Plenary 3: Challenges and chances for high touch interaction and communication in health care in an era of high tech
High tech digital health solutions enabling high touch relationships
Bob Gann is an independent consultant, specialising in digital inclusion and combating digital health inequalities.
He is currently working as Digital Inclusion Specialist for the National Health Service (NHS) in England, and has recently carried out an independent review of digital inclusion and health in Wales.
He is a Specialist Advisor in Digital Health to the Care Quality Commission, and Visiting Professor in Health Informatics at Plymouth University. He also advises on research programmes for the Health Experiences Research Group at Oxford University.
Previously in his career Bob was Director of the NHS Widening Digital Participation programme, Director of Strategy & Partnerships for the NHS website (www.nhs.uk) and Director of New Media at NHS Direct.
He presents regularly on digital inclusion and health worldwide, and was a member of the WHO eHealth Technical Advisory Group.
"At its best, technology supports and improves human life; at its worst, it alienates, distorts and destroys" (John Naisbitt, High Tech, High Touch: Technology and Our Search for Meaning).
The futureologist, John Naisbitt, laid down his challenge as long ago as 1999, in the early days of the internet. Even he could not have foreseen the enormous advances in digital health: millions of health websites, hundreds of thousands of health apps, personalised self management, virtual consultations, wearable technology, big data analytics, genomics, artificial intelligence.
There is a common perception that increased use of technology furthers human disconnection. On the contrary, at its best, technology can facilitate communication, reduce isolation, build relationships, and promote lifestyles which are healthy and engaged.
The presentation will illustrate how health organisations, particularly in the UK, are working with patients and consumers to ensure digital technologies support, rather than replace, high touch human relationships.
Digital technologies are enabling personal interactions with clinicians, freeing us from the constraints of the physical world (including the time, cost and stress of travel) through video consultations.
Digital self management and lifestyle plans are personalised and relevant to individual concerns and preferences, rather than impersonal “one-size-fits-all” approaches.
Intergenerational befriending schemes are connecting schoolchildren and older people in care homes, where the children introduce the older people to digital devices and how to use them. Virtual reality headsets are allowing people who would otherwise be withdrawn and isolated to experience a world outside the confines of their care environment.
Rather than meaning people become inactive, digital technologies can be a powerful way of motivating people to get mobile. People are using wearable fitness monitors to motivate physical activity, often sharing experiences with others in communities.
Loneliness and isolation is a major public health challenge, with a health impact equivalent to living with a long term condition or smoking 15 cigarettes a day. People who would otherwise be lonely and isolated are being supported to get online so that they can keep in touch with friends and family – technology enabling rather than replacing human contact.
Shared-decision making in the context of new information technologies
Professor Glyn Elwyn BA MD MSc PhD FRCGP
Glyn Elwyn is a clinician, researcher, and innovator. He is a tenured professor at The Dartmouth Institute for Health Policy and Clinical Practice, USA, and at the Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Netherlands.
He is a Visiting Professor at University College London, UK, and retains an Honorary Chair at Cardiff University, UK.
After reading the humanities he qualified in medicine, completed a Masters in Education in the UK, and obtained his doctorate in 2001 at the Radboud University Nijmegen Medical Centre, Netherlands, with Professor Richard Grol.
He leads an international interdisciplinary team examining the implementation of shared decision making into clinical settings. He developed Option Grid TM patient decision aids, evidence-based tools that empower people to choose the care that suits them best, licensed in 2017 to EBSCO Health. He has developed the Observer OPTION and collaboRATE measures of shared decision making. He is the lead editor of Shared Decision Making: Evidence-Based Patient Choice, Oxford University Press, 3rd edition, 2016. Peer-reviewed publications: 381, H-index 90.
New information technologies are changing the relationship between users and those who deliver services to users. Platforms such as Uber and Lyft change the way we use vehicles, time and space. Airbnb has changed how we travel. Wikipedia changes how we learn and keep up to date. But in healthcare, change seems slower. Yet there are indications that technology will soon transform the relationship between people and healthcare delivery services: it will lead to coproduction as the only feasible way to practice medicine.
- By providing people with easy-to-access trustworthy information
- By enabling healthcare professionals to see useful personal profiles of their clients in real time at any workstation
- By making a digital version of the clinical encounter available to people who need to have it - at any time
- By analyzing the content of clinical encounters - for the correct evidence, for communication skills - and making use of this information to improve practice
- By connecting people with illness to the right peer network of others who have more experience and knowledge
- By making sure knowledge gaps are identified, shared and solved by facilitated networks
Some clinicians embrace this vision. Indeed, they are frustrated that current electronic records stand in the way of being able to do this new work. Others worry that this is a vision of hell. For sure, there is no doubt that the interface between the internet, information technology, and healthcare is problematic, and needs solutions.
Health promoting person-centred care over the whole care chain
INGER EKMAN RN, PhD, Professor, founder and former director of University of Gothenburg Centre for Person-Centred Care (GPCC) www.gpcc.gu.se
During 2006-2010, Inger Ekman was head of Institute of Health and Care Sciences and 2010-2012 vice dean at the medical faculty (the Sahlgrenska Academy). Between 2010 - 2019 she was the director of GPCC, a research centre including care sciences, medicine, pedagogics and economics. Her research focuses on long term illness and person-centred care interventions. Inger Ekman has more than 140 publications in scientific journals and is since 2016 the chair of COST 15222 (www.costcares.eu) a European initiative with 28 countries, on testing implementation of person-centred care within the frame of cost containment and improved quality of care.
The focus of person-centredness in health care is that a patient is a person with capabilities and needs. Person-centred care involves a partnership between the health care professional and the patient (often with relatives) and contain the following interrelated parts:
- Initiating the partnership – the patient narrative, the patient’s experience, resources and needs can be identified in the narrative, and forms the basis for the continued planning, together with relevant examinations and tests.
- Working the partnership – the personal health plan is co-¬created by the patient and the health professionals.
- Safeguarding the partnership - documenting the agreed goals and the personal health-plan
Based in this operationalizing of person-centred care, Centre for Person-Centred Care at University of Gothenburg (GPCC) has performed more than 20 controlled studies evaluating the effect of PCC, most of them showing positive results. In this presentation examples of randomized controlled studies evaluating person-centred health promotion over the whole care chain and over distance (tele-care) will be presented.
The intervention in the respective study will be presented in detail and some of the results were
- Return to previous activity (e.g work)
- Increased self-efficacy
- Sustainable effects 2 years
- Significantly better effect in low-educated patients