Question: How can existing technologies be used to improve healthcare outcomes?

Ron Dixon: I think that we can use available technology to really transform how we deliver care. So for example, cell phone platforms are available for patients to manage their diabetes, to manage blood pressure. We can take examples for example from Sub-Saharan Africa where patients with malaria, instead of coming back to the clinic after they have had the test to see whether they have malaria or not, they receive an SMS to say, “Yes you have it and start this medication.” or “No you don’t. You don’t need to do anything else.”

There is an available technology, readily available. Cell phone penetration is extremely intense throughout the United States. Why not use that platform as a way to deliver care?

I think if we start thinking differently about technology; it’s not whiz bang, it’s what we use every day, and implementing that in to how we care for folks, that’s where we can start to create value and add efficiency in the system.

When I finished residency, I remember trying to innovate around how I took care of my high blood pressure patients. I started to email back and forth with the high blood pressure patients to titrate their medications, and to prevent them from coming in to have a visit with me. I thought that that would be slightly more convenient for them and really, I didn’t think it was a good use of my time to sit and talk about blood pressure when I could be handling it over a very simple media such as email.

Unfortunately, the payment system didn’t acknowledge that as a visit and my practice administrators said, “You can’t do that.”

I started to think, “Well, that doesn’t really make sense for a system. If I can’t practice in a way that makes sense for the patient and the way that make sense for me and keeps the patient happy and actually provides good quality care for the patient then what am I doing?”

In any culture, whether you have a shaman or a physician, the basis of the care is the relationship between the person delivering and providing the care, and the patient. We seem to think that technology does have some potential, a lot of potential. But technology in and of itself is not the answer.

It’s like how we use email to share stories together. I don’t share stories with people I don’t know, and usually stories that come to me from people I don’t know are spam.

If I’m going to be using available technology to manage patients it has to come from a trusted source, and it should be based in some relationship. So the work that I’m doing, for example, is really housed in that relationship between the primary care physician and the patient, but using the technology to enable that relationship.

Again for example, I have a patient who is depressed and I send him home on a medication. There is data to show that patients might be more comfortable interacting with the machine when rating their depression, as opposed to interacting with the person. That’s not to say that they prefer to receive their treatment for depression from a machine, but they might be more honest in rating their level with the machine.

Imagine if we enable patients with the tools to rate their, with their depression scores at home and then send those to the provider, and then have an assessment over video conferencing, which is shown to be effective for a lot of psychiatric issues, have that assessment and follow up or video conferencing.

So these are the ideas that I think we need to explore more in the care delivery stream.

Recorded on: May 28, 2009