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onsumers and providers are generally optimistic about digital healths potential to
improve physician-patient interactions and enhance the delivery of high-quality
care. However, there is an equal amount of clinical skepticism related to digital
health, especially given the challenges of some direct-to-consumer health devices that
have lead uninformed consumers to pursue unnecessary care. Recognizing the physician
perspective in the design, implementation and evaluation of new technologies is key to
realizing digital healths full potential.
Some providers have good reason to be skeptical of digital health technology. James
Madara, MD, CEO of the American Medical Association, aptly described the anxieties
surrounding digital transformation in healthcare in his remarks to the House of Delegates
in 2016.
Today, we have really remarkable tools robotic surgery, new forms of radiation
treatment, targeted biologics, Dr. Madara said. But appearing in disguise among these
positive products are other digital so-called advancements that ... actually impede care,
confuse patients and waste our time. To Dr. Madara, ineffective apps and misleading
products are the digital snake oil of the early 21st century.
The mention of snake oil refers to a popular product sold for its medicinal qualities,
which are unsubstantiated by scientific evidence. And as pointed out by Dr. Madara,
consumers are not the only targets of todays digital snake oil. Many early digital health
technologies sold to hospital buyers, though aimed at improving care, werent designed
around physicians unique workflow or professional needs and unintentionally created
additional barriers to efficiency and care coordination, core competencies healthcare
organizations require for success under value-based reimbursement models.
For instance, poor interoperability between different EHRs has challenged providers
ability to share patient information in real-time between outpatient, inpatient and
ancillary caregivers. Manual or time-intensive workarounds increases the chance
information will be lost or wont arrive in a timely manner.
For physicians to adopt digital tools into their daily practice, physicians said technology
must meet four essential criteria, according to the same AMA survey: The tools should be
covered by standard malpractice insurance (81 percent), the vendors must ensure data
privacy is protected (82 percent), it should integrate seamlessly with EHRs (81 percent)
and data privacy should be assured by the purchasing hospital system (81 percent).
Digital health continues to play a greater role in the practice medicine, regardless of a
physicians age, gender or specialty. Understanding physicians concerns and satisfying
their user preferences is integral to achieving the potential of digital health to improve
physicians professional lives through reduced administrative burden, improved
professional and patient-physician relationships and more effective clinical care.
T
echnology and market conditions have transformed the traditional patient-
physician dynamic into one of patient-centered care. The patient today plays an
active role in managing his or her health alongside medical professionals. Digital
health technologies that teach health literacy help chronic-needs patients feel better
prepared and more confident in their decision making about treatment options and self
care, and contribute to a positive patient experience.
Striking the right balance of compassion, rationality and trust is difficult for some
physicians, especially when it comes to discussing complicated or sensitive topics.
Patient-physician communication in the exam room is ripe for misunderstanding due
to time constraints, medical jargon and emotions. Studies show up to 80 percent of the
medical information patients receive during an office visit is forgotten immediately, and
half of the information patients do takeaway is incorrect.
Decision aids are informational tools meant to help individuals understand their medical
conditions, treatment options and associated risks by presenting complex information
in an easily digestible format. These tools can walk patients through different treatment
options, translate complicated medical statistics into simple language and visual aids,
and give patients access to their health information. Once limited to print pamphlets
and brochures, decision aids now include web-based resources and interactive apps
and videos patients can view on their smartphones or tablets in the convenience of their
own home.
For shared decision making, providers and patients must work together to balance
clinicians expertise with patients preferences and values. Patients can be overwhelmed
by massive amounts of [health] data they now have access to, says Jamie Roots,
Healthcare Cloud Solution Architect at Microsoft. The easer it is for them to understand,
the more personalized the information, the more likely they will use it.
Other digital decision tools are designed for physicians and patients to use side-by-side.
