Developing health IT? Involve physicians from the start

Troy Parks , News Writer

Transitioning to electronic health records (EHR) was a gigantic step toward a more digitized health care workflow, but, even in the age of marvels such as retina-identification technology, many of the digital tools available steal time from physicians that should be spent on patient care. At the Healthcare Information and Management Systems Society (HIMSS) annual conference in Orlando, Florida, Michael Hodgkins, MD, discussed an answer to this problem—physician involvement at the ground level of tech ideation and development.

“As you go around HIMSS … you hear a lot about enterprise solutions,” said Dr. Hodgkins, AMA chief medical information officer. “Well, a physician practice of 10 is not an enterprise and doesn’t have the resources available to large enterprises when it comes to the implementation and support of health information technology. And so, their needs are quite different than the enterprise needs, but we seem to always concentrate on the enterprise.”

In 2013, the AMA sponsored a RAND study to investigate sources of satisfaction and dissatisfaction for physicians in practice. The No. 1 source of satisfaction was delivering high-quality care, Dr. Hodgkins said.

But the primary sources of dissatisfaction were anything that got in the way of delivering that care to patients, he said. And the (EHR) was identified as one of the largest sources of dissatisfaction for physicians.

“I think a lot has changed since 2013, but there’s still a lot more improvement that we need to see and it’s not always the fault of the vendor,” Dr. Hodgkins said. “Many of the vendors are working pretty hard to improve their products.”

“It’s often overlooked how the Meaningful Use program has impacted the design of EHRs in ways that have adversely impacted physicians and other health care professionals,” he said. Also overlooked, are the “implementation decisions that are made, especially at the enterprise level for business reasons which, can have a significant impact on the usability  of electronic health records”

An AMA survey, conducted last September, asked 1,300 physicians about their motivations and requirements for integrating digital health tools in their practices. The majority of physicians surveyed see potential for digital solutions to improve patient care, but adoption comes with key requirements.

Physicians stated that tools should be easy to use and as effective as current methods of patient care, if not more effective. If physicians adopt these tools, they want to make sure they are covered for liability, that data privacy and security are assured  and that these solutions integrate with their EHR and workflow. And physicians also want to make sure these tools work with new payment and care delivery models

For digital and mobile health tools to be effective, they must be interoperable with the EHR and fit comfortably into patient care, allowing physicians to improve that care without adding time-consuming burdens.

“A lot of physicians feel, whether perceived or actual, that many of the problems that are happening with their EHR is because their voices have not been listened to either by vendors or by the people making decisions in their organizations about how the tools are being implemented, how [physicians are] being trained and how they’re being used,” Dr. Hodgkins said. “If you think the impact of the electronic health record has been significant, what do we expect from the impact of the proliferation of mobile apps and devices?”

“What about the data streams that are going to come out of these tools?” Dr. Hodgkins said. “What are we going to do with those data streams? We don’t need more data; we need more actionable information.”

Dr. Hodgkins offered an example of an application that was developed without physician involvement.

Once one of the top downloaded apps in the Apple App Store, “was an app that said it could measure your blood pressure,” Dr. Hodgkins said. “It sounded pretty cool. Unfortunately, when it was studied by independent researchers, it was found that 80 percent of the time it was wrong. In fact, 80 percent of the time it told people who had hypertension that they were normotensive.”

“Fortunately, the FTC [Federal Trade Commission] intervened in this particular case … and the application was withdrawn,” he said. “But a lot of people used this application and relied on it. To me, that’s the tip of the iceberg.”

“It’s great to have all these shiny new toys, but if they don’t work in your practice, what’s the point?” Dr. Hodgkins said.

Apps like the one Dr. Hodgkins highlighted pose a risk to patients because of a lack of validity and a misalignment with professional standards and ethics. But when physicians are involved, there can be tremendous progress.

Last year, the AMA partnered with Omada Health and Intermountain Healthcare in Utah to develop an online diabetes prevention program (DPP) with physician input. As of today, about 200 patients are enrolled in the one-year program, which builds on what was proven effective in the Centers for Disease Control and Prevention’s in-person National DPP.

The results so far are promising. Omada reports that patients who have made it to the 16-week mark are averaging about 5 percent weight loss.

Building on that progress, the AMA, the American Heart Association, HIMSS and digital health nonprofit DHX Group founded an industry collaborative called Xcertia to develop a detailed framework of principles and best practices to guide the mobile health app industry.

Currently in pilot mode, the AMA has also launched the AMA Physician Innovation Network, a platform designed to connect physicians and entrepreneurs.

“The innovator community knows a lot about technology,” Dr. Hodgkins said. “What they often don’t know  is how health care professionals work and think, the complexities of care and … the dynamics of the delivery and payment systems.”

“Physicians, on the other hand tend to know a lot about those subjects but no so much about the technology,” he said.

Right now, physicians have to make a binary choice of whether they want to get involved in the development of digital tools or continue practicing medicine., Dr. Hodgkins said. “We want to make it possible for them to stay in practice and be very much engaged with the innovator community.”