When even a child of the 60s and 70s like me is connected via texting, Twitter, Facebook, etc., it’s safe to say that the digital revolution is over, and digital won. The last holdout, it seems – the analog equivalent of the tsarist White Army – is health care. Sure, we have robots for surgery, telemedicine for remote diagnosis, and an increasing use of electronic health records by hospitals and providers, but it still feels very old school. Sort of like education: even if you take notes on an iPad, attending a lecture is still a very traditional method of learning. Health care is still very provider- and facility-centric. To paraphrase the NY Times columnist Thomas Friedman, the world of health care has still not gotten very flat. Yet there are some steps toward leveraging new modes of communication that have the potential to disrupt the model of health care delivery.
Many people today use texting as their primary means of communication, but it is seldom used in medicine. Expanding its use would not only be more patient-centered, but may really improve efficiency. We recently ran a trial of texting appointment reminders to patients in our sickle cell clinic, which has a traditionally high no-show rate. The day after text reminders were sent, only 1 of 14 patients did not come for their appointment. Anyone who has ever dealt with a teen knows that this is a group where texting may provide a particular opportunity to vastly improve provider-patient communication. Providers and staff appear to be open to the idea of greater electronic communication, but some barriers are apparent. One is reimbursement: under current payment systems, electronic communication is a service for which it is difficult to collect a fee. Another concern is confidentiality, though some progress has been made to ensure that texts or other electronic messages are secure, such as a HIPAA-compliant messaging app.
Texting of course, while seemingly radical by the conservative standards of health care, is not exactly a disruptive technology. But some providers are pushing the envelope with “virtual clinics,” where almost all interaction is electronic. Check out, for example, these examples in New York and Minnesota. Experience is limited, especially regarding outcomes, but these experiments suggest that at least two elements of the triple aim – lower cost and better experience – can be met.