Time To Get Clear About Digital Care Limitations

Today. I stumbled across a story featuring what has to be one of the more unfortunate uses of digital health technology I’ve ever encountered.

According to a news item, Ernest Quintana, a 79-year-old grandfather who was an inpatient at Fremont, Calif-based Kaiser Permanente Medical Center, was in the ICU because his lungs were failing.

At one point during his stay, the report says, a hospital robot entered Quintana’s room and a video visit with an off-site doctor began. (The hospital uses the robot to allow physicians to go on virtual rounds.)

During the consult, the physician told Quintana that his condition was terminal, apparently for the first time, a message which the family felt should never have been delivered via video. Adding insult to injury, his granddaughter had to pass along the bad news, because the dying man had trouble hearing the doctor.

This incident took place in March of this year. Since then, the hospital has hopefully updated its telehealth policies to state that doctors shouldn’t share highly sensitive news in such an impersonal manner.

However, a larger problem remains. There are probably many situations in which digital care just isn’t the same as in-person consults. In fact, we may not even have identified even most of the situations in which the need for a personal touch applies.

For example, patient expectations will differ from one digital medium to another; the use of videoconferencing, emailing and texting, for example, come with slightly different norms. For example, consumers are used to getting very prompt responses when they text their friends and family, so providers should either try to meet this expectation or warn patients that they won’t do so.

In addition, different patients will have different issues in interacting with technology.  Like Quintana, they may have sensory issues, or absorb information at different rates. Some may relate better to text and others only to a human face.

Now, none of this is to suggest that providers should dial back their use of digital technologies in patient care, which is reaching new heights among both hospitals and physicians. However, this incident should draw our attention to how we think about the more personal aspects of digital care communications.

After all, while we’ve spent a great deal of time working to ensure that digitally-mediated care could achieve comparable outcomes to in-person care, we’ve paid little attention to discovering what aspects of care simply don’t translate well to a virtual environment.

As video visits, email, text, apps and other communications technologies play a larger role in healthcare, it would be smart to reach a broad industry consensus on when it’s best to put them aside. It would be a shame if we let insensitive or inappropriate uses of digital technology tarnish their steadily improving reputation.