What Is The Digital Health Perception/Reality Gap?

If Richard Nixon had employed Russia to hack the DNC instead of having had to burglarize the Watergate Hotel he might still be president. Unfortunately, at least from my limited perspective, Al Gore had yet to invent the Internet.

Tanned, rested, and ready.

Executives are too quick to dismiss what technology can do to improve their business. Those same executives would be outraged if the firms with which they do business didn’t employ that same technology.

And what do the desks of these healthcare executives look like? Healthcare executives have the latest technology at their fingertips, smart phones, tablets, laptops, and large PC monitors. They use all of these tools to manage their health systems. Emails, messaging, reports, systems. Online and interactive. They manage them from their offices and from home and from the country club. They manage those health systems when the call centers are closed, they manage them on the weekends, and they manage them from St. Lucia when they are on vacation.

Health system employees have twenty-four-seven access to their employer from anywhere on any device. What a novel concept.

Health system employees interact with their health system using technology. Patients interact with it by calling it.

Do you know how a health system executive makes a healthcare appointment? I do. They either get their admin to do it for them, or they do what every other person in America does who needs and appointment. They pick up the phone and call.

I call it 8 x 5 access. They can call from anywhere and they can use any type of phone.

These same executives are the ones spending millions of dollars on firms like Disney, Ritz—not the cracker company, and Studer to try to raise the experiences of people who are in the hospital. They are also the people who authorized spending millions of dollars to ensure that when someone walks through the lobbies that their experiences make them feel like they are at a Hilton.

So, what have health system executives done to improve the experiences of people before they get to the hospital and after they leave it?

Almost nothing.

Excluding the ED, ten percent of us visit the hospital each year. Do the math with me. That means ninety percent of us do not visit the hospital during the year. That does not mean though that those people do not use their health system during the year. Almost all of us will have dozens of health-related experiences that do not require a sleepover.

That begs the question—who, if anyone is in charge of designing and managing all of the experiences that happen outside of the hospital? The most obvious answer must be that no one is, for if someone was, those experiences would not be as consistently poor as they are.

To me, the lack of effort to provide a good experience to health system stakeholders leaves me feeling like Dorothy in the Wizard of Oz—We’re not in Kansas anymore. The Emerald City is your health system’s lobby. Do you remember that when they got to Oz the scarecrow was restuffed with clean straw, the Tin Man got oiled and buffed, and the Lion got washed, cream-rinsed, and blow-dried? Great things happen once you get to OZ. the same is true for patients.

But you also may recall how difficult it was for them to get to Oz. The yellow-brick-road was fraught with peril. Trees threw apples at Dorothy. The witch tried to burn Scarecrow. She made the Tin Man rust. Flying monkeys tried to kill them, and a poppy field nearly ended their journey.

That is what people encounter before they get to the hospital. That is what it feels like to schedule and appointment and to dispute a charge. And we do not even have a yellow brick road. We simply use trial and error, knowing that it will be a trial and that there will be many errors.

Nothing about healthcare is easy until after you stand nearly naked in your hospital room trying to figure out how to tie a knot to close the back of your hospital gown. (Every time I take a travel I get on my knees and thank the hospitality gods that Hilton does not make me put on a gown.)

So if health systems hire firms to make the inside experience Oz-like, why don’t they hire firms to make the inside experience equally Disneyesque? They do. Sort of. They hire marketing firms and agencies to create gossamer experiential images of the health system as a whole, images of a health system that will give you the experience you expect.

Digital health agencies create branding campaigns that depict healthy people. The healthy people are shown using all sorts of technology. The healthy people then meet with doctors and nurses at the Emerald City Clinic. The doctors and nurses are using all sorts of technology. Then the healthy people go on a picnic, or they go skydiving, and the doctors grab all of their technology and they go meet with other people who BMIs are too small to measure.

All of those memorable experiences are brought to you by the wonderful people at Emerald City Healthcare. And people do remember those experiences. They remember what happens when they call the system after 6 p.m. They remember sorting through thousands of links on your system’s website without finding a useful link.

And branding your system to get patients to see it as a modern, up-to-date, technology friendly health system is worthless. Patients do not want to imagine that they can access and engage and interact with their health system and have the same experiences and effectiveness that they get from their banks and their airlines.

Until your health system offers those types of experiences, all of your system’s marketing efforts targeted at convincing your patients that your system is customer-friendly and accessible and engaging only work, until like Dorothy, people realize that Oz’s Wizard’s promises were all hat and no cowboy.

Nobody wants to interact with a system which brands itself as a digital health provider. They want to interact with a health system that is a digital health provider.

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