As people began buying telephones in their homes, they used the handsets to listen to broadcasts of symphony orchestras. This was through subscription services like Electrophone in the UK and in Théâtrophone in France in the 1890s. By contrast, early radio usage was for point-to-point communication, sending telegrams wirelessly. It was not until the first world war that people switched to using radio for music broadcasts, and telephones for point-to-point conversations. Downton Abbey’s script writers were correct in showing the confusion about how and why to use a telephone.
It also takes while to perfect the use of a new medium. The first radio shows were recordings of theatre plays; the first TV shows were video recordings of people talking rather than showing movement and scenery; and the internet broadcasts were of TV shows until YouTube arrived with its slogan Broadcast Yourself™.
And so it is with patient-controlled medical records. In the beginning, most clinicians and patients are unsure of how to use them. When I started showing Patients Know Best to clinicians back in 2009, the commonest request they had was for sending messages with and about a patient across institutions. The first hospital doctors just wanted to send clinic letter to family physicians.
I found this frustrating, because I knew that there were so many other possible uses, but the clinicians were right that this was an immediately useful feature that would generates huge savings. So I followed their lead. (By contrast NHS HealthSpace, Google Health and Microsoft HealthVault ignored this feature, which is why the first two sites have shut down, and Microsoft’s efforts continue to fail.)
But I also learned the importance of teaching alongside developing software. We hired amazing nurses to work shoulder to shoulder alongside the clinicians at our customer sites. Our nurses show how to use patient control to deliver better care at lower costs. For example, we create personal health plan templates customized to the workflow of each clinical team. The templates make it fast to create plans for the safety of each patient in clinic, and easy to collaborate in multi-disciplinary teams.
Yet we too have much to learn about the possibilities from patient control, and so we listen early and often to new user groups. When we started in 2008 our business plan focused on hospitals as the market opportunity. But by 2011 pharmaceutical companies had become our biggest customers; the Clinical Commissioning Groups (the UK’s equivalent to US Accountable care organizations) had become even bigger customers; and by next year local authorities and social workers will become our biggest customers yet.
Each of these groups has used patient-controlled records in different and surprising ways. Our staff’s focus is on learning these ways and teaching them to all our other customer sites. Especially as technology’s usage may come full circle. We launched in 2008, the same year YouTube Symphony Orchestra did. YouTube.com/symphony has become one of YouTube’s most popular channels, broadcasting symphony orchestras live, through internet connections delivered by telephone lines.