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Ideas and Opinions |5 December 2017

Technology and Medicine: Reimagining Provider Visits as the New Tertiary Care

Christian Terwiesch, PhD; David A. Asch, MD, MBA; Kevin G. Volpp, MD, PhD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 24 October 2017.
  • From The Wharton School of the University of Pennsylvania, Perelman School of Medicine, Penn Medicine Center for Health Care Innovation, and Crescenz VA Medical Center, Philadelphia, Pennsylvania.

    Financial Support: This work was supported by the Penn Roybal P30 Center on Behavioral Economics and Aging, which is funded by the National Institute on Aging.

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0597.

    Requests for Single Reprints: Kevin G. Volpp, MD, PhD, Perelman School of Medicine and Wharton School, University of Pennsylvania, 1120 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail, Volpp70@wharton.upenn.edu.

    Current Author Addresses: Dr. Terwiesch: University of Pennsylvania, 3730 Walnut Street, Jon M. Huntsman Hall, 5th Floor, Philadelphia, PA 19104.

    Dr. Asch: Penn Medicine Center for Health Care Innovation, PCAM 14-171, 3400 Civic Center Boulevard, Philadelphia, PA 19104.

    Dr. Volpp: Perelman School of Medicine and Wharton School, University of Pennsylvania, 1120 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.

    Author Contributions: Conception and design: C. Terwiesch, D.A. Asch, K.G. Volpp.

    Drafting of the article: C. Terwiesch, D.A. Asch, K.G. Volpp.

    Critical revision of the article for important intellectual content: C. Terwiesch, D.A. Asch, K.G. Volpp.

    Final approval of the article: C. Terwiesch, D.A. Asch, K.G. Volpp.

    Obtaining of funding: K.G. Volpp.

    Administrative, technical, or logistic support: C. Terwiesch, K.G. Volpp.

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Connected health provides a novel way of delivering care. Instead of relying exclusively on episodic encounters in a practice or hospital, connected health leverages advances in communications technology to create a high-bandwidth information exchange between patient and provider. This enables new processes, such as remote patient monitoring, secure messaging, and telehealth. Its promise is that providers can better care for patients when more closely connected to them, including during the large parts of their lives when patients are not in examining rooms or inpatient beds (1).
Achieving this promise, however, requires getting past the operational demands connected health places on providers. Although remote patient engagement is often assumed to be a substitute for time-consuming face-to-face visits, in recent studies we found just the opposite: Patients introduced to a portal allowing them to send secure messages to their care team had more rather than fewer face-to-face visits (2). Once patients began using the portal, many started sharing health updates and new symptoms. Such messages could not be ignored by the care team and thus created not only more work but also additional office visits.
Our view is that early conceptions of connected health traveled a flawed path largely premised on the idea that gains could be achieved by increasing connections between patient and provider. However, this path piles more responsibility on already-overtaxed providers. A better model might aim to decrease connections between patient and provider by using technology to allow for more efficient use of the provider's...
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Terwiesch C, Asch DA, Volpp KG. Technology and Medicine: Reimagining Provider Visits as the New Tertiary Care. Ann Intern Med. [Epub ahead of print 24 October 2017]167:814–815. doi: 10.7326/M17-0597

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Published: Ann Intern Med. 2017;167(11):814-815.

DOI: 10.7326/M17-0597

Published at www.annals.org on 24 October 2017

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