When it comes to electronic health record technology, the American Medical Association has been an outspoken critic about what it perceives as the shortcomings of EHRs, voicing the widespread dissatisfaction of the doctors who use the systems.
However, the nation’s largest physician group is now taking aim at new and emerging health IT technologies—such as mobile healthcare apps—that it believes are leading to practice disruption.
In a June 11 address to AMA’s House of Delegates at its annual meeting in Chicago, CEO James Madara, MD, blasted the current technological landscape, calling it a “digital dystopia” that has generated tools that lack the medical evidence necessary to demonstrate the efficacy of the technology.
“From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality, this is the digital snake oil of the early 21st century,” said Madara. “Even those digital products that might be helpful often lack a way of enriching the relationship between the physician and the patient. It’s like trying to squeeze a 10-gallon product idea into a 2-gallon healthcare knowledge base.”
While mHealth apps and wearable sensors for diagnosing, tracking and treating diseases such as chronic conditions are growing in popularity among consumers, Madara is concerned this technology could lead to harm or even death. And, despite the promise of mobile technology for improving patient outcomes, he says there are a scarcity of clinical trial data and lack of evidence justifying its use.
Supporting Madara’s claims is an analysis of about 1,000 patient-facing health apps targeted at individuals with chronic illnesses. The study, funded by The Commonwealth Fund and published in February, found that only 43 percent of iOS apps and 27 percent of Android apps were in fact useful.
Without mentioning anyone by name, Madara took a swipe at Eric Topol, MD, chief academic officer of San Diego’s Scripps Health and author of two recent books—The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare, and The Patient Will See You Now: The Future of Medicine is in Your Hands—for fueling the hype around mHealth.
The latter work, published last year, makes the case that smartphones and other mobile devices in the hands of patients will serve to “democratize medicine,” giving them control of their data, which has historically been the domain of physicians. In the future, Topol suggests that most of the routine diagnostics will be done by patients using health apps, while doctors will be relegated to the treatment of disease.
“Energizing this rush of new products, we find popular books predicting a future of digital healthcare, that in the near future, will bypass physicians altogether—where patients can largely look after themselves,” Madara said. “The future is not about eliminating physicians, it’s about leveraging physicians.”
At the same time, he praised another 2015 book—The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age—authored by Robert Wachter, M.D., professor and associate chair of the Department of Medicine at the University of California, San Francisco.
“Fortunately, more sober analysis of the current state can be found elsewhere, as in Bob Wachter's wonderful book,” declared Madara. “Wachter provides no false illusions as to the current state, and well describes the present. Something I’d call our digital dystopia: from direct-to-consumer digital health devices—which, only in the fine print say ‘for entertainment purposes only’—to our clunky electronic records, to ICUs that sound like primitive swamps, abuzz with a cacophony of bells, alarms and whistles.”
Unlike other industries, he charges that medicine has digital tools that “make the provision of care less, not more, efficient,” adding that some these products “just don't work that well” or “actually impede care, confuse patients and waste our time.”
Digital tools that “simplify and better organize our lives, and also adapt to the natural variations in our practices—those that would free more time for patient interactions—that's what we want,” Mardara said. “We do much better if new products and services are deeply informed by our actual problems and needs, rather than flying on an entrepreneur's incomplete views.”
His vision for a digital future is one that “enhances the physician-patient relationship, produces better and more efficient care, and allows more time for physician-patient interactions—the type of outcome that has been so falsely promised by much of the current digital snake oil.”
Nonetheless, Madara’s criticism highlights a growing gap between physicians and patients, who have a significantly different view of the way they view emerging medical technology and its potential value.
A survey of more than 1,400 providers and 1,100 consumers, published in September 2015 in the Journal of Medical Internet Research, revealed very different attitudes towards digital tools. In the survey, consumers preferred new technologies for a medical diagnosis (39.7 percent), compared with providers (13.8 percent), while more providers (28 percent) than consumers (15.9 percent) reporting feeling uneasy about using technology for a diagnosis.
In addition, another survey published late last year in the Journal of Medical Internet Research’s mHealth and uHealth showed that 65 percent of consumers indicated that apps improved their health, and a majority had strong faith in the accuracy and effectiveness of the apps. In addition, 58 percent of the 1,604 adult smartphone users surveyed had downloaded one health-related mobile app, while 42 percent had downloaded five or more.
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