Digital health is experiencing what I would characterize as its adolescence. The rudimentary pieces are in place for adoption; Awareness of the technologies, the progressing maturation of mobile technologies, realization of its critical need in the marketplace, interest by large companies (though with widely variable levels of commitment and material projects), and development of breakthrough technologies. Changes occur slowly in healthcare but they need to accelerate because of the increased urgency. There was once a time when patients would refuse to see a physician assistant or nurse practitioner. These providers are now integral parts of the healthcare team and patients value them. I will now touch on missing puzzle pieces which, if addressed, can substantially impact the mission of digital health.
- Comprehensive and standardized telehealth laws. According to The National Business Group on Health’s 2016 Health Plan Design Survey (free with sign up) employees can expect “…More resources and tools to help…navigate the health care system: Care shopping tools, care decision support resources, and telehealth.” This increased acceptance and expansion of telehealth services must be preceded by regulatory and legislative changes addressing payment and professional licensing issues. Telehealth itself speaks to society’s mobility, direct and indirect costs of in-person care, and healthcare professional shortages. The time has come for telehealth to become the norm and in-person visits to supplement this under-appreciated and underutilized modality of interaction. The immediate expansion of telehealth into mainstream care by all payers, public and private is necessary. Healthcare professional licensing reform is also necessary to decease the red tape and expenses of telehealth. Patient safety will benefit with the increased transparency of professional conduct bought about with a Federal license.
- Clinically designed and connected electronic health records (EHRs). The Federal incentive program called Meaningful Use has essentially achieved its goal of widespread adoption of EHRs. What has yet to occur is the presentation and flow of data by the large vendors in a way which is intuitive to users. EHRs were designed to meet data requirements of regulatory and payment agencies. Clinicians have become data entry technicians and spend less time interacting with patients. According to a recent study an estimated 785 hours/year is spent per physician on data entry to satisfy payment requirements for the documentation of quality measures. The two biggest problems with EHRs today are usability (presentation of the interface and clinically oriented workflow) and interoperability. Clinicians or testing centers utilizing disparate EHR systems are unable to share data. This includes the ever-expanding sector of retail healthcare centers (pharmacy or urgent care centers) as well as home care organizations.
- Wearables as remote monitoring. The utilization of remote patient monitoring (RPM) is increasing. RPM has entered the spotlight as a means of decreasing hospital readmissions which now result in Medicare payment penalties. However, the benefits in this regard to have not been demonstrated on a large-scale and the success might very well be tied to other factors mentioned in this piece. In addition, the reduction of readmission rates has not translated to improved patient outcomes. The proliferation of wearable sensor technology in the consumer realm has accelerated exploration in the traditional healthcare market for this technology, yet there are substantial differences between these markets. Bolstering interest in wearables by strange bedfellows as sports equipment companies and medical device manufacturers is the desire of the healthy aging population of baby boomers for unobtrusive monitoring technologies. Wearables can easily fill that order but according to a survey on wearables by AARP as part of a six-week trial, “…participants also said the devices’ design and utility are lacking in features that would encourage long-term use or adoption. The gap between expectations and reality indicates a significant opportunity to better serve the 50-plus market, the study concluded.”
- Better payer-enterprise partnerships driving needed sharing of analytics and data. As the healthcare payment model in the USA shifts from fee for service to value- based (which considers quality performance measures, outcomes, and patient satisfaction), the importance of data analytics becomes clear. We will see a shift of responsibility for the collection and analysis of patient and care management data from the payer to the provider. Analytics will be the best way a provider can track performance quality, efficiency, and interventions affecting patient outcome. This de-identified data will benefit both payers and providers and might ultimately become a commodity sold to multiple payers by providers. This scenario dovetails with the massive consolidation we are seeing in healthcare. It remains to be seen how this all benefits the patient/subscriber. However, the hope is that the more available and granular the data, the more transparent the costs of care vs outcomes might become.
- Incorporation of social media in healthcare. Social media is the most underutilized resource available to all stakeholders in healthcare. While there are understandable concerns and barriers to unbridled participation in social media by healthcare enterprises, payers, Pharma and other stakeholders, there remain huge opportunities to help patients and caregivers via social media which can direct them to other sources of disease-specific educational content. The current focus on population health management as public policy as well as basis for payment could greatly benefit from data derived from social media discussions on healthcare. How that is designed and processed is a potentially powerful collaborative project among many stakeholders including patients.
Plans for improvement of the current healthcare system must consider technology a critical component. Public healthcare initiatives and market stresses require it. All of the asks above are doable now. It is up to patient advocates to demand them and decision makers to implement them.