Connected Health: Technology First or People?

For some reason of late, I’ve noticed the tagline of the automobile insurance company, Esurance. In case you haven’t seen it, it goes like this: “Technology when you want it, people when you don’t.” When I first heard this, I thought it would be a good tagline for connected health. Then I pondered further and wondered if in healthcare, the goal should really be “People when you want them and technology when you don’t.”  The premise here would be that in healthcare we are different and that the human relationships are sacrosanct.

In a way, the tagline as they’ve stated it, is emblematic of how many service industries have transformed. We happily do our own travel planning online, pump our own gas, buy groceries with automated systems, check ourselves in online or at the airport and draw cash out of machines. However, when something goes wrong with any of these processes, we want to talk to a person at our convenience. Think calling your telephone service provider for tech support and being frustrated as you navigate phone menus.

We haven’t really gone that way in healthcare (though I did check myself in by Kiosk when I went to my PCP for a visit recently). Is it because healthcare really is different and the human interaction is critical to success?  It is not so simple.

My favorite mind bender example of why not comes from my friend and colleague Tim Bickmore who is a professor at Northeastern University and works on relational agents (www.relationalagents.com). We collaborated with Tim to show that a relational agent coach was powerful in terms of sustaining improved walking behavior in an experimental cohort. He has also shown that patients who are preparing for discharge from the hospital prefer getting their discharge instructions from a computerized agent as opposed to a person. The reasons cited are that the patient never feels stupid in front of the computerized agent and that the patient doesn’t feel time pressure. They can ask the same question over and over until they learn the answer. This is at least one well-documented case where technology is preferred over people. However, I’m guessing that if you asked the next 100 folks you bumped into if they’d prefer a human interaction for their healthcare vs. technology, they would default to the human interaction.

This conversation has come up recently in a well-written book by MIT professor Sherry Turkle (Alone Together) as well as other discussions by the likes of Dr. Jerome Groopman and Sustainability by Design Author, John Ehrenfeld. In different ways, all three do some hand wringing over what, to many, is a troubling concept – that we might be forced to substitute technologies such as caring robots for people in healthcare’s future.

There seems to be a gulf between what people worry about and what they prefer.

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