6

Making Connections
Through Technology

EXPLORING THE PROMISES AND PITFALLS OF TECHNOLOGY

Technology has great promise to transform health professions education, health care, and health itself. Current, emerging, and future technologies will change the structure of the health care system and have the potential to address broad societal challenges such as poverty and inequality. However, leveraging the potential of technology will require overcoming challenges—such as institutional inertia—and grappling with the ethical issues surrounding the use of technology. Diane J. Skiba, professor and director of Health Care Informatics at the University of Colorado Denver, spoke to workshop participants about what the future of health care will look like: what types of technologies will be used by patients and provid-

ers; how will people and devices be increasingly interconnected; and how will health care professionals be prepared for this future? Radhika Shah, co-president at Stanford Angels and Entrepreneurs, shared her perspective on harnessing the power of technology to bring positive social change to the world while addressing the potential downsides of these tools.

Examining the Future of Connected Health Care

Skiba started by defining the “Internet of Things” and the “Connected Age.” Both of these concepts describe a world that is made up of connections between everything and everyone, said Skiba. The Internet of Things focuses on connections between physical objects (e.g., smartphones linked to home systems), whereas the Connected Age refers to virtual connections, such as those between people, resources, and ideas. Several groups have attempted to estimate the scope of the Internet of Things: IHS Markit estimates that there are 17.6 billion things that are interconnected. Future projections are that by 2020, the number of Internet-connected things could reach as high as 50 billion with more conservative estimates at 20–30 billion (IEEE Spectrum, 2016).

These types of interconnectivity between people and things are related to the concept of “Connected Health.” This model of health has the patient at the center and the goal of achieving proactive and efficient health care with the help of interconnection. Caulfield and Donnelly (2013) define Connected Health as:

Connected Health, said Skiba, blends high-tech devices with high-touch connections between people. Skiba gave some examples of how the ecosystem of Connected Health works. A provider may connect with another provider to discuss an experience with a patient and seek advice. Patients may reach out to a patient community to get information about a diagnosis and to get peer support. Families, patients, providers, and caregivers are involved and engaged as part of a collaborative care team that shares information and resources. This health care system may largely take place outside the walls of traditional health care, said Skiba.

Skiba introduced workshop participants to a vision of a future patient who lives in a Connected Health world: “Josephine,” an 86-year-old who

is recovering from a hip fracture. While in the hospital, Josephine is given a tablet with a Web-based patient toolkit. This program helps her learn and keep track of who her health care providers are and their roles on her team. Josephine would be responsible for setting her own goals. She would learn what will happen when she goes home, and how her health care team would continue to help with her recovery. The Web-based toolkit would allow Josephine’s family members to access information to stay current on how Josephine is doing with her care. It would also allow multiple providers—primary care provider, surgeon, and physical therapists—to share information and manage handoffs between providers. When discharged from the hospital, Josephine would be sent home with various digital tools to continue to manage her care: for example, a blood pressure monitor, a scale, and a digital stethoscope. She would wear an Internet-enabled necklace to allow her to order prescription refills, call for emergency services, or connect with her providers. She would have virtual visits with providers via her computer. She would wear smart socks and use a smart cane that could help keep track of her progress by monitoring her gait. Sensors in these items would collect information and alert someone when there is a problem. A smart watch would remind her when it is time to take her medicine. She would have a smart refrigerator that could order groceries, act as a virtual assistant, show her educational videos, and give her recipes that are appropriate for her health conditions. These tools are all interconnected, and the data are available to her providers and caregivers. She may be assisted by robots like Zora, Pepper, or RoBear, which interact with patients and help them navigate their care.

This future of connected health care, said Skiba, will require overcoming several challenges. First, it will require new skills and knowledge for health care providers. Health professionals will not only need to know how to use these various technologies, but they will need to know how to incorporate them as part of a health care team. There will be a “data deluge” from wearables and other in-home technologies, said Skiba, and providers will need a way to manage these data and use them to improve their services. Health care is undergoing a transformation, and health professions education needs to prepare students for the future rather than for the present; professionals need to be agile and able to respond to and incorporate new technologies into care. In addition to the issues with preparing the workforce, said Skiba, there is a need to address the digital divide. Some patients—particularly those in low-income brackets and rural communities—lack broadband or smartphones that are needed to become part of the connected world. Payment may also be a barrier; health insurance companies have begun paying for virtual visits, but the reimbursement for technologies may lag behind the innovation. Ethics and the issue of patient choice must also be dealt with; some people may not want sensors

and robots in their home while others welcome these technologies. Finally, said Skiba, patients differ in terms of their comfort with and aptitude for technologies. The challenge will be to ensure that all patients are able to access their personal data and information and know how to use these tools in ways that has the greatest benefit for each person.

Leveraging Technology to Solve Global Challenges

Technology offers solutions to some of the biggest challenges of our times, said Radhika Shah, including poverty, inequality, public health, and gender equity. The world is at an inflection point right now in two ways, she added. First, the United Nations developed a set of 17 ambitious global goals known as the Sustainable Development Goals (SDGs) that weave together social, economic, and environmental challenges (see Figure 6-1). The 191 World Health Organization member states are working on these intertwined goals and it will take a collaborative effort from the global community to solve the challenges. Second, technology is rapidly developing and spreading across the globe, making it possible to integrate and leverage technology to address global issues. Investors have recognized this potential and are funding technological innovations to achieve social change.

