Communication is the key What the health world needs now is ways to connect and communicate. James Knox talks to clinicians how tech can work.
Information and communications technology (ICT) in healthcare can reap significant benefits for clinicians and patients when successfully scoped, designed and implemented. The pitfalls of ICT projects, however, are often due to poor governance, as we have witnessed at all government levels, and that can lead to massive financial blowouts, not to mention wasted opportunities to deliver better health care. Successful implementations require a bottom-up approach, guided by clinicians on the ground, yet our current experience has seen digital technology usually engineered from the top-down, and the tools and projects that result languish from lack of participation. If health care revolves around patients and the ICT systems revolve around the clinicians, then Occam’s razor would suggest that the most effective systems should be developed by clinicians. To get a snapshot of where transformational technology is heading, Medical Forum spoke to some of the leading figures in the industry to hear their perspectives.
The human element Innovation is not necessarily synonymous with digital technology, yet they are often intertwined, especially in medicine, where algorithms and artificial intelligence (AI) are forging ahead at a rapid pace. Innovation goes beyond the creation of advanced tools and comes back to their user; how they utilise the benefits to assist clinical decision making and ultimately to provide patients with better care. That speed, according to Professor Moyez Jiwa, Associate Dean of
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Notre Dame’s Melbourne Clinical School and formerly of Curtin University, is putting pressure on a critical aspect of care – especially at the primary level – the “art of doctoring”. “That skill involves getting information from people. If we ignore that, everything else becomes a distraction, a toy, a program in the consultation over and above the actual business of forging a relationship with a patient and getting that information from them,” he said. Moyez sees technological innovation as an important part of medicine, but cautions on top-down designed applications. “Innovations can become distractions largely because they're not fit for purpose. When they are designed by somebody who has not ever stepped in the doctor’s shoes and hasn’t been in a consultation, where you've got literally 10 to 15 minutes to make a diagnosis, they are not going to work. The technology, whatever it happens to be, has to fit into those confines. “We need to design innovations that doctors themselves have tested in real life, not in a randomised control trial, and shown that this actually will speed up the process of making a diagnosis in often very difficult circumstances.” Moyez describes a doctor-led innovation, of which he was a part, that involved switching the seating position of the doctor and patient in a mock consultation room. The simple act of the patients being provided with the larger and more comfortable chair significantly improved the patient’s experience.
“The impact was enormous, absolutely astonishing,” he said. The footage from the videoed consultations was analysed for non-verbal communication between the doctors and patients and, according to Moyez, the patients who were given the doctor’s chairs demonstrably changed their behaviour. “There was much more of a connection. Patients were more open to ideas and accepting information coming from the doctor and more open to saying what was bothering them.” For all of the advancements with AI in medicine, such as in imaging, where an algorithm can be more effective than the human eye, the intangible elements of the patientdoctor relationship cannot be so easily replicated. “When it comes to the business of doctoring, when it comes to how we respond to people who are distressed, who are anxious, who are in pain, you can’t beat the best technology we have – the human touch, the human interaction,” he said. “I'm not decrying robotics or artificial intelligence in other fields, but when it comes to the interaction between the doctor and patient, we can’t do better than what we have already.”
Clinicians lead The healthcare industry is going through a phase of rapid development in a whole range of areas and the traditional boundaries of where technology and healthcare intersect are being redrawn, says Dr Daryl Cheng, paediatrician and clinical informatician from the Royal Children’s Hospital Melbourne. Echoing Moyez, Daryl says the successful integration of advanced technology relies on the architects being from a health care background with an interest in technology and vice-versa, so as to ensure the development of these tools actually reflects the clinical needs of the end-users.
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