Make the Technology Disappear

A version of this post was published on The Health Care Blog, Oct. 7th

When Esther Dyson asked me to participate in a panel at the Louisville Innovation Summit called “Real-world Care Technologies for Medicaid Recipients That Institutions Actually Deploy," I could hear the frustration in her voice in the name of the panel. “Make something useful that people will actually use.”

I stumbled on the word “technology.” What if we said, “real-world care solutions for Medicaid recipients that institutions actually deploy.” Is there a difference? Yes. A solution solves a problem. How we solve a problem shouldn’t be the focus.

I think our customers would say, “if you have to do it with technology, fine.” They are not excited about technology. Who can blame them? In health care, technology has created real-world unhappiness, implementation complexity, low morale and a poor user experience for patients and care providers. To our buyer, technology invokes extra steps on the way to getting the problem solved: IT implementation backlogs, security review, and anxiety about data stewardship.

It would be best if the solution was apparent and the technology disappeared.

Which reminds me of this story:

The architect hired to re-design a famous museum pitched his designs to the Board of Trustees as follows: He said, “If you give me enough money, I'll design you a beautiful building. If you give me more, I'll make it disappear." What a seduction!

Can technology ever be so good it disappears? Yes! Here’s an example: my husband and I were on a long drive recently on an unfamiliar road. I was driving and we were deeply engrossed in a conversation. The kids were asleep in the back of the car. For a moment, in our busy lives, it felt like we had all the time in the world, just to talk.

I had forgotten the one earphone in my left ear. At the right moment, Google maps told me to turn right, and I did so effortlessly, without even a pause in the conversation, as if we were driving a route we had driven hundreds of times. The conversation stayed in the foreground, the technology disappeared where it belonged.

Health care technology needs to disappear. Instead, it’s ugly, heavy infrastructure is everywhere. EHRs interfere with conversations, portals and call centers do not recognize us the way our consumer technology does, fancy algorithms serve only to generate paper lists. We are, perhaps, at the peak of ugly, cumbersome, awful technology. It can only get better from here.

Vital Score, the technology, is a system of motivational indexing that captures and categorizes people’s motivations, supported by configurable survey software, a matching engine and automated emails and text messages. Yes, that’s the technology that supports our solution. The problem we solve is the most intractable problem in health care: how to get people to participate in improving their health. Our solution gets people to participate in programs and services that can have the biggest impact on their health. We do it in 3 minutes of wait time in provider visits. Our solution is lightweight and our implementation is the same day we show up. We don’t talk about our technology, we talk about our results: 5-20x the participation rate of current engagement efforts or that we replicate the engagement results of a case manager embedded in a clinic talking to patients 1:1 to assess them and motivate them to participate in services.

At its best, Vital Score is an uninterrupted conversation.

Better conversations are key to higher quality, lower costs and better patient experience. Motivational interviewing, advanced care planning, shared decision-making and good old thoughtful recommendations all require time-consuming and often intimate conversations that can make both patient and provider feel quite vulnerable. These conversations can never be replaced, but they can be supported by...technology, especially the disappearing, consumer-friendly kind.