Archive for the ‘healthcare technology’ Category
What Do I Do With This?
A woman I saw last week was trying to figure out a number of important issues, including how to pay for dental work, and what to do about the ambulance bill that evidently was going to collections.
But in the midst of all this was the impending technology that had been given to her, technology that was supposed to make her life better.
Now, she was not in disagreement that it might be nice to use the cell phone. But after a year, it remained in the box, attempts at having put the thing together evident. A neighbor had charged it, but I found the back still in packaging. The woman’s problem, she told me, was how to turn it on.
“And the company keeps calling my home phone, telling me they do not want to lose me as a customer! But no one can show me how to use it.”
The phone was very similar to mine, and I found the power button. A message appeared saying that her minutes had expired, gave a number to call–not the same phone number on the packaging. But by the time I could get a pen, the number had disappeared.
“This is just harassment, don’t you think?” the woman put her head in her hands and put the phone and its cords back into the box. “Maybe later, but right now I just cannot deal with all this.”
A few weeks earlier, she told me, a visiting nurse had appeared at the door with a large piece of equipment to measure her vital signs. They tried to put it into her dining room, which has only one electrical outlet, already filled.
“They wanted me to unplug everything, and this is my dining room! I am sure it is much easier for them this way,” she told me, “but I asked them to take it away.”
Two good ideas, that would undoubtedly have been helpful to this woman, remain unused, unuseful, and furthermore, a source of enormous irritation to a person recovering from a serious illness.
I guess we could make arguments about the need for people, even older people, to adapt to a changing world. But it may always be a fact of life that not everyone will be able to do catch up with the technological advances that seem to come faster and faster as time goes by. I have spoken about the importance of personal contact, the fact that technology cannot replace humanity, and what we experience when we sit down and talk to a person, especially in the home.
But humanity tied to a piece of equipment can go a long way. The woman I visited would have been thrilled with the equipment she had received, if only a caring, thoughtful person had showed her how to use it, or made it easy for her to fit it into her home. It is so easy to assume that everyone can figure out how to use a cell phone, and that it makes sense to put equipment close to the place a person most often sits. But assumptions are often wrong. It is not an issue of noncompliance, or even stubbornness, for a person–any person–to ask for explanations and for accommodations. In fact, this is the greatest demonstration of will and self-determination. We can do much better to honor that.
Decisions, Decisions
After some drama and bated breath, we learned last Thursday that the Supreme Court–the same Supreme Court that has let me down a few times this term (i.e., regarding strip searches and campaign financing)–has upheld the Affordable Care Act… kind of.
And then, of course, the reactions poured in.
I want to be happy about this–and I am surprised that the individual mandate stood up past this test. It is only right that every person in this country should have insurance to cover health. It is just a right, as I see it, that in modern civilization that we should not only pick up trash and fight fires, but also make it possible to seek prevention and treatment around the various facts of our human condition.
But I am still sorry not to see many things here. This should not be an individual mandate, but an individual right. We should not be fooling around with different insurers–I just do not believe that the creativity of market forces will bring us the best solutions around health. An enormous amount of effort now goes into knowing the particular rules of various health plans, people who work in the healthcare field focused not on figuring out the most effective treatment so much as how to maneuver treatment so that it is even possible financially.
I had a discussion this afternoon with a social worker in a hospital around our perceptions of sickness and death. Somewhere along the way we lost touch with the finite nature of our lives, perhaps because the potential to save lives has become so effective, perhaps because we have had the good luck of relative prosperity and longer lives, perhaps because we have so effectively warehoused and silenced those who do not fit the image of wellness that we want to see in ourselves. We simply give up on the question of long-term care (i.e., the dissolution of the CLASS Act), an unattainable financial goal perhaps because we have not spent enough time considering the need for it.
But to go into the homes and the hospitals and the nursing homes and the shelters, it is not such a pretty story: countless foreclosures, bankruptcies, tragedies in the make when people are hit–for whatever reason–by illness or accidents (and this includes even the insured). In spite of our best efforts, people still get sick and become disabled–or perhaps because of our best efforts at times: people who might have died without such effective treatment now live, though the support they need to live their lives may now be much greater.
I want to cheer for the survival of the individual mandate, but I fear that having it without Medicaid expansion–and dare I say, without a single-payer system that includes long-term care, healthcare may improve, but not reform.
And the naysayers–the states that will simply refuse to participate in any efforts at all toward change–are the undoing of a country as told on one front, a country divided under the illusion of liberty, a country that pretends to save lives, but in the process refuses to accept and represent all of its citizens.
Tea and Technology
Being invited into a person’s home is an enormous privilege. Most people I see have recently been quite ill, or more often have chronic ailments that have put them into the situation of wanting to find out how they can stay in their homes, so a good number of them also spend some time apologizing in advance for the mess.
With all the technology that is available now, I can see that it would be far easier and faster for me to teleconference. It would save my driving time–and mileage costs–and the consumer would never have to worry about the mess in the house. We could talk, and I could look things up immediately in my office, much more easily than is often the case when I go out. And I could see more people. I could teleconference with hospital staff, and even meet with patients if portable devices were available there.
But the problem, you see, is that you cannot drink tea by teleconference.
You cannot shake hands, or smell the lemon–or gosh, the kitty litter. You cannot sit beside a person in a hospital for a few minutes, and you cannot run into a colleague in the hall.