Digital visual aides in the exam room, for instance, can support physicians dialogue
about potential side effects of treatment options. Touch-enabled screens that feature
detailed anatomical renderings of organs, body systems and medical conditions help
physicians visually explain how a certain treatment works by rotating the organs up,
down, right or left and adding or removing layers of tissue, muscle and bone to reveal
whats underneath.
Studies have shown shared decision making can lead to better health outcomes, fewer
invasive procedures and lower costs. Patients who were encouraged to review decision
aids had 5.3 percent lower medical costs, 12.5 percent fewer hospital admissions and
were less likely to choose invasive elective surgeries compared to their peers who didnt
use aids, according to a 2013 study in Health Affairs.
Digital tools that allow caregivers to spend more time with the patient and communicating
about treatment options can improve both provider and patient satisfaction. Because
of its ability to connect remote users in real time, digital technology is also used by
healthcare organizations like accountable care organizations to keep caregivers informed
of changes in a patients health status and provide timely interventions.
ACOs are groups of physicians and caregivers who jointly assume responsibility for the
quality and cost of healthcare for a defined population. ACOs can include governmental
and commercial payers and a range of provider organizations, from clinically integrated
health systems to multispecialty group practices.
Much of the effort and expense of the past decade has been directed toward increasing
the sophistication of hospital information systems, says Simon Kos, MD, CMO of
Worldwide Health at Microsoft. Dr. Kos is responsible for providing clinical guidance,
thought leadership, vision and strategy for Microsoft technologies and solutions
in healthcare. What this has led to, unfortunately, are deep silos of patient records
between care providers and no effective way of coordinating them.
Some cloud technologies unite information streams from diverse sources fitness
trackers, mobile nutrition apps and remote monitoring devices, for example into
a single, secure, shared thread that patients and care teams access and update in
real time. Shared information platforms like this engage an array of caregivers whose
contributions can give the acting physician insight into factors influencing patient health
outside their institution.
The silent enabler of the latest digital revolution in health is the cloud, Dr. Kos says.
There is a raft of more visible technologies disrupting health, but almost all of them are
using the scale, availability, performance and importantly security of cloud.
ACOs must address the health needs of their total patient population but by personalizing
each interaction to the appropriate level, site and quantity of care. ACO providers must
find ways to proactively engage patients who rarely interact with the healthcare system
in addition to those who use health services regularly. The extent to which the ACO can
identify hard-to-reach patients at risk for developing a chronic illness, and then either
prevent or treat that illness, is central to the ACOs and patients outcomes.
One way provider organizations proactively manage risk is through forecasting tools
that facilitate targeted interventions aimed at high-risk patients across the community.
Predictive analytics tools can trawl large stores of health data to identify patients at
risk of any number of events, such as developing chronic conditions, acquiring hospital
infections, requiring hospital readmission or being overdue for a mammogram.
Providers are using innovative, digital tools to monitor patient progress from afar and
help them to sustain positive self-care.
Remote patient monitoring devices use digital technologies to collect medical and other
forms of health data from individuals in one location and electronically transmit that
data, via the cloud, to healthcare providers in a different location for consultation in real
time. Monitoring programs can collect a wide range of health data from the point of
care, such as vital signs, weight, blood pressure, blood sugar, blood oxygen levels, heart
rate and electrocardiograms. Devices include blood pressure cuffs, two-way virtual care
devices, glucometers and heart-rate monitors.
Conclusion
Digital technologies have transformed the way consumers work, shop and socialize.
Now healthcare providers are beginning to deploy digital tools to better understand
and serve their patients, especially those with the greatest health needs who typically
incur the highest costs.
Digital technologies continue to play a greater role in hospital exam rooms, board
rooms and waiting rooms. To be sure, not all technologies will add value to promote
better health. But from the digital ashes of past electronic failures, healthcare technology
developers are learning how and what physicians need to improve their everyday lives
in practice as well as the tools they need to pursue long-term goals with their patients.
BECKERS
HOSPITAL REVIEW