Portals, Skype, and wearables: What primary care should look like

At your last doctor’s appointment, you may have noticed that the experience hasn’t really changed over the last few decades. In fact, with doctors constantly typing and clicking, it may have actually gotten worse.

In general, scheduling is difficult, signing in feels eerily similar to filling out paperwork at a government agency, and the patient interview is like speed dating.

The truth is that healthcare is about five to seven years behind the rest of the service industry, mainly because physicians haven’t quite realized they are in the business of customer service. Adding to the issue, complicated payment structures and policies haven’t done much but make the situation worse.

Technology can help us change that if the politics surrounding health care allow it to. Given the right political environment, here’s what the medical practice of the future will look like:

24/7 Secure Communication Across Various Media

Phone calls have been the standard for patient communication for decades, but now electronic mail, text messages, and even social media sites have come into play. The problem with these media is one of privacy and security. So most providers seem to agree that using a secure platform like a patient portal is the best digital form of communication to manage care. Many practices have started using them, but considering that less than half of patients actually access them, their full potential has nowhere near been reached

Retail stores, banks, and automobile dealerships are excellent managers of customer relationships. Healthcare, on the other hand, needs to take a lesson. At this point, scheduling, reminders, messages, lab results, and appointment summaries should be the bare minimum. In future patient portal platforms, expect better user interfaces that paint a more complete picture of patients, personalized information about diseases and treatment (such as an Amazon-style — “patients with this disease were also interested in reading…”), more mobile capability, and quicker response times when you’re in need of care.

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Less Documentation, More Care

It is debatable that electronic health records (EHR) have made care better, but going back to paper is not the solution. Much of the software in today’s market is an electronic version of the paper chart. The format is still disconnected from the actual manner in which care is provided.

Five years from now, software will match office workflow. No time will be wasted on scheduling and sign-in. Medical histories will be up-to-date within something like a “patient profile”, which the patient and/or office personnel will maintain. Minutes before an appointment, a physician will see an organized and visually appealing summary of the patient (all of the history including current medications), a short timeline of events (hospital visits, sick visits, changes in medications, online messages), and notification of any changes made to the above information.

Much of this is already being done, but the limiting factor is the presentation. Most software packages probably make physicians feel like they have been transported back in time to the world of Windows 95. Again, intuitive user interfaces and graphical displays, possibly in the form of dashboards, will make all the difference.

Integrated Care Teams

Many practices are starting to operate in a patient-centered manner, where specialists and other consultants care for a patient as a team. This strategy has the advantage of allowing experts in each aspect of a disease to cooperatively design an optimal care plan for each patient. As an example, patients with diabetes can work with primary physicians, endocrinologists, podiatrists, ophthalmologists, and nutritionists. As complicated as that might sound, the model will be very effective if the information from each provider can be easily communicated with the rest of the team, preferably on the same online platform. Taking a huge step toward health care integration, Henry Ford Health System in Detroit is going as far as trying to connect retail clinics, which are generally unaffiliated with any health system, to its own EHR.

Telemedicine Consults

There are a few subfields of medicine that require a little less face-to-face interaction with patients to make a solid diagnosis. Dermatology is one of them. With a primary physician supplying all of the pertinent information about a person with a particular skin lesion, a dermatologist really only needs a high-quality photo or video in order to give a recommendation. This saves patients from scheduling another appointment, eliminating time spent worrying, driving, and waiting in line. This concept isn’t being limited to specialists, either. Expect telemedicine to be available for almost any kind of physician, therapist, or counselor in the future.

Home Monitoring for Chronic Conditions

Sick patients require more care. Appointments just won’t cut it for these folks, and knowing immediately when they start to deteriorate could be the difference between a quick medication change and an emergency department visit with a three-night hospital stay. Cardiologists have understood this for years and have used implantable devices that upload data to call centers. Even a decade ago, the Veteran’s Health Administration was successful with its Internet-based monitoring system. Expect a dramatic surge in the use of home health monitoring in the next five years.

Wearables and Apps for Better Lifestyle Optimization

MyFitnessPal and Fitbit are taking the lead in helping people quantify their own health. Their popularity is growing rapidly, too. In 2013, MyFitnessPal had already surpassed 40 million registered users. Hopefully, this technology will soon replace food journals, activity logs, and home blood pressure recordings, strategies used by providers in the past.

In the end, a physician only needs to know if a patient’s habits are improving or not. This can be achieved by 1-2 charts in the patient record. Simple metrics like footsteps can be approximate representations of a person’s activity level. Similarly, calorie count — maybe even broken down into macronutrients — can be more than enough to assess a patient’s diet. No need to interpret a food journal. Conveniently, some of this data can already be uploaded to certain EHRs. AtlasMD, a practice based in Kansas, has already made the leap to let patients automatically upload health data to its records.

The technologies that exist today are well beyond what I’ve described in this article. The major limiting factor is not development but implementation. Once we can find a way to navigate through this complex fiscal and political environment, health care is going to thrive like never before.

William Rusnak is a resident physician in radiology, financial investor, writer for NueMD, and entrepreneur. He covers topics such as healthcare technology, biotechnology, and nutrition. He plans to practice in pediatric or interventional radiology.