patient-friendly language, such as: "Your potassium is low, here's why that's a problem, and here's what you should do about it."
Many will question whether this technology will lead to a deterioration of the doctor-patient relationship, relying too much on a virtual connection and the potential to diminish the human factor, the healing touch. But that is precisely the upside. With more time for doctors to concentrate on patients who really need physical consults by physical visits, more time can be spent with those individuals. Furthermore, the value of patients who are becoming empowered and data-driven with their own information is not to be diminished. That activation alone can strengthen the patient’s participation and sense of equal footing with the doctor. Just think how uplifting it could be for patients to avoid such “parking” problems like the usual 60-plus-minute wait to see a doctor, coupled with the average 12-minute new visit or seven-minute return visit for simple and routine matters. This is not about outsourcing patient care to a computer, but rather decompressing the bulk of tasks that can be automated without compromise to the quality or intimacy of patient care.
To enable this futuristic form of medicine, we will need more physicians to move from analog to digital. For physicians to support letting go of things that can be done better by algorithms (as long as they have been rigorously tested) and embrace the new era of patient-generated data. It’s about having patients take a major, active technology-assisted role in their care and enhancing a vital relationship through a true sense of partnership.