Shah gave a few examples of how technological innovations have already begun to advance the SDGs. Technology has the capacity to solve existing problems, for example, new artificial intelligence tools are outperforming humans in medical diagnosis. Technology can give people all across the globe access to information through free courses and resources

available online. Technology can disrupt markets and transform the workplace through innovations such as Samasource digital microwork, which allows marginalized women and youth to perform work from home via the Internet and receive a sustainable wage. Technology can use the power of data to solve problems; for example, in a natural disaster, credit card usage data can provide information about which stores and services are still operational. Above all, said Shah, technology enables knowledge sharing, transparency, and anticipating and locating major trends.

However, despite this remarkable potential, technology is a two-sided coin. There are potentially harmful side effects of technology, and technology can be leveraged to do harm as well as good. For example, Shah said, animal poaching has increased in recent years because of the ability of poachers and buyers to transact anonymously on the Internet. Disinformation that is spread on social media can lead to xenophobia, distrust of the media, and negative treatment of others. Technological innovations can bring the risk of identity theft and invasion of privacy. There is the potential for technology to bridge the inequality divide, but technology may also increase this divide if people have unequal access.

As technology continues to advance and spread, it is essential that the world think about these potential downsides, and take action to mitigate the consequences, said Shah. There is a need for leadership on this front, and a number of questions need to be answered. Should government, technology creators, academia, or consumers be responsible for controlling or anticipating the downsides to technology? Should policy be made on the national or global level? What other stakeholders should be involved? How do we solve the tension between freedom of expression and manipulation of social media and information? Should technological innovation be seen as a tool to achieve social goals, or as an end unto itself? Should educational institutions be teaching technology ethics? How do we make decisions about controversial technologies such as genetic engineering?

Shah concluded with a quote from the Copenhagen letter, which was a letter signed by more than 100 participants at the Techfestival in 2017: “Let us move from human-centered design to humanity-centered design” (Copenhagen, 2017). Shah said that technology should be seen as a tool for global good, not just as an individual benefit, and that humans are the custodians of technology and must make informed decisions about its proper usage. She called for the global community to come together to collaborate, innovate, and leverage technology, while being careful and accountable about the negative externalities.

In the next part of her presentation, Shah shared numerous examples of innovators who have leveraged technology for addressing certain SDGs. The first example seen in Box 6-1 intertwines education and health care within the technology field.

Coordinated out of Stanford University, the initiative brings best practices from Stanford’s emergency room to places like Inner Mongolia and now rural India by engaging with organizations such as the Healing Fields Foundation. They use a train-the-trainer model to build the skills of doctors and other local providers in underserved regions using in-person and virtual connections.

After citing many more examples of technology-enabled learning in line with local customs, Shah expressed her sincere appreciation for what she referred to as “deep collaborations among people from across the globe.” This is only possible because online technology can be used to train and connect people, she added. With that, Shah made a final call to action for all people to come together as a global community to collaborate, innovate, and leverage technology while remaining ever vigilant to avoid the potential negative externalities of technology.

DISCUSSION

With these potentials and pitfalls in mind, workshop participants held table discussions about the ethics and unintended consequences of technology. Individuals at each table reported to the group about the issues that arose during their conversation. Issues included

• Guiding health professions students in the proper use of social media through establishment of boundaries between personal and professional selves
• Teaching digital professionalism and digital ethics at educational institutions
• Leveraging digital immigrants (those who grew up without today’s technology) for teaching digital natives about the social mores and professional roles that existed prior to the digital revolution
• Getting health professions organizations to restate their professional mandate in the age of technology, and express how the values undergirding the profession have not changed despite changes in the tools
• Calling on health professionals to help consumers filter through the enormous amount of health information that is available and determine which sources provide quality information
• Engaging technology developers with communities to identify and define real problems that need technological solutions (i.e., using technology to enable collaborative problem solving)
• Using technology to challenge and upend deep-seated cultural beliefs and structures

LESSONS LEARNED

At the closing of the workshop, Jeffries asked participants to identify notable messages or “aha moments” and share them with the group. Responses included

• To be effective, technological innovations need to be scalable and sustainable. (Scrimshaw)
• Research incentives need to be changed so research and practice are not siloed but instead work hand in hand and inform each other. (Scrimshaw)
• A major challenge to leveraging the potential of technology is overcoming institutional and professional inertia, getting leadership on board, and preparing faculty for the changes ahead. (Cahill)

• Innovations need to start with the user and a well-identified problem and be built from there. (Ascione)
• We should focus efforts on using technology in order to do things we cannot do otherwise, or improve the things we are already doing. While high-tech tools are exciting, sometimes the most impact can be made with low-tech, low-bandwidth solutions that are reliably and widely implemented. (Merrick)
• As technology advances, it will be essential to teach responsible and ethical use of technology. (Cain)

After listening to the forum members and other workshop participants, Jeffries shared her memorable points from the meeting that included a Wordle (see Figure 6-2). Technology has to be married with good pedagogy to be a truly learner-centered approach, she said, and technology is not the end, it is the instrument. This new learner-centered approach will enable and empower students to take responsibility for their learning, but it will also require faculty to shift from being a transmitter of knowledge to a facilitator of learning. The learning of the future will focus less on gaining knowledge of facts, and more about building relationships and seeing ways to connect people, information, and ideas.

Open access to information resources is a dramatic shift from the traditional model of education but one that will open doors and broaden the

impact of education. The promise of technology must be tempered with the pitfalls; people must be cognizant of the downsides, take action to mitigate them, and teach “digital wisdom” as part of health professions education. With that, Jeffries closed the workshop.

REFERENCES

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