Clinical technology specialists

We are in the midst of a rapid proliferation of patient facing clinical technologies. More than 50 000 mobile health applications are available for people to download directly onto their mobile devices, and the number grows daily. A range of commercial wearable sensors (such as wristbands, patches, chest monitors) are also appearing to promote healthy lifestyles or to monitor medical conditions in the context of clinical care, strengthening the role of patients in quantified self tracking.1 2 Two way video and texting applications are making different forms of telemedicine increasingly accessible and popular. Every day more and more people look to internet based resources such as chat forums to help them understand their medical conditions and explore treatment options.

In the United States, the Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law in 2009 to promote and incentivize the broad adoption and meaningful use of health information technology to improve healthcare.3 Apple recently began offering software that culls and centralizes users’ health information as a standard feature of their new operating system (iOS 8), and people will soon be given the option to send their data automatically to healthcare providers’ electronic health records. As more people grow up with digital technologies and become “digital natives” the demand for clinical technologies will continue to grow, their role in healthcare will become ever more integral and mainstream, and the traditional doctor-patient relationship will change.4

Those who develop and deploy technologies for medical and mental health conditions know, however, that even the most well designed patient facing clinical tools require some level of human support to ensure that patients and providers use them successfully.5 6 Patients may feel apprehensive or confused about the functions of these new instruments and may struggle with basic operations or in understanding the output that clinical technologies provide (such as graphs, summary scores).7 They may need help to translate the feedback they receive from a digital resource for follow-up action (for example, exercise, medication use, blood glucose monitoring, or self management strategies). Without support, patients might misuse, underuse, or altogether disengage from potentially helpful clinical tools.

On the healthcare organization side, providers may be skeptical about the clinical value of new patient facing technologies or worried about the time needed to learn how to use new resources. Many will not know how to make sense of patient data collected by clinical technologies or will struggle to find effective ways to incorporate the new information into treatment decisions. The challenge of implementation will affect both patients and providers. Patients will probably require continuous motivational coaching, practical training, ongoing technical support, and troubleshooting. Providers who are already stretched by their clinical and administrative duties will not have the time or expertise to fulfill these roles effectively. A new breed of healthcare professionals—clinical technology specialists—could play an important role in helping patients and providers maximize the benefits of health information technology and minimize any potential harms.

Professional clinical technologists, who are familiar with the range of digital health resources, could assess patients’ interests, literacy, hearing, vision, dexterity, cognitive function, and preferences to match them with the tools most likely to work for them. They could also educate patients about the strengths (evidence supporting efficacy, ease of use) and limitations (cost, time commitment, common pitfalls, potential unintended consequences) of different technologies; engage patients in a shared decision making process to select the most appropriate information website, downloadable software, or medical device; help patients gain access, perhaps by linking them with subsidized resources; individualize the chosen tools where possible; train patients how to use new systems and devices such as touchscreens, clinical prompts, or blood pressure cuffs; help maintain engagement and adherence over time; and encourage family members to serve as supports to technology aided care. Activities could include technical support when a patient runs into difficulties; periodic check-ins using motivational interviewing to encourage persistence; or communication of positive feedback through phone calls, texts, or face to face communication. The human element, often overlooked in technology based interventions, should help ensure uptake and continuity of use.

Clinical technology specialists embedded in healthcare systems could be essential in linking patients and providers. Armed with practical, ethical, and regulatory knowledge, they could educate, train, and support providers. By responding to technology related patient queries and concerns, they could streamline clinic activities and enhance productivity. Moreover, a technology specialist with some clinical training could provide support to a range of clinics and specialty areas within a single healthcare organization—for example, overseeing clinical technology deployments for weight management, asthma, and diabetes.

New clinical technologies will continue to be developed, successfully evaluated, and deployed rapidly because they offer many advantages to patients and doctors.8 9 Used correctly, they have the potential to help improve education, patient centeredness, access, acceptability, fairness, productivity, quality, outcomes, and cost effectiveness. However, they will also present new challenges, including patient and clinician training; adaptation of models of care and infrastructure; and unknown risks associated with misuse, malfunction, or error. Implementation within routine healthcare settings will require a lot of support, and clinical technology specialists could play an important role during that transition.