Why Does a Digital Mindset Matter to My Health Care?
We need to listen to the digital generations in a new way. They are powering the change in healthcare.
I still remember the name of my childhood pediatrician – Dr. Nichols. I don’t know how long he was my pediatrician and I don’t recall the names of most of the doctors that followed him. My memory of him is vague – as a kind, older (to a 6 year old!) gentleman who seemed to know our family and fix boo boos. I didn’t have major health issues, so my visits were limited to annual checks on my birthday. The other doctor I remember from my early years was the one I worked for at an occupational medical center during high school – Dr. Litrenta. I don’t remember his first name – he was just Dr. Litrenta to me. He was quirky, kind and knew everything about every patient who walked through his door. During these early experiences, it seemed that primary and preventive care were important. And being raised by Baby Boomer parents, it was expected that career stability was a necessary step toward providing healthcare and retirement security. Preventative care was always provided through annual physicals and twice yearly dental appointments, and our doctor maintained our health history. Medical care involved traditional western medicine approaches, while ‘alternative’ therapies’, such as acupuncture, were not considered scientifically based and therefore not “really” medical care. A digital mindset was a concept that had not yet emerged.
When I started my career in health research after college, I knew I was supposed to sign up for health insurance and there were no other options or alternatives. Like most young adults, I was healthy and sought medical care for the same annual physicals and twice yearly dental appointments as was the norm when I was a child. For the next three decades, I can recall only a few of the other physicians who treated me. I changed jobs, changed cities, and changed doctors.
Commitment to Healthcare Principles or Delivery?
My childhood experience is vastly different from my adult experience. The integration of technology into nearly every aspect of our daily lives over the past two decades has shifted how we conceptualize and deliver healthcare – away from a traditional, and toward a digital, mindset.
I recount these childhood memories because in the early days of my career in health research, experts focused on how to maintain a traditional concept of primary care. Giants in the field, like Dr. Barbara Starfield, expressed that comprehensive, continuous, accessible, and coordinated primary care was critical to positive long term health outcomes. This was the gold standard we needed to maintain or, as the healthcare system continued to fracture over time, we needed to recapture. Throughout my career I researched organizational change in health care, barriers to and variations in care, and why certain patients lacked access to these fundamental principles. What emerged in my research over time was that the fundamental principles were consistently acknowledged as important, but the mindset committed to the delivery of these principles remained stuck in time.
A different view began to materialize on how to maintain the principles but reconsider the delivery. The data painted a clear picture of the underlying challenges to health care delivery and access. Colleagues asked me: what are those challenges? What problem was I uncovering? What needs to be fixed to get back to these fundamental principles of primary care? My answer was consistent, but often dismissed: the solution is not going back to something. It is looking forward and adopting a new mindset: a digital mindset. Early on, the contrary view was that the digital generations were young and healthy and would eventually adopt the existing system as they grew older and became affected by chronic illness. The data suggested something else was going on: like generations before, young adults were the least likely to be insured. However, the difference was that they were not joining membership roles in the same pattern as older generations even as they aged.
Rise of the Digital Mindset
We need to listen to the digital generations in a new way. The digital generations, or the combined generations of the Millennials and Gen Z, encompass nearly two hundred million people who are diverse across demographic, cultural and social characteristics, but they have many things in common. When it comes to healthcare, they are a generational group that has only known their world with technology literally at their fingertips. Being born into ubiquitous technology has created a digital mindset which is different from older generations. Dr. Starfield’s principles of comprehensive, continuous, access to and coordinated primary care weren’t unimportant or unattainable. It wasn’t that any single aspect of health, health care delivery, or the providers within it were doing the wrong thing. It was that the system, and those within it, were doing the same thing.
The mindset has changed and, with it, the requirements for how the system functions. The digital generations are now the largest since the Baby Boomers (bigger in fact), are now adults and leaders, and embody a digital mindset. The collective mindset of a generation to make significant paradigm-shifting change is the first since the Boomer generation. Change is powered by more than the size of these digital generations. It is powered by their diversity across nearly all demographics and their embodiment of digitalization, not as a thing but a way of being. The world has changed, access to information has changed, and health challenges have changed. As a result, the problem for healthcare is not necessarily due to specific aspects of the system. The very definition of healthcare and how to manage it has permanently shifted. The digital generations demand a different definition of health, as well as a different approach to accessing and interpreting information, care and treatment.
Their version of health is about a person not a patient; a journey, not a disease;
a personal interaction, not a guideline-driven plan.
They demand an approach where sickness and health is not a binary relationship. In this space, health and care is what happens outside a medical office, where a person is living, interacting, and being. The future of health care is not about adding technology to a broken system. The path to a more functional health system requires embracing comprehensive, continuous, accessible, and coordinated care attained through rethinking what healthcare really is and how to approach it.
The Path to Healthcare Innovation
Many leaders in the current health care structure have been reluctant to adopt the digital mindset. Yet, the digital mindset has been putting pressure on the system almost imperceptibly. Over the past decade, new approaches and ways of thinking about and delivering healthcare have been created and tested only to be marginalized as wellness tools, futuristic products or ‘doomed to fail’. These include, but are not limited to, online doctoring, virtual-based mental health tools, wearable data tracking, and remote monitoring. The emergence of practices that integrated ‘“wellness” care (such as acupuncture, acupressure, biofeedback, hypnosis, imagery or yoga) connected western medical approaches to a broader health journey. The COVID-19 pandemic of 2020 forced a reconciliation with what the digital generations have been asking for, and quietly (or not so quietly) building all along since the existing system does not meet their needs. Approaches built alongside the healthcare system have become essential to providing comprehensive, continuous, accessible, and coordinated care during one of the most significant health crises in over a century. Examples abound where wearable technologies such as an Apple watch, once not considered a reliable replacement for in-hospital testing, became a resource during the pandemic to keep people out of the hospital. Restricted waiting room access reduced crowded waiting rooms full of sick patients with lengthy wait times, an approach many offices are reluctant to change. Care through retail clinics, once disparaged, became essential to fill pandemic and other healthcare needs due to overwhelmed health systems. Techniques were not just online delivery of care, but embracing social and mental wellness as essential components of comprehensive health management. The pandemic proved that virtual care was possible, necessary and often preferred and that a whole person’s health journey was more than adding mobile apps to a personalized health portal. Even as the pandemic shifts to endemic, virtual care is not going away and a health journey will continue to replace a binary system of care. COVID was not a pressure test of the existing system – the pandemic exposed and exploited the known weaknesses. What the pandemic actually tested were the approaches being built alongside the current system – and they worked. Not flawlessly, but what if we tested and evaluated them as a new health paradigm over the last decade, instead of sidelining them as ‘wellness’ or ‘alternative’ health tools and approaches?
Nothing is constant. This digital mindset is the path to and the product of innovation. It is the constantly evolving process of broadening access that is inclusive and individualized, and truly centers the person in their care. It is embracing a new and perhaps unfamiliar perspective. This is how we create, rather than inherit, a future for ourselves and our children.