Are we there yet? ??

Since a few months I have this weird question floating around in my head…Wherever we look, wherever we go we hear about digital transformation, digital alignment, structuring the approach,... About how to move things to the cloud, making apps, opening up to the public, empowering the media, …. You get my drift.

My interest being in Digital health I projected that on this field and then my question became: “Is everybody accounted for in the new digital world?”

A seemingly treacherously simple question and before you answer it, I want to tell you a story. It isn’t mine, but the people who told it don’t mind me using it, as an illustration of something that needs to be spoken about!

Are we including the elderly?

That morning I stopped by my uncle's house and just as I was opening the window and getting ready to start the engine, the elderly neighbor Lea walked by. She spoke to me and asked me, all upset and in tears, if I could help her. I thought maybe she had lost her way...

She showed me a bill with a number on it, and told me that she had a water leak at her house and she didn't know what to do anymore. She is all alone. Her husband and son deceased, no other family or friends, no neighbors who would help her...

I got out and she asked me to go with her to look at the wooden floor in her old home. All swollen with moisture and probably beyond repair. She had already called the Housing Society, where they told her that they could do nothing for her and that she had to contact the Water Group. And that's where it had gone wrong.

Press 1 for this. A problem with your bill? Press 2. If it makes me sick to my stomach, what about someone that is around 90?

So I called the Water Group (which did indeed make me go berserk again ...) until I got someone on the line who said that Lea had to read the meter tonight before going to bed, not use any water all night and then check tomorrow to see if anything had changed on the meter to make sure that the problem was inside her house ... Huh? Wasn't her badly damaged parquet already proof of that?!

Then I called a plumber, who was very sympathetic and promised to contact her this afternoon to solve the problem quickly.

Lea, in all her confusion, also didn't know any more if she had any insurance... She invited me to look in her drawers for some kind of insurance contract myself. Nothing found. Then I asked her if she could look at her bank statements to see when the premium was collected by the bank.

More tears and panic ...Bank statements? She hadn't taken them out in a while... When she went to the bank, she always waited until she could speak to another customer who could help her with that strange device you must collect your statements from...

Calling the bank was the next step. Lost bank card, press 1. Press 2 for questions about your savings account... Press 4 if you wish to speak to a member of staff. Number 4, that would definitely be our salvation.

Lea had fire insurance with the bank itself. Whew, that makes it easier... A bank employee would call Lea this afternoon or tomorrow at the latest to discuss with her what she needsto do to start a file...

Digitalization, automation... It's all very well, but as a result some people are totally lost and left to their own devices. Is it normal for an elderly person to have to talk to a complete stranger in the street to find her way around all kinds of services? Is 'services' still the right word? Banks, hospitals and companies are cutting back on staff and referring everyone to an automated counter, a website or a phone number with a menu that gives you a stomach ache.

Are we including the non-digital people in our society?

The above, dramatic as it is, illustrates that we are living in a fast paced, techno driven world and more and more I hear the divide between “you can use an app for that” by young people and “I can’t even answer an SMS or …” from technically less apt people. NO, not all of those are in their nineties, some are much younger.

We also have the problem of less well-off people, … What is going to happen to the homeless, the technically challenged, the sick etc… In our fast moving society I see a lot of people potentially been left behind.

Take "Artificial Intelligence" and "Machine Learning", two buzzwords that even for those involved have so many different meanings.

I interviewed over half of the hospitals on this subject and everybody has fear of being left out but when push came to shove less than a handful hospitals have really dabbled in the murky waters that AI/ML are.

We start to see the formation of real Data Science Institutes and what warms my heart is that it isn’t IT people or mathematicians that lead the curve but that they are employing real world doctors in this arena, people who are well versed in what a hospital needs.

But I still see misunderstanding and incomprehensiveness as major stumbling blocks aren’t these the same doctors that a lot of people don’t understand? To say it with a cliché, doctors are hard to understand, let alone read their hand-writing! Data Scientists, being doctors become difficult to understand SQUARED!

