Electronic health records are only the beginning when it comes to technology in medical practices. Here are five trends to look out for in the coming year.
Technology is driving the revolution in healthcare, and it’s dramatically influencing how you, other physicians, and your patients access healthcare information and communicate it.
Smartphones, iPads, mobile health (mHealth) apps, remote monitoring devices, cloud-based computing, and other technologic advances are continuing to rewrite the script for healthcare delivery for both patients and physicians, so much so that Forbes already has declared 2013 as the year of digital health. Consider that 60% of physicians accessed health content online using their mobile phones, and 44% turned to tablet computers, according to the 2012 comScore Physician Mobile Survey.
“While mobile phones have already emerged as a means for doctors to look up medical information quickly and efficiently, tablet usage is ramping up quickly and shows significant promise to serve as a substitute for computers in handling more involved tasks like record-keeping,” says John Mangano, vice president for comScore Health and Pharmaceutical Solutions, following the release of the survey results.
Kevin Pho, MD, a social media expert and primary care physician (PCP) in Nashua, New Hampshire, expects patients use the technology to tap into the growing reservoir of healthcare information available to them.
“Patients have access to increasing amounts of data, driven by the proliferation of smartphones.” Pho says. “Almost half of patients have smartphones, and, of those, one in five uses health apps. These apps, which include GPS fitness apps, calorie-tracking apps, apps to diagnose skin lesions etc., give patients data they never had before.”
Derek Kosiorek, a consultant with the MGMA Healthcare Consulting Group, agrees that patients will be a driving force behind healthcare’s continued technologic transformation, which took flight with passage of the Health Information Technology for Economic and Clinical Health Act.
“The difference this year is that changes are going to be pushed [by] the patient,” he says. In fact, Kosiorek predicts that patient demand and outside influences from receivers of care will have a much stronger influence on the adoption of healthcare technology compared with the government incentives.
So here is a look at five technology trends that are likely to affect how you practice medicine this year.
1. PCP as “curator”
As patients have increasing access to information and data about their own health, Pho says physicians no longer will be the gatekeepers of medical information. Instead, he says, they must become “curators of information,” directing patients to the best apps and online sources of medical information.
This effort becomes easier as more doctors, generally not known to be early adopters of technology, jump on the digital health bandwagon. The 2012 comScore study of physician online behaviors revealed health social media sites (such as Sermo.com) now reach half of doctors going online, showing the largest growth in visitation over the past year, whereas 72% of physicians spent time exploring general health content online and 39% visited health and wellness Web sites.
Pho argues that doctors have no choice but to become as active as their patients in the mHealth revolution.
“Patients are coming to our offices armed already with information or a diagnosis of what they think they have,” he says. “It is up to us as physicians to accept this new paradigm and become partners with patients.”
Today, more than 85% of American adults own a cell phone, and nearly one-third of them have used a phone to look up health or medical information online, according to the Pew Research Center’s Internet & American Life Project 2012 survey.
Although “Dr. Google” is always on-call for the American public, the online medical advice being doled out is not always accurate. The same can be said of the more than 13,000 health and medical apps now available for mobile devices. A recent report in JAMA Dermatology, for example, found that that three out of four melanoma-diagnosing apps reviewed misclassified at least 30% of melanoma lesions.
“If doctors aren’t taking the time to stay consciously up-to-date with these trends, patients are going to go elsewhere for health information,” Pho says. “Eventually that is going to lead to physicians losing their standing as healthcare authorities. The way I see it, the medical profession doesn’t have a choice when it comes to embracing these mobile and online trends.”
2. Personal health records
Kaiser Permanente, one of the nation’s largest not-for-profit health plans, demonstrates patients’ ever-growing interest in online access to their personal health information. Today, 65% of Kaiser’s eligible members have direct access to My Health Manager, its personal health record (PHR), via www.kp.org. Since 2008, the number of members registering for secure features on My Health Manager has climbed from 2.7 million to more than 4 million. In 2012, for example, patients viewed more than 32 million lab test results online, nearly double the usage in 2008.
When Kaiser made My Health Manager accessible by smartphone in 2012, members downloaded the mobile app nearly 400,000 times, and the mobile-optimized Web site was visited 19.2 million times in the first year, accounting for 22% of traffic to the site.
Thuc Huynh, MD, a family practice physician in Macedon, New York, says her patients-particularly those aged fewer than 50 years-want access to details about their medical care and are using PHRs to take a more hands-on role in their healthcare. She says about one-fifth of her patients signed up for Epic’s My Chart PHR in the 8 months after her practice began using an Epic electronic health record (EHR).
“They like being able to be active in their care and seeing their results firsthand instead of waiting for us to send them a letter or verbally tell them what their lab results are,” Huynh said. “They appreciate being able to say, ‘I am going to sign off on this and take a look at my own labs and take a bigger part in my care.’ ”
Nonetheless, Huynh says most PHRs have room for improvement in design and usability.
“The design of many of these software applications is pretty substandard,” she says. “Some of them are easy to use, but many are garbled, with a lot of information that is hard to decipher.”
She believes competitions such as the New York eHealth Collaborative design challenge will help lead the way to PHRs becoming more patient-centered.
“I’m looking forward to PHRs becoming more interactive and patients being able to see a bit more of what doctors are doing with patients and, in general, the PHR looking better.”
Kosiorek also expects privacy and security concerns surrounding PHRs to eventually be solved by the use of biometric identification systems, