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  • Letter from America. Technology PDQ: potentials, dilemmas and questions

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    In this month's Letter from America, Lorri Zipperer discusses cautions and capabilities associated with healthcare technologies.

    Letter from America is a Patient Safety Learning blog series highlighting new accomplishments and patient safety challenges in the United States.

    This is Lorri's last blog in the series and we'd like to thank Lorri for sharing her insights with us over the last 12 months. Read here all the Letter from America blogs


    I had been trying to get my Mom to do video calls on her computer for a decade. Pushback and inexperience with new technologies just didn’t give her the confidence she needed to step over that line. A lack of trust in the systems to work right and in her ability to navigate the hiccups minimised her willingness to give it a shot. And then along came covid. Due to necessity and front-line assistance (my sister and niece get a hat tip here), Mom finally began to see how beneficial the tools were for improving her state of mind and increasing our awareness of how she is from a long distance during the lockdown. 

    There also has been hesitancy in healthcare to fully embrace communication technologies that can optimise and energise processes. Uncertainty and optimism are certainly warranted in the use of electronic mobile connections in healthcare and the devices that support it. These new approaches touch facets of training, appointments, personal health monitoring and overall system reliability. Beyond the changes necessitated by the pandemic, the need to embrace new technologies in healthcare is now essential and will be for the future despite expected challenges to universal adoption.

    The covid pandemic has motivated healthcare to broaden its vision of the potential for remote technologies. Now telemedicine, telehealth, telecoaching, digital therapeutics and mobile patient outreach has become absolutely necessary. They are here to stay. Changes in reimbursement policies have provided coverage for telehealth services that, before the pandemic, was much more restrictive. While patients and physicians may appreciate the convenience of this “new normal”, there are quandaries associated with its uptake. At a time when relationships are so vital to our lives, having technology to either build them (granted in a new way), inform them (via a new set of communication tools) or damage them (dependent on the willingness, system robustness and comfort of the individuals involved) is worth considering. For example, worries about diagnostic accuracy, limitations of the virtual physical exam, concerns about privacy, usability and the loss of the person-focus of patient/physician communication.

    The effectiveness of telemedicine and telehealth is also impacted by health literacy, access to reliable networks and patient comfort with using digital tools. Physicians and care organisations have to be creative and rely on partnerships and local resources, such as school district hot spots or public library broadband access, to make the system reliably work for all their patients. On another level, Dissent Magazine discusses a range of economic concerns stemming from the accelerated adoption of telehealth, including the primary worry that services have the potential to be structured as profit centres shifting the focus of decisions toward stakeholder and executive compensation rather than effective care.

    Then there are questions surrounding the apps and tools patients are using to make decisions about their health. Dr. Google has known weaknesses. Patient-facing diagnostic apps, wearables and symptom trackers, while showing promise still require appropriate risk evaluation before patients should fully trust them to track and manage their health without clinician guidance, and protect against worry and overuse of health services. The Skeptical Cardiologist shares reasons to resist the temptation to rely on, for example, the blood oxygen monitoring accuracy of a much anticipated product for reasons that include lack of reference to primary data and cost. Use of symptom trackers could proliferate as patients remain hesitant to visit physicians due to covid concerns. One project from Georgetown University was forthcoming about its rapid development strategy when sharing the results of a covid symptom tracker pilot test. Areas covered included size of the beta test (48 students), use of unique identifiers to address privacy concerns for both patients and organisations involved, access to condition-relevant patient-centered educational information and instructions to seek medical care should symptoms indicate that necessary step. It is this sort of transparency that aids the healthcare community and patients to appropriately select and trust tools to manage symptoms and situations for public and personal health safety.

    Voice activation technologies, so convenient for getting the latest news and listening to music, are seen as having great potential in healthcare monitoring as well. Voice characteristics are being explored as a diagnostic indicator. As covered recently in Nature, vocal biomarkers can track mental status, pulmonary function and coronary distress. But a myriad of factors could affect verbal characteristics reducing voice as a reliable mechanism for diagnosis. While promising, teasing out these differences in vocal diagnostics is still an emerging opportunity being explored in the US and around the world. Also, the use of voice-activated technologies in certain care settings can impact the privacy of the patient and may therefore not be suitable.

    On a systemic scale, the growing dependance on technologies leave patients, clinicians and organisations vulnerable to purposeful or accidental incidents or outtages, such as cyberattacks, that create disruptions and compromise patient safety. Recently a large health system in the US was crippled due to a ransomware attack. Patients needed to be rapidly moved to another out of system facility to ensure their safety. Experts caution that this is not the last of these situations and advise systems to train their staff and create awareness to recognise the early signals of a cyberattack to quickly reduce the extent of the damage and corresponding interruptions to healthcare services.

    Mom is now expanding her use of technology to make life better. She is exploring her first streaming service and becoming comfortable with its capabilities to binge on popular programmes. Who knows if that will lead the way to virtual visits with her cardiologist, or being able to track her vital signs from across the country and her personal use of a smart watch to monitor her heart? Let’s hope for all moms and other patients the adoption of technologies in the health space can be folded into our daily lives with minimal harm and negative disruption.

    About the Author

    Lorri Zipperer is the principal at Zipperer Project Management in Albuquerque, NM. Lorri was a founding staff member of the US-based National Patient Safety Foundation (NPSF). Lorri is an American Hospital Association/NPSF Patient Safety Leadership Fellowship alumnus and an Institute for Safe Medication Practices (ISMP) Cheers award winner. 

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    Hi Lorri

    Thank you so much for your latest (and now, last) blog. I've learned a lot and they always have given us an interesting perspective.  Who'd have thought we'd have been reflecting on the impact of Covid 19 on the physician/patient relationship and safety issues? That was a 'stand out' article for me from this month.

    Best wishes from us all at Patient Safety Learning and thanks again for your fascinating insights.


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