My apologies to all if I ruffled someone’s feathers as I have no negative intent. What I’m trying to make clear is that we need more clarity, more transparency at the right level of complexity.

I had to look it up but the right word for it is: obfuscation!

Wikipedia states following: In software development, obfuscation is the act of creating source or machine code that is difficult for humans to understand. Like obfuscation in natural language, it may use needlessly roundabout expressions to compose statements.

We see this all around us, not willingly, certainly not maliciously, but the result is that we often do not get what we need. We can’t properly interact with others as in the example above where the interface is “broken”, even though when I call my Mobile network operator I think it might actually be with INTENT of discouraging me, like we all have felt from time to time.

Are we including time to listen?

Just the other week I had another example. My wife and I had booked a flight to Germany to visit a friend who turned 60. The day before we would fly he got in a nasty bike accident and ended up in Intensive Care, so no “need” for us to fly. I try to contact the airline company to get either a refund, or book alterative flights hoping not to lose my money.

4 language choices set me up for the fall. 21 minutes on hold, to then get dropped in a menu that tells me all operators in the language of my choice are having lengthy waiting times. Whether I want to continue in English…

Confirm and the call gets dropped, try again, 4 times, total 2h11 minutes lost and in the meanwhile I get to the airport where they refer me back to the line I’m trying to call as they will not help me, they claim they can’t.

4 hours in my suffering I get a live operator on the phone, who tells me what to do: Present myself back at the counter to get everything sorted!

But the person on the phone and the person in front of me disagree on how to move forward, even a supervisor doesn’t get it resolved. I lose my tickets and they have won through obfuscation, I’m frustrated and decide to no longer fly this airline.

We all LOST. If you would talk to the designers of the system, they will point out the major advantages that just don’t come up for the CUSTOMER!

And here is where the analogy with what is happening in HealthCare land. We have started the digitalization of healthcare based on the same rules that apply in these other “worlds”, those of business, not lives and living people!

What happened to KISS? Keep It Simple Stupid (or whatever variation you prefer)! I hear patient telling me that they are not allowed to have access to their complete medical record because GDPR and privacy doesn’t allow it. That is simply not true as GDPR has been put in place to allow the patient/citizen access to ALL AVAILABLE DATA concerning the person! Why keep relevant data from the source knowing that #datasaveslives?

Are we including family and communities?

Another example is what happened when both of my parents are in the same hospital being treated each for a different ailment! My father a planned day hospital operation, my mother fell on the way back home and broke her wrist nastily. I brought her to the same hospital to have them at the same location so it would be easier to have info on both.

But I had to revert to CALLING the hospital (in which I was sitting, waiting) to hear about progress of my father and I had to ask the receptionist for info on my mother’s condition, repeatedly. These hospitals use apps to keep my parents up-to-date on appointments et all and they can’t/won’t/don’t provide next of kin or designated care people information. What is the use of such technology when only used to help the doctor keep his notes together? It’s time we start thinking about community care.

Have a look at the labyrinth at Health House in Heverlee where they explain the hospital as it should/will be in 30 years. No more 4 walls but community care, environments where the patient feels well. When we want that to happen, we will need to start building that in the current way of working NOW because as professor Thimbleby rightly states in his book “FIX IT”: If we want to fix digital healthcare, to do what it needs to do, we will need to make it a generation play, starting with young people NOW and not wait another generation!

Also important is that we need to transition. Ways need to be found to merge the old and new - without standing in the way of progress and like the story at the start without forgetting those more challenged.

I normally write in the first place about healthcare, but this applies to the financial world, the transport industry and so many more places. Digital transformation is still too often seen as an IT process, while it is a PEOPLE process! And right now, we are excluding people.

What are your experiences with obfuscation, in healthcare, … or elsewhere?

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Thank you so much for your help.

Jan Vekemans

#1patient1record4belgium #gezondheidszorg #healthcareit #ziekenhuis