I see a tremendous solution in this technology to the difficulty so many people have just in securing transportation to medical appointments–or at least some of them. It could open so many doors, decrease the number of times a visiting nurse has to go out to a home…
But I think of the woman I saw two weeks ago. She had just made coffee when I arrived, in spite of the infection that was developing right then, post-surgery, in spite of the fact that a day later she would be in the hospital once more. She told me about her pets, her life before moving to this country, the flowers she had long ago planted in the backyard–and I could see the hostas from the kitchen table.
She was alone in the house, and spent many days without seeing another person, she told me.
Another couple showed me the schedule of their appointments to a variety of doctors and clinics, the pharmacist. It seemed to be the only time they left their house, and their lives revolved around it.
“Being young isn’t for sissies,” a consumer once told me. He confessed later that he had stolen the line from Bette Davis. But he said it was true–I was trying to figure out how he could get some help while his wife recovered from flu. He had just come home from the hospital after a bout of it himself, and they went round and round with that, then pneumonia from hospital to home, or short-term rehab, then home.. and the insurance?
I see people all the time whose lives are focused on their healthcare. It is hard to imagine them not going out to see their doctors this way, not to depend on the daily visits from a nurse. It would be so nice if the visits were not focused on this sort of monitoring, but if the people were healthy–even with disabilities–these visits would stop. It is a huge shock to lose a friendly face who comes every so often, or even just once in a while. It is hard to give up leaving home for a few hours, even to go through another blood test, or lecture. There is always the stop for lunch, the chat with the woman with the baby in the waiting room.
People with chronic illnesses and disabilities are often so isolated, and so easily defined not by their unique qualities as human beings, but by what is perceived by most of us as abnormal: their illness, their disability. I wonder, if we remove the barriers to easy treatment with telemonitoring, with other technologies… can we also devote so much time and expense into removing the barriers to bringing people back to the community? Can we devote the savings to better transportation for non-medical needs? Can we build better communities in general, more accessible housing, more available housing? Can we figure out a way to make it more possible for people to use their time in ways that they choose?
Can we fill the gap that we will create by removing so many in-home visits for providers, so many office visits for consumers?
Are we smart enough?
Some evenings, I like to go to meetings that take me to the flipside of my day job–a job that focuses on the day-to-day needs of people I see. I like to enter a world where ideas freely flow, where people think about what is possible with technology, with innovation in all spheres.
But then, as I sit and watch, I so often find myself feeling like that “yes, but…” person–a role that makes me very uneasy. You see, I am idealistic, a dreamer–and yet, as I listen to creators, I find myself ever questioning feasibility, accessibility, practicality. And I keep wondering if there is not a better way.
To be more precise, I come from a nuts-and-bolts operation, the non-profit, state-funded program. Things move slowly, often somewhat inefficiently, and I maneuver through systems that operate in archaic and difficult ways.
And beyond the question of public services is the bigger issue of people themselves, people with varying experiences, people whose adaptability varies also, greatly. Not always, but often, it can be difficult to bring in the new, the unfamiliar.
Enter the smartphone.
Yes, the smartphone, the I-Phone, the apps, and the digital world as a whole.
So much potential, and I can see as I hear the ideas how much it would help so many of the people I see.
I think of the woman a few weeks ago who had the meticulous paper diary of blood sugar levels, food she ate, things she had changed, stress level. If only she could have plugged it all in. (and then, also, if only her doctor had time in a 15-minute visit to review the data and make sense of it).
This woman does not have a computer.
I was fascinated this morning as I read the newly-released poll from NPR, Robert Wood Johnson Foundation and Harvard School of Public Health. It discusses the difference in perception about our healthcare system, depending on whether a person has had a chronic illness or disability within the last twelve months. You can read a summary of the findings here. I was not surprised to learn that people who are sick have a worse impression of what is going on. But more on that later.
The data fascinate me in this sort of study. So, while I find myself distressed (though not at all surprised) to learn that nearly a quarter of people who have faced a healthcare crisis have also faced a “very serious” financial crisis as a result, I am astounded to read about telephone use.
Yes, telephones.
In the most basic modern mode of communication, what is a person’s link to the outside world? (and I must add that the individuals polled seem to represent a good cross-section of adult age groups, as well as income brackets). A full 16% of individuals polled said that they do not own a cell phone.
I wish I knew more. I wish I knew about internet access, whether households have computers, or tablets, or smartphones.
At one of these “ideas” meetings that I love, I started talking to a man. Great ideas–I could see how useful they could be. And I told him about what I see everyday–the people with limited computer experience, the people who could really use the ease of technology, but who need for it to be accessible.
I felt that I was talking to another world–he told me that everyone has smartphones.
Another man, at another meeting, told me that I-Pads are great for people with disabilities, very intuitive, and insurers would pay for them, because it only makes financial sense to them if it can save on office visits. On what planet? If the insurer happened to be Medicaid, for example, can you imagine the uproar? Poor people using government funds to get Apple products?
But the the question of accessibility is not only financial, or technical. It is also very real. What about a person with low-vision, or no vision?
And that issue–as I note every time I look at so many things in my job–is not limited to the idea-world after work. A woman, at a day-job-related meeting, explained that an application for her program–which isonly for people with disabilities–is not available in an accessible format, yet.
I have the same feeling every time I pass by a new subdivision, all with lovely front entrances, elevated, stairs heading up to the door.
What are we thinking? If I could impress one thing on any new thinker, it would be to consider the user first and foremost–not an ideal user who thinks and looks like you, but a user who really needs that great idea of yours to work for him, for her.
Consider starting from scratch–where you turn it on, for example. Consider training, equipment, and whether it is usable at all as you are creating it, for whom you are creating it.
Only Anecdotal 