Digital communication in healthcare: One millennial's perspective

Recently I was asked to speak to some key execs from the pathology industry to discuss what their businesses could look like in the future. The meeting 'Pathology 2030' had four presentations that together would paint a picture of how pathology services in New Zealand will be delivered over the next 10 - 20 years.

The speakers included:

No pressure right?

Following behind some of the industry's top thought leaders who had been in the pathology, data and technology game a long time made me a little nervous about presenting to this group. But there was one thing I could bring to the room that no-one else could - I'm a millennial. So the aim of my presentation was to sum up how we like to communicate and how the healthcare industry might use this to their advantage to improve health outcomes.

I don't have the solutions, and I know there are endless challenges, but here's how, as a millennial, I'd like to interact with the healthcare system.

Patient generated data and the Internet of Things

The one thing I still struggle with is that not too long ago New Zealanders couldn't access their personal health records on a whim. I simply can't comprehend that my health information wasn't mine to access. My free iPhone health app that pulls in data from a series of other free apps tells me more useful information than I could ever possibly expect to get from MY health records.

With all our wearables, mobile technology, and eventual sensors on everything I'd like to think we'll have these three things along with it:

  1. All my health data in one place: The data I generate about my health to be sent and interpreted in a cloud based health portal, which includes my electronic health records (EHR). I want to be able to login and access this information from my phone.
  2. Signals when things are abnormal: the whole concept for me of tracking my health is to stay out of clinics and avoid medication, so if my health portal is intelligent enough to identify when things are tracking differently or above health thresholds for my demographic then I want intervention before it becomes a problem.
  3. Grant permission to my health support team: I like the idea of not only a pathologist, clinician and nurse being able to access my health data quickly, but an identified health support team outside of the health system - family for example, to receive those signals when things aren't normal. It's not so relevant for me today, but is for me as the support person. The example I used in my presentation was that I would received a notification when my grandfathers blood glucose levels dropped too low, or that a family member's spent an abnormal amount of time scrolling on their phone, which matches patterns of potential mental instability, then I can act as a member of the family before anything gets serious, helping my family also avoid ending up in the clinics.

We use social media - so should you!

I'm not sure how harsh I came across when I said to the room, "if you think social media is a fad, or a waste of time, then get over it." As you might imagine not everyone agreed, but the fact that Facebook has over 1.7 billion people on the platform, it's obvious that it's not on par with Google Glasses or the mini-disk. So how can the healthcare system leverage our insatiable use of social media?

  1. Incident monitoring and communication: The Massachusetts General Hospital used social media to monitor reports from the Boston Marathon Bombing. They were able to monitor what was happening on the ground, correct misinformation about the hospital being in lock-down, and confirm reports across multiple sources.
  2. Predicting trends: Some very innovative research was undertaken using Twitter along with air monitoring sensors and EHR to determine how many asthma sufferers would be in an ED ward on any given day. They were able to estimate this to 70% accuracy.
  3. Data mining to predict outcomes from lifestyle: If every post, photo or text is treated as data, mined analysed and mapped against our EHR, we come to understand relationships between our everyday lives and our health - yes there are privacy implications (but that's for another day).

Doctor in your pocket - AI medical chat bots

"mHealth apps are so 2014"

According to Facebook they have 11,000 bots on Facebook Messenger already, and apparently there are over 21,000 developers building bots for the platform, so around the world this is something companies see worth investing in. Medical chat bots are no exception, and they are far more advanced than Dr. Google. Not only do chat bots pull data from massive databases of information, but they also ask follow up questions and learn as they go.

The big benefit to medical chat bots being on Facebook Messenger is that we don't need another login, another app, and another 'thing' they we eventually stop using - whereas Facebook is where over 1 billion people spend on average 50 minutes a day - texting is almost a thing of the past. So how might millennials use medical chat bots?

  1. Continue efficient patient-clinician contact to improve medication and treatment plan adherence. Chat bots can remind us to take our medication, ask how we're feeling, to which we can respond to a selection of emotions, and consolidate this user-generated data to create a report.
  2. Avoid clinics and in-person visits: we'll be able to access accurate advice immediately with no appointment - freeing up clinics for more important cases. I put the idea to the group that the pathologist and the patient may communicate more closely in the future as chat bots could determine if we need a blood test taken without ever visiting our doctor. The results then come from the pathologist who can access a report from the chat bot about the condition and can provide the diagnosis.
  3. Access to advice and treatment for conditions people are embarrassed about: The data from one of the most popular medical chat bots today, Your.MD, found that the most common conditions its users need advice on are STIs and mental health. Are chat bots are way to reach people that would otherwise go untreated?

There are obviously a lot of challenges with all of this, but if we continue to dwell on all of the barriers and not get excited about the opportunities then we'll never take the leap.

I'll end on two points: The first - my electronic health records belong to me and therefore I should be able to decide who accesses them and how (with some caveats obviously). And two - talk to a millennial and ask how they get information on their health and how they'd like to access healthcare, because apparently we think differently.