Executive Voices: Wendy Sue Swanson, M.D., MBE, Chief of Digital Innovation at Seattle Children

With the digital transformation and the shift to value-based care, patient engagement and satisfaction is a top priority for health systems. New technologies and social platforms give health systems opportunities to strengthen the doctor-patient relationship, all while building trust. These tools also give physicians a chance to reach more patients daily. But privacy concerns and stakeholders who want to stick to traditional methods could get in the way of the potential benefits.

Wendy Sue Swanson, M.D., MBE, is the chief of digital innovation, digital health, at Seattle Children’s Hospital. She is interested in the intersection of media and medicine and its impact on the doctor-patient relationship. Swanson also writes Seattle Mama Doc, a blog that provides parents with tools and information for handling their children’s health.

Swanson attended the University of Pennsylvania School of Medicine and completed her residency in pediatrics at the University of Washington.

I spoke to her about how health systems can use social media and health tech to reach patients and make a stronger impact. We also discussed how Seattle Children’s is leveraging voice-enabled technology.

Editor’s note: This interview has been lightly edited for length, clarity and style.

Samara Rosenfeld: How can health systems use social platforms to inform parents and caregivers and decrease the divide between patients and their physicians?

Wendy Sue Swanson: There is ultimately a deluge of healthcare information and advice available to the public. It comes from government organizations, for-profit entities, lay press and, in the world of pediatrics, parenting sites.

What patients and families are looking for is sound and trustworthy advice and information. Historically, we used to do everything in person. We required that patients and families be in our presence when physicians like myself gave advice on anything from car seats and protection against needles to what to do about a new diagnosis.

Of course, everything has changed with the advent of health information and advice online. Because of that, the nature of our relationships in the traditional clinic or hospital space is also dramatically shifting.

The actionable step that we all can take is to acknowledge that we can’t practice medicine the way we used to. We have to take into account the bounty that comes from the ability for patients and families to find each other, to read primary research sources, to get information that’s up to date and to use the information, sources, opinions, facts and data to make decisions.

We can wait for people to come into our offices to review what they learned online, or we can meet patients and families where they are. Ultimately, they’ll build relevance, trust in science, trust in research and trust in our role in people’s lives.

There’s anthropological research that looks at how parents and families make a decision about vaccinating their children. They consult people in their network — their spouse, friends and colleagues. Their decision on what they do for their child is strongly based on the advice from those people. Data shows that 70% or more of those who don’t follow a traditional vaccine schedule have someone in their network telling them not to vaccinate. That’s compared to a parent who does follow the traditional schedule, where only 13% said someone in their network told them not to vaccinate.

There’s certainly influence from networks on how we make decisions. And our job is to connect to patients and families when we are not with them. So if I’m a pediatrician and I understand vaccine science, safety and infectious disease, I can tell people one at a time. Or I can take to — like I do — a blog, a podcast, Twitter, LinkedIn or Instagram, and create content that’s relevant, trustworthy, accurate and leads someone to even more information if they want it. It’s just like we would do in the office. But I believe using a social tool to speak to a population or a segment of a population is the way forward to more efficient translation and more efficient and intimate relationships among patients, families, clinicians and caregivers. And ultimately, it’s a way to redesign how we manage populations and how patients get and seek advice from those we trust.

S.R.: What is Seattle Children’s doing on this end?

Wendy Sue Swanson: Ten years ago, I started Seattle Mama Doc, a pediatrician-authored blog. For about nine years, I was posting about twice per week. We’ve made over 1,000 instructional YouTube videos. Some are about up-to-date parenting concerns, like the measles outbreak, while others are more evergreen issues, like what to do if your child has a speech delay. I also do a podcast where I interview everyone from behavioral health experts and psychologists to dermatologists to community providers. I use Instagram, Twitter and Facebook for dissemination of content and newsworthy information.

We also have a public relations blog and an autism blog authored by our Autism Center.

We’ve been exploring on the edges. This past year, we partnered with a group in the innovation center at Boston Children’s and created the first consumer-facing Alexa Skill on flu vaccination. So at Seattle Children’s, we put those Alexa devices into waiting rooms for high-acuity groups like our transplant and diabetes clinics where we wanted those people to get flu vaccinations. We put the devices with Flu Doctor, so you could ask Alexa questions about flu vaccinations, and she would stream information that we scripted and information that I created audio samples for.

We had two goals with this. One was to explore new technology, to really understand and learn how patients and families would interact with voice technology in the waiting room. We also wanted to take what I have been doing with my integrated media work to the voice skill, as voice technologies are becoming more widespread, with Siri and Alexa in your kitchen. When Seattle Children’s is thinking about patient experience, we consider how they access information and if we can explore how they interact with smart speakers. Can we help engage and drive decision-making based on what we think is best for our patients and families?

S.R.: How has engagement with the Alexa Skill been since it launched?

Wendy Sue Swanson: What’s interesting about the Alexa Skill is that some estimate that by 2020, 50% of search will be voice-enabled. So, hospital systems at large can’t ignore voice technology and have to think about how patients and families will use it.

