Implementing digital health technology has been a challenge for those without a clear course to success. – AMA Chair-elect Jesse M. Ehrenfeld, MD
Four months into 2020, the world is facing an existential global health crisis: the outbreak of a novel coronavirus– caused respiratory disease (COVID-19). Cases of a novel coronavirus were first reported in Wuhan, Hubei province, China, in December 2019 and have since spread across the world. Once individual states throughout the U.S. started to implement stay-at-home orders, basically halting the economy, the fragmented, inefficient, and bureaucratic American healthcare system became exposed and has shown how outdated it is – both digitally and culturally.
The continued spread of this virus will naturally increase the demand for healthcare services, as patients seek consultation when showing symptoms, testing to confirm cases, and treatment. To ease the already strained U.S. healthcare system and help reduce the risk of spreading the virus with unnecessary in-office doctor visits, the request for digital health tools has exponentially increased. To reduce barriers for healthcare providers to utilize digital health tools and telemedicine services during this pandemic, the U.S. Congress lifted requirements that limited telemedicine services to rural areas, allowing the use of these services for all beneficiaries of fee-for-service Medicare.
Before COVID-19 and despite the increasing prevalence of digital technologies in most Americans’ everyday life, digital health tools have taken longer to become adopted. With many healthcare organizations focusing primarily on fighting this pandemic and keeping some sense of normality during increased patient flow, many health systems are putting teams together to explore digital health technologies and services. The meaning of digital health tools includes a broad scope of devices that engage patients for clinical purposes; collect, organize, interpret, and use clinical data; and manage outcomes and other measures of care quality. This includes, but is not limited to, digital solutions involving telemedicine and telehealth, mobile health (mHealth), wearables, remote monitoring, apps, and others.
Could digital health tools be used for COVID-19?
According to the CDC, coronavirus (COVID-19) is a family of viruses that is contagious and hard to contain, which means that it’s safer for many human-to-human interactions to be done remotely….this includes many in-person office visits. Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with fever, cough, and difficulty breathing. As of April 2020, there is no vaccine.
When it comes to choosing health care, patients most value the quality of care they receive. But affordability is also a priority. The needs of patients haven’t gone away just because of COVID-19. To meet these demands and to keep a healthy patient population, health systems must evolve and embrace connected health applications and services.
There is a fundamental cost-saving component to connected health, as researchers pointed out in a recent publication of The New England Journal of Medicine, stating that the new remote service options that health systems are rapidly attempting to adopt require payment structures to support its growth. The authors noted that the crisis demands a broader strategy to address three specific areas: reimbursement for new digital services, expanded regulatory relief, and evaluation of clinical care provided utilizing these technologies. While reimbursement for new digital health services is, without a doubt, an essential strategy for the growth of telehealth services, we will focus this article on how health systems can more easily adopt new digital health tools into a new clinical workflow model.
In 2019, the American Medical Association released a Digital Health Implementation Playbook to provide critical steps, best practices, and resources to help physicians and health systems efficiently and effectively integrate digital health tools. The Playbook’s first six steps can be used to implement any digital health solution while the second six steps focus on adopting a specific digital health solution. A 12-step process guides the implementation of a variety of digital health solutions. The first six steps are fundamental to performance, while the next six steps focus on specific digital health solutions and their unique considerations. The 12 steps covered in the Playbook are:
- Identifying a need
- Forming teams
- Defining success
- Evaluating the vendor
- Making the case
- Designing the workflow
- Preparing the staff
- Patient partnership
- Evaluating success
While all digital health tools have seen increases in physician adoption since 2016, the most significant growth in adoption was among digital tools in the categories of telemedicine/virtual visits and remote monitoring for improved patient care. As we move through 2020, the adoption of digital technology will be essential for every healthcare organization. Digital health tools are not intended to replace all clinical interactions. Still, virtual visits can help decide whether in-person consultations are, in fact, needed or if treatment can effectively be managed otherwise.
In a study comparing 20,000 Cigna customers who used MDLive with 20,000 customers who did not, Cigna found:
- Total Medical Cost: Virtual care users demonstrated a 17% lower total medical cost when compared with non-virtual care users.
- ED visits: Virtual care users experienced a 36% net reduction in emergency department use per 1,000, as compared to non-virtual care users.
- Generic prescriptions: 45% higher use of generic medications for virtual care users compared to non-virtual care users.
Accenture’s 2020 Digital Health Consumer Survey found that nearly a quarter of healthcare consumers (23%) say reliable and secure digital tools that help them to understand their health habits would motivate them to take a more active role in managing their health. Notably, the survey revealed that a bad digital experience with a healthcare provider ruins the entire experience with that provider.
The rise of the digital-native physician will have a profound impact on health care and patient outcomes, and will place digital health technologies under pressure to perform according to higher expectations. – AMA Board of Trustees Chair Jesse M. Ehrenfeld, MD, MPH
The American healthcare system is considerably still the way it was 70 years ago. The balance of power in healthcare will shift from providers to consumers and to those companies who can engage the consumer. As people become more aware of their own health and how to influence it, healthcare providers will continue to focus on prevention programs. Today, there is a seemingly limitless amount of health data online. Even after the world overcomes the COVID-19 pandemic, healthcare organizations should continue to plan to use digital technology.
No digital health initiative can be developed, pursued, or commercialized without data. Digital health innovation relies on massive amounts of data in a variety of types, in various forms, from a wide variety of sources and through a wide variety of tools, including patient and consumer wearables and mobile devices. It can be argued that ultimately it would’ve been impossible to resist the health tech revolution as we move into the 2020s. The COVID-19 pandemic just helped speed the need for digital health tools to be adopted and implemented into the clinical setting.