How Doctors Think About New Technologies

From the post by Leslie Kernisan at The Health Care Blog

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My questions when considering a new technology

To begin with, here are the questions that I think about when considering a new technology:

Does it help me do something I’m already trying to do for clinical reasons? Examples include tracking the kind of practical data I describe here (sleep, pain, falls, etc), helping patient keep track of — and take — medications, helping caregivers monitor symptoms, coordinating with other providers…my list goes on and on, although I’ll admit that I prioritize management of medical conditions, with issues like social optimization being secondary. (Social optimization is crucial, it’s just not what physicians are best at, although I certainly weigh in on how an elder’s dementia or arthritis might affect their social options.)

What evidence is there that using it will improve the health and wellbeing of an older adult (or of a caregiver)? Granted, the vast majority of interesting new tech tools will not have been rigorously tested in of themselves. Still, there is often related and relevant published evidence that can be considered. For instance, studies have generally found that there’s no clear clinical benefit in having non-insulin dependent Type 2 diabetics regularly self-monitor blood glucose. (And it is certainly burdensome for older people with lots of medical problems.) Hence I would be a bit skeptical of a new technology whose purpose is to make it easier for older adults to track their blood sugar daily, unless it were targeted towards elders on insulin or otherwise at high risk for hypoglycemia.

How does the data gathering compare to the gold standard? Many new tech tools gather data about a person. If we are to use this information for clinical purposes, then we clinicians need to know how this data gathering compares to the gold standard, or at least to a commonly used standard. For instance, if it’s a consumer wrist device to measure sleep, how does it compare in accuracy to observation in a sleep lab? Or to the actigraphy used in peer-reviewed sleep research? If it’s a sensor system to monitor gait, how does it compare to the gait evaluation of a physical therapist? If it’s the Scanadu Scout Tricorder, which measures pulse transit time as a proxy for systolic blood pressure, where is data validating that pulse transit time as measured by this device accurately reflects blood pressure? (BTW I can’t take such a tricorder seriously if it doesn’t provide a blood pressure estimate that I can have confidence in; blood pressure is essential in internal medicine.)

How exactly does it work? Especially when it comes to claims that the product will help with clinical care, or with healthcare, I want to know exactly how that might work. In particular, I want to know how the service loops in the clinician, or will facilitate the work the clinician and patient are collaborating on.

How easy is it to use? Tools and technologies need to be easy to use. Users of interest to me include older adults, caregivers, and the clinician that they’ll be interfacing with. BTW, all those med management apps that require users to laboriously enter in long drug names are NOT easy to use in my book.

How easy is it to try? Let’s assume a new technology is proposing a service to the patient (or to me) that offers plausible benefits, either because it’s a tech delivery of a clinically validated service, or because it passes my own internal common sense filters. How easy is it to actually set up and try? I’m certainly more inclined to explore a tool that doesn’t require a large financial investment, or training investment.

How cost-effective is using this technology? I’m interested both in cost-effectiveness for the patient & family, and also for the healthcare system. Sometimes we have simpler and cheaper ways to get the job done almost as well.

Can this technology provide multiple services to the patient? My patients are all medically complex, and have lots going on. Products that can provide multiple services (such as socializing with family off-site AND monitoring symptoms), or that can coordinate with another product — perhaps by allowing other services to import/export data — are a big plus.

Does this technology work well for someone who has lots of medical complexity? I always want to know if the product is robust enough to be usable by someone who has a dozen chronic conditions and at least 15 medications.

What I’d like to see on the websites

These days, a website is the generally the place to start when looking into a product or service.

It’s a great help to me when a product’s website addresses the questions I list above. Specifically, I find it very helpful when websites:

Have a section formatted for clinicians in particular. I’m afraid I don’t have much time for gauzy promises of fostering a happier old age. I just want to know how this will help me help my patients. Specific examples are very very helpful.

Have a “how it works” section with screenshots and concise text. Personally, I have limited tolerance for video (videos can’t be skimmed the way text and pictures can) and find it a little frustrating when most information is in videos. Note that it’s probably best to have separate “how it works” sections for clinicians and for patients/caregivers.

Provide a downloadable brochure for patients/families, and another for clinicians.Although it’s annoying when information is presented ONLY in a pdf brochure, I’ve discovered that I quite like having the option of a brochure. Brochures are much easier to read than websites, in that you don’t have mentally decide how to navigate them, or search through them in quite the way you do with websites. Also, brochures can be conveniently emailed to colleagues or patients, which is nice when you want to suggest that your patient try something new…..

 

Read the entire blog post here

 

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