Implementation science looks to eHealth technology to enhance doctor-patient relationship
INDIANAPOLIS — New and developing eHealth technologies have the potential to improve the patient-provider connection and patient-centered health care. An opinion piece authored by three physicians looks to rehabilitation medicine, with its long history of use of technology, as a model for positive ways to incorporate technology to enhance the doctor-physician relationship across the spectrum of medical care specialties.
The opinion piece highlights roles for eHealth technology in three aspects of the doctor-patient relationship — (1) knowing the patient and contextual factors of his or her life; (2) information exchange and education, and (3) shared goal setting and action planning.
"There have been a lot of ambivalent thoughts about technology and health care both on the clinician side and the patient side," said Center for Health Innovation and Implementation Science scientist Sophia Wang, MD, assistant professor of clinical psychiatry at Indiana University School of Medicine. "We need to rethink the potential positive benefits of technology in enhancing the patient-provider relationship and act upon that potential." Dr. Wang, a geriatric psychiatrist who is the medical director of the Older Adult Mental Health Clinic at the Richard L. Roudebush VA Medical Center in Indianapolis, is the first author of "Can eHealth Technology Enhance the Patient-Provider Relationship in Rehabilitation?" which appears in the Sept. issue of Archives of Physical Medicine and Rehabilitation.
"Rehab medicine has clearly demonstrated that it's possible to employ eHealth tech — real time televideo showing quality of life shared with the clinical staff, for example — and use it well. Dr. Wang said. "Doctors can't be with patients all the time. We can use existing personalizeable 'apps' to coach and incentivize patients. In addition to monitoring the patient in their own environment, implementation science shows us that we can disseminate and use persuasive e-tech to provide nudges to the patient for things like exercise or calorie control."
Dr. Wang and colleagues Dan Blazer, MD, PhD, and Helen Hoenig, MD, MPH, of the Durham VA Medical Center and Duke University School of Medicine write, "It is critical that as a field [medicine] we are aware of new and developing eHealth technologies that might help to foster patient-provider connection and patient-centered health care."
"Rehab medicine — with its successful use of technology — is an ideal discipline to serve as a role model for many other medical fields including geriatrics, mental health and cardiology," says Dr. Wang, an implementation scientist. "As in rehab medicine, understanding patients and how they exist in their daily context is extremely important. eTech can help the doctor learn a lot of vital information that's not typically seen or acquired in the office setting."
Studies have shown that if an individual feels advice from the physician is personal they are more likely to actually act upon it than if handed a generic information sheet about the problem. eHealth technology enables wide dispensation of specifically targeted information with significantly less staff effort.
"We haven't discovered anything really novel, but from a busy doctor's perspective — from my perspective — I have to ask why we aren't doing more with eHealth technology. Wouldn't it be every doctor's dream that instead of simply noting in a patient's electronic medical record that a certain health issue had been discussed and that an information sheet had been handed to the patient, we could click on something that would provide personalized, individualized attention to the patient or identify an app that would allow the patient to follow up on our advice at home?"
The Center for Health Innovation and Implementation Science, which is part of the IU School of Medicine and of the Indiana Clinical Translational Sciences Institute, was launched in 2013 with the mission of using implementation science and innovation to produce high quality, patient-centered and cost-efficient healthcare delivery solutions.
Cindy Fox Aisen