A part of me wonders where we are going with this. It means that more and more places where we live come with smart speakers and with smart, artificial intelligence (AI)-capable search. Wouldn’t it be great if when a patient parked their car, they interacted with the hospital where they parked it, and the hospital knew the travel time from the parking spot into reception, so they knew when the patient would arrive?

In some cases, you’re using voice technology to run hospital operations. I’m always looking at front-of-house engagement to learn how parents and families are learning about what we know about protection and prevention of illness, disease and suffering and the services offered on a system. We wanted to see if there was a way to take patient content that lives on a website or through our receptionists, phone lines or even referring doctors that we could embed into something that’s more efficient.

We went through the process of working with our ambulatory clinic, clinical leaders and privacy and security officers to make sure we weren’t putting patients and families at risk and to move the needle to have our developers get comfortable with Alexa Skills.

We had good engagement. We launched it in late fall during flu season. In December, the most common thing done on the Alexa devices was playing Christmas music. You can call that a failure, but at the same time, 10 to 15% of the interactions with Alexa were about flu. So it means that yes, some people decided to play around with the device in the waiting room and play Christmas music, but other people were also inquiring about how we were guiding them to ask about Flu Doctor and learn about flu vaccination. It’s my goal as a pediatrician and enthusiast of public health and prevention to build trust in the science and safety of that vaccine.

Alexa Skills are not a gimmick. We’re just in the infancy of learning how to do it. I think the pilot was a great success, and we gained some innovation capacity with smart speakers and voice.

S.R.: How else can tech play a role in ensuring patients and their families are more informed?

Wendy Sue Swanson: We can build efficiency in how we deliver care using technology. Healthcare is expensive, inefficient and fraught with errors. Patients and families suffer when they don’t have access to their data and experts — when they don’t understand what to do.

Where I see technology building the most value in the next decade is in an ongoing and deepening connection that patients can have to their own data — not just through their electronic health record (EHR) — but in ways that are meaningful and explained. So, when a patient gets home from a clinic and their partner asks what the doctor said, the patient can explain it or use technology to record what the doctor said. Or the provider could give meaningful, personalized and relevant information in person that was captured and delivered, or connect the patient with online information that they can read, absorb and share with those who help them make their own decision.

There’s also going to be a ton of service recovery and service inefficiency that’s facilitated by technology, whether that’s way-finding, parking or referral support, insurance payment or price transparency. So much of what ails us in healthcare is the waste around those kinds of processes and automation. AI, voice technology, social engagement, access to education information in places where people are — in social networks and online — could help up bring healthcare to places where patients and families enjoy. And we can be a relevant voice in those networks as they make decisions. I think that’s ultimately where we are headed and why health systems and hospital leaders need to make sure they’re investing in digital health and technology — because startups are gradually going to reach more patients and families and be more relevant. If traditional healthcare wants to keep operating as traditional healthcare always did, we’ll become less relevant, and the march of science will slow down.

I can go to the clinic and see 24 patients in a day, but using a smart communication tool, I could potentially message a segment of 1,000 patients every day if I wanted. Or if a new study comes out that’s relevant to children with chronic ear infection, I can go into my EHR and search for my patients with chronic ear infection and message them specifically based on what I learned. It’s much more efficient than me doing that one at a time.

The burgeoning responsibility and simultaneous opportunity in digital technology, when it comes to communication ailment and efficiency, is that this one-to-many communication can become more of a part of care delivery to reduce the waste.

In pediatrics, for example, in the winter we recommend the flu vaccine for every child over the age of six months. We say that until we are blue in the face every single day. But we could directly message all of our patients at once the exact same spiel and potentially build trust in that, so we can just field questions when patients and families are with us.

My hope is that some of these experiments over the years are teaching me how to be a pediatrician using digital tools, and I’m hoping to continue to guide clinicians and health systems across the country in understanding from those lessons.

S.R.: What’s the first step for health systems to get in on the action?

Wendy Sue Swanson: We can be more forward-leaning in the sense that health systems or doctors have a Twitter profile, but how are they building loyalty with their patients and families to their clinicians? How are they distributing their educational resources, the new research and the talent they have?

The most important value in health systems is the relationships that exist between patients seeking and needing care and those who help them get what they need. How are you using a platform or technology in the exchange of knowledge, trust, data and personalizing health records? What part of the care delivery model can you automate or trim waste from by using social and digital tools?

We have to methodically think about what the system is doing for people and how they are staying connected.

The reality here is that, unfortunately, we are all in the cost-containment era of healthcare, and it’s hard to make investments that don’t give you immediate operational return on investment. But we need to think about our biggest threats. For example, the World Health Organization in the last year listed vaccine hesitancy as one of the largest threats to human health. We might not make a lot of money distributing information on measles, but I might embolden loyalty to my hospital system if I have a pediatrician communicating with parents through a blog about that. And the long-term outlook is a really important step for systems. It’s going to be upfront investments on technology that’s not going to immediately give you a return, but it will probably be a much longer return.

Get the best insights in digital health directly to your inbox.

Hear from More Executive Voices

La'Wana Harris, Global Diversity and Inclusion Consultant

Denise Pirrotti Hummel, J.D., CEO of Lead Inclusively

Michael Hogarth, M.D., Chief Clinical Research Information Officer at UC San Diego Health