Monday, May 18, 2015

The future is already here, it just not very evenly distributed.

By Courtney Lyles, PhD

The title of this blog post is a quote by science fiction author William Gibson (who coined the phrase many years ago, by the way).  And I think it is spot on in a number of ways.  It is clear that so many seemingly futuristic technologies have already been developed: from using your smartphone to passively track your activity and mood, to the development of a sensor to test blood glucose through the skin without drawing blood.  But the reality that is so clear to us working in the safety net is that most of these tools are not distributed to those who need it most, and sometimes even only make their way to our settings after they become somewhat obsolete in the tech space.

But my second interpretation of this quote is more subtle, even within a single safety net healthcare system.  Because I work on spreading health technologies to vulnerable patients, I often get one of two very different responses when trying to explain my job to other people outside of healthcare:
  1. Everyone has a smartphone now, I am sure designing a mobile phone app is the way to reach diverse populations.
  2. A lot of patients at SFGH have never even used a computer, right?

And I must say that neither and both of these ideas are right, at the same time.   Not to sound too academic, but the truth is that it depends.  

Here is one concrete example of this phenomenon.  We are currently videotaping patients interacting with a website for a research study, and the thing that strikes me most in this project is the huge range in existing computer skills/knowledge.  We have had patients enroll in the study who tell us they have just signed up for their very first computer class last week, and they don’t have any baseline knowledge about creating capital letters or characters on a keyboard.  And then the next interview will be with a very low-income older patient who lives in a single resident occupancy but has owned his own computer for years.  So I want to make the case that it isn’t so easy to tell someone’s computer literacy by asking them if they “use the Internet.” 

Moreover, among those who don’t know how to do much online, interest in using the Internet can similarly be nuanced.  Some of the patients that we expect not to be able or want to use a computer are motivated to learn how to do so if you are open to discussing it with them.  For example, another participant started off the interview adamantly opposed to using the Internet in her everyday life, and ended the interview wanting to purchase her own computer.

Based on these experiences, I want to put forth a new pillar of patient-centered care:  let’s ask patients how they prefer to communicate (phone call, texting, email, in-person only), and have a real conversation with them about interest and ability in using the Internet for health and healthcare management.  As policy makers and healthcare practitioners/leaders, we all know that we will be increasingly relying on electronic communication more in the coming years – so let’s start those conversations with patients now.  I think that we can design systems and programs that better meet patients’ needs and preferences, but a one-size-fits-all approach – even within a single healthcare system – will not work.

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