Why it’s crucial to solve challenges stalling digital health adoption

There’s widespread hope and optimism surrounding emerging technologies, but progress is often stymied by several factors.

John Lee, MD

In recent years, digital health has made significant strides, with several use cases demonstrating its potential to transform healthcare.

For example, consider the rapid adoption of telemedicine during the COVID-19 pandemic. With in-person visits restricted in traditional healthcare settings, telemedicine enabled healthcare providers to continue offering essential services to patients remotely. This shift not only maintained continuity of care but also demonstrated the potential for telemedicine applications to be used more broadly in the future.

Another example is the emergence of diagnostic tools powered by artificial intelligence. These technologies have the potential to revolutionize healthcare by providing more accurate and efficient diagnoses. For example, AI algorithms have been developed to detect diabetic retinopathy and certain types of cancer with remarkable accuracy, often outperforming human experts. By integrating these tools into healthcare workflows, clinicians can significantly reduce diagnostic errors and improve patient outcomes.

Devil in the details

During a recent conversation with a colleague about digital health, I expressed my skepticism regarding many of these endeavors. I believe that while strategic efforts in digital health are often impressive and have undeniable appeal, progress is often stymied by several factors.

One type of digital health initiative often touted as a significant opportunity is telehealth. However, there is still a fixation on the legacy CPT/encounter-driven workflows. Likewise, current remote patient monitoring (RPM) deployments rely heavily on reimbursement via CPT codes. But in analyzing the most promising opportunities, the real value of these tools exist in the context of population health.

For example, diabetics having difficulty managing blood sugar can provide frictionless feedback on their progress (or lack thereof) using remote patient monitoring. A care team then can make adjustments before patients’ blood-sugar levels get out of control. In another example, recently discharged heart failure patients may not know that they are taking their numerous medications incorrectly. A telemedicine follow-up by a pharmacist doing discharge medication reconciliations after patients arrive home is highly likely to prevent rehospitalizations. The true value of these sorts of efforts does not correlate with an encounter-minded CPT reimbursement arrangement.

Additionally, the workflows for these various digital tools often are very fragmented – many of these tools do not interoperate. In my consulting work with a vendor of remote patient monitoring technology, I have noted that full integration into the electronic medical record (in this case, Epic) workflows is crucial for success. To the end user, the data appears as if it were any other Epic data, with no other portals or workflows to manage.

This also touches on the concept of usability. The greatest technical tool in the world does no good if only a few people can use it. We can't require the users to log on to multiple portals or read lengthy training documentation to use these tools.

Getting past resistance

Clinician resistance is also a genuine concern, as the profession has been trained to work within an encounter-based mentality, requiring substantial change management. Much of this is related to the payment model, but the lack of willingness to change is also a function of simple inertia.

Using myself as an example, let's say I am used to walking in a room and relying heavily on an initial assessment that depends on my being in the same physical space – so as a result, moving to a virtual environment would be quite disconcerting. But that consideration does not incorporate the advantages of being able to have relatively low-friction interactions (if the technology cooperates).

Likewise, a physician may not want to relinquish the ability to manage and respond to the voluminous data points that a remote patient monitoring solution may produce, but it is unrealistic to manage all of this – a team would be needed to manage a large population.

There are many shiny objects in digital health now, but the underlying technology is only a small piece of the puzzle. There are enormous structural issues that impede our progress – these include the payment model, usability, workflow engineering and plain old inertia. We will need to address all of these before these solutions are successful.

John Lee, MD, has been a clinical informaticist since 2006 and has been Chief Medical Information officer at two health systems. In 2019, he was honored with the prestigious HIMSS Physician Executive of the Year award. He is a firm believer that the key to solving the myriad problems we experience in our healthcare system is efficient and transparent delivery of information.

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