Guest Post: Khan Academy Approach Poised to Solve a "Wicked Problem" in Healthcare

The current Forbes cover features Salman Khan who may be having more impact on education than any other teacher before him. His impact isn’t limited to education.

Education and Healthcare are two industries least affected by technology, however this has begun to change. From millions of students and parents to Bill Gates, the Khan Academy has impressed many and inspired some teachers to flip the classroom lecture/homework model on its head as described in the video below. Doctors are now recognizing Khan’s approach can help solve a wicked confluence of issues.

Wicked Confluence

It’s generally known that patients don’t comprehend or remember 80-90% of what doctors tell them when they are with them. Meanwhile doctors are time starved. [See Think Your Doctor's Busy Now? Just Wait Until Obamacare Kicks In.] Worse, they are hitting the “replay button” hundreds of times describing to patients common diagnoses, treatment options, prescriptions, etc. Every doctor has their own FAQ. Since 80-90% of what they say is forgotten, this is a colossal waste of talent and time. This goes from being a waste of time to being a disaster for healthcare providers as the rapid shift to paying for outcomes over mere activity. The fee-for-value model replaces the old “do more, bill more” healthcare reimbursement model that is bankrupting states, feds and families. The catchphrase is increasingly “No outcome, no income” which presents a huge challenge for healthcare providers. Fortunately, necessity is the mother of invention. Like Sal Khan, smart healthcare providers are flipping their “classroom”.

Read more about flipping the classroom in The Economist

As you can see in the video, technology has brought a human element back into the classroom making it more interactive and tuned to specific kids’ needs. Why limit this to students? Why not use this model to help improve health outcomes? In fact, we may not have a choice with the ever-increasing shortage of primary care physicians. One can look to what happened after Romneycare was implemented as a preview of what is to come. The shortage of primary care providers only increased. Simply trying to put physicians on a faster hamster wheel isn’t the solution. In fact, that is part of the problem.

One of the nice things about Khan Academy is learners with different skill levels can watch the videos in different ways. Some may get it just watching it once while others may want to replay the video over a few times before a concept sinks in. In many ways doctors are teachers wearing white coats. In fact, they have taught many of the same lessons hundreds or thousands of times. Some forward-looking doctors have caught on to this.

Click here to watch the video: Flip This Classroom: Khan Academy Brings Lectures Home

Doctors as Teachers

Perhaps because Dr. Wendy Sue Swanson was a teacher before she was a pediatrician, she was naturally drawn to using her videos and blogs to benefit her patients’ families. [Disclosure: Dr. Swanson is a Medical Advisor to my company, Avado.] Dr. Swanson shared the reaction she gets from patients. “I’ll launch into something in clinic and a family will say, ‘Dr Swanson, you don’t have to explain that, I read your blog post/saw your video, etc!’ We start at a different place. A place that feels easier to connect, more informed, and one with more respect for our mutual vantage points.”

Click here to watch the video: Understanding Growth Charts - Seattle Mama Doc

Click here for the accompanying blog post on Understanding Growth Charts.

Dr. Rob Lamberts wrote a piece entitled Riding Dinosaurs. He has recognized the shortcomings of an office visit that is heavily driven by the billing needs versus a long-term focus on a patient’s overall health. In his own way, he’s suggesting a model for higher value physical exams.

If there is a need for seeing the doctor in person, 95% of the encounter is already done and documented, leaving only the physical exam to be done in person – something that can be accomplished in a few minutes for the vast majority of visits.

Dr. Natasha Burgert has written about how social media has changed her medical practice. Here is how she describe the benefit to her practice and patients.

Investing time in relevant and complete posts actually saves me time in the long run. Questions I am repeatedly asked,  like “How do I start solid foods?“, can be answered quickly and completely by directing them to my site. This saves face-to-face clinic time for more specific concerns for their child. I can actively communicate, acknowledge, and positively influence the choices that my families make for their children between the checkups. My anticipatory guidance can be repeated, reinforced, and repeated again.

Dr. Burgert explains The New Infant Acetaminophen (Tylenol) in this video: Tylenol 2.0: The New Infant Acetaminophen

Of course, the benefit of doctor videos aren’t limited to primary care. Specialists such as Orthopedic Surgeon, Howards Luks, also have been realizing the benefit of videos.  As Dr. Luks states, “Every patient who sees my videos prior to their visit says. ‘OMG it’s you, you’re just like you are in the videos.’ Very powerful. It humanizes your practice.” The video below is an example of Dr. Luks’ video explaining Achilles tendon ruptures.

Click here to watch the video: Achilles Tendon Tears - Is Surgery Necessary?

Bit by bit, there is major change underway. Many doctors, particularly in primary care, are unhappy about the way they have been practicing and are unleashing their own creativity. Here is how one describes how these current delivery model changes are:

So much of our present care delivery is rote and could be practiced online or provided via video/blog/text. And that the ‘real medicine,’ the service and the relationship or helping people in moments of anxiety and indecision are rare and undervalued. That oddly enough, there is simply no time in the day to do what matters most. Or if we get the opportunity to forge a real partnership, it comes at the cost of making somebody wait, and running late. So yes, we’re headed in the right direction by making these changes.

Imagine targeted video or textual content that has been curated or created by your physician automatically being delivered to you based on your diagnosis or condition into a secure environment (i.e., most people wouldn’t want articles on their medical conditions going into their regular email where others might see it). This isn’t a science fiction scenario. Rather, it will be possible to do today. Patient relationship management systems are replacing providers’ old patient portals (if they even had one) that did little to impact health outcomes. Modern patient-focused systems are focused instead on improved health, not just administrative items. See Patient Engagement is the Blockbuster Drug of the Century for more.

Click here to read more from this author

Dave Chase is the CEO of Patient Relationship Management company, Avado, is the 1st cloud-based EHR-agnostic patient portal built for healthcare providers in accountable models such as medical/health homes, accountable organizations, etc. Avado was selected by 22 pioneering healthcare providers in NY state for a statewide program pioneering accountable models. Chase has been invited to the White House, presented before the head of Medicare and the Pioneer ACOs. Chase is co-editor and writer of a book commissioned by HIMSS on Patient Engagement. Avado has been featured in the NY Times, Wall Street Journal, TechCrunch, Washington Post and numerous healthcare industry publications.