As healthcare stands on the cusp of a new technological revolution, the Future Health Index team sat down with David to talk about the changes he’s seen throughout his career, as well as what must happen next for health to harness the potential of connected care. Scher is a digital health technology consultant as Director of DLS Healthcare Consulting, LLC.
What stands out as the biggest technology changes you’ve seen as a doctor?
Over the course of my career, healthcare has really gone from the Stone Age to the Space Age in technology terms.
When I started my training in 1984, for example, ECG machines were still manually operated and were these big clunky carts that would be wheeled around the hospital. I collect old medical technology and the only difference between an ECG machine from the 1920s and the ones I used in 1984 is that the latter was on wheels.
The real advance has been how the results from the ECG machine are digitally downloaded to a server, which allows a physician to interpret them remotely. All present machines use algorithms that enable them to interpret the ECG results themselves. In addition, there are FDA devices attached to smartphones or associated with smartwatches that can record and detect abnormal heart rhythm.
How have pacemakers changed over the years?
Their sophistication has increased dramatically. The initial rate-responsive pacemakers had vibration sensors attached to the inside of the pacemaker housing. Attempting to simulate activity, the heart rate driven by the pacemaker would increase if you tapped it repeatedly.
This led to some interesting situations. One patient in Philadelphia, where the roads have lots of cobblestones, would drive her Volkswagen Beetle causing her heart rate to suddenly increase to 120 beats per minute. So I was very happy in 1991 to implant the first pacemaker in the world that had an accelerometer rather than a vibration sensor – the same technology that was developed by NASA for use in space and which helps smartphones manage trip progress via GPS. A lot of people wouldn’t have appreciated the technology at the time, but it made a big difference to the world in different ways.
Today, pacemakers provide physicians with a wealth of information. There are now thousands of data points on an individual’s arrhythmia status and about the functioning of the device, which has made it easier to manage patients.
The computing power of today’s pacemaker is magnitudes greater than that of the spacecraft that landed men on the moon.
Another major advance was the digitization of imaging, which is illustrated by my ability to view an ECG result (or any radiology image) remotely. When I first started my training, of course, none of this technology was digital and, even when it first became digital, I’d have to go into the hospital to look at the image.
When did you first get remote access to patient data?
We’ve had it for a little longer than you might think – I had an electronic medical record (EMR) system in 1996 that I could access from anywhere on my PalmPilot. The system was home-grown and the cool thing was that it had a lot of different functions. It didn’t just have our patients’ information – it contained our schedules, linked to referring physicians’ contact information and recommended medications.
Before that, if someone called into the hospital on a Friday night with chest pains, they’d possibly be stuck there all weekend because of lack of medical record access. With the PalmPilot I could be in bed and look up the patient’s office medical record, see that they had a catheterization a couple of days ago at another hospital and tell the ER that the pain was not from a coronary artery blockage and they could therefore likely be sent home.
At that time in the mid-1990s, my practice had to actually convince hospitals to buy PCs so that my group could access our office records from the hospital. In those days it was all just totally backwards.
In some ways, though, things haven’t changed much. The fax machine is still the most used piece of technology in medicine in the US, for example. And while today’s EHRs are more effective than rummaging through a patient’s paper file that’s five inches thick, they can still be very cumbersome and not great at visualization or the user experience.
What needs to change in order for technology like EHRs to improve?
We’re getting to the point with digital technology that we’re screaming for the second layer – the analytics layer – to come in and make all the data we have relevant and easier to manage. I think we’re just approaching the moment where data can be analyzed at scale and really become useful. The problem, of course, is that this is expensive and at the moment only the most advanced institutions really understand the value of this proposition and are investing in it – everyone else needs to know why it’s worth the money. Not all ROI is a financial one. Much of physician dissatisfaction today is tied to the frustrations that EHRs have wrought.
From my work as a digital health consultant, I know how analytics can transform the way data is processed and even change how diseases are treated. The Western world’s biggest healthcare burdens today lie in the growth of an ageing population and the epidemic of chronic disease. It has been proposed that remote patient monitoring can impact outcomes in patients with chronic diseases, but a lack of associated communications systems and analytics that deliver only actionable data to clinicians remain challenges. This lack of analytics and algorithmic technology is the solution to the fear physicians have of being deluged with useless data.
Is there anything in your work that’s almost the same as it was in the old days?
I always used to stay after work in the office to review charts for the next office day. Now, I can do this at home with the EHR. This usually takes about 45–60 minutes and I take a few short notes consisting of what’s been going on with the patient since the last visit and what my recommendations might consist of (with allowances for any curveballs, of course). This chart review allows me to interact with the patient and not a computer screen during the encounter, leading to a higher quality and more satisfying visit. This significantly reduces my stress during an office day.
The way I approach a patient is very similar to when I started, but digital technology improves disease diagnosis and treatment. For example, I order cardiac MRIs for certain diseases, whereas before I might’ve said: “I think you have this based on what I see”.
What is important to know is that the fear of technology replacing the physician is not going to be realized. Human interaction including empathy is why physicians enter medicine.
Technologies are tools which can help us, not replace us.