As the health care system faces unprecedented challenges in the form of workforce shortages, burnout and rising costs, technology and collaborative efforts offer the potential to mitigate some of these concerns—but they need to be used correctly and with upfront patient and physician input to guide their development.
“It's really important to have doctors and patients involved in the early stages of development of these digital tools,” AMA President Jack Resneck Jr., MD, told attendees at Total Health 2022.
Some 500 health and technology CEOs, innovators and policymakers met in Chicago for the event, sponsored by the Reuters news agency.
“As president of the American Medical Association, I get to talk to doctors across the country—it’s one of the fun parts of my job,” said Dr. Resneck, a professor and vice chair of the University of California, San Francisco, School of Medicine’s dermatology department. “What I hear is pretty uniform excitement about the potential for digital health across the spectrum.”
His enthusiasm, however, was tempered with words of caution.
Dr. Resneck cited the examples of early burnout-inducing EHRs that were designed and rolled out with little physician input, device interfaces that aren’t “user-friendly,” and augmented intelligence, or “AI,” programs that introduced bias into their decision-making algorithms.
“What physicians are looking to us to do is to help tell them which ones are going to actually work and advance health, and which ones are more driven by hype or are going to risk patient privacy or are going to set back health equity,” Dr. Resneck said.
The AMA has convened the AMA External Equity and Innovation Advisory Group to provide direction on a shared vision for health care innovation.
“There's a real thirst to not only adopt these tools, but to make sure we’re choosing and deploying ones that advance health,” Dr. Resneck said. “At the AMA this is work that has really affected every business unit in our organization.”
He noted that this includes the AMA:
- Federal advocacy team working to ensure that the use of digital health tools is covered by Medicare.
- Medical education experts creating new curricula “so that we produce physicians who can function in a digital health world.”
- CPT® Editorial Panel developing new Current Procedural Terminology codes to ensure appropriate payment for physicians using telehealth.
- Health and science experts examining the level of evidence and scrutiny needed for new digital health tools depending on the level of risk that they carry.
Supporting telehealth is an essential component of the AMA Recovery Plan for America’s Physicians.
Telehealth is critical to the future of health care, which is why the AMA continues to lead the charge to aggressively expand telehealth policy, research and resources to ensure physician practice sustainability and fair payment.
Integrating behavioral health
Dr. Resneck, who appeared on a panel that discussed managing patients’ conditions from a distance, said he was able to have telephone visits with farmworkers in his area while they were on their breaks, which allowed them to visit with their physician without missing work.
A separate Total Health 2022 panel covered the integration of behavioral health care and included Don Mordecai, MD, Kaiser Permanente’s national leader for mental health and wellness.
Dr. Mordecai noted that, as a physician in an integrated health system, it’s easier for him to collaborate with colleagues, but he recognizes the restraints others face.
“When I'm seeing a patient, I'm on the same EMR as that patient’s cardiologist and nephrologist,” said Dr. Mordecai, who is also director of mental health and chemical dependency services for The Permanente Medical Group, a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“Outside of an integrated system, it’s a real challenge getting physicians, especially if they're small-group physicians, to talk to each other,” Dr. Mordecai said.
He has observed his wife, who is a pediatrician, acting as “quarterback” for her parents’ care and noted how difficult it must be for nonphysicians who are thrust into that role.
With workforce shortages, Dr. Mordecai noted the importance of collaboration, using technology and developing new ways to address concerns.
“Our primary care physicians are so overwhelmed, and so when I say to someone, ‘Hey, we can do collaborative care and it’s going to be great, and it's going to make your job easier,’ they're like ‘I don’t know, show me,’” he said.
Patients’ acceptance of behavioral health telehealth visits is a “huge, great step,” Dr. Mordecai said, explaining that the public perception of mental health services is generally outdated and based on weekly, one-on-one visits they’ve seen on television and in movies.
Improving outcomes, removing stigma
Some patients—including teens and young adults—are still reluctant to seek help because of a lingering stigma attached to accessing behavioral health services.
To reach that population, Kaiser Permanente worked with Cloud9, an esports gaming team, to post videos featuring prominent gamers sharing insights, positivity, and personal mental health messages.
Also posted was a series of free, online interactive training sessions to help address critical mental health issues.
In a study published in NEJM Catalyst, it was noted that viewers of those training sessions were more than twice as likely to report they knew what advice to give a friend with a mental health condition and nearly twice as likely to show better attitudes toward mental health treatment, including counseling, medication and recovery.
“I was skeptical at first, but the impact has been quite large,” Dr. Mordecai said.
Learn how the AMA helps physician practices achieve behavioral health integration.
Other Kaiser Permanente panelists at Total Health 2022 included Executive Vice President and Chief Medical Officer Andrew Bindman, MD, and Tatjana Kolevska, MD, medical director of the Kaiser Permanente National Cancer Excellence program.
Other physician panelists at Total Health 2022 from AMA Health System Program member organizations included Susan Turney, MD, president and CEO of Marshfield Clinic Systems, and Geisinger health system president and CEO Jawon Ryu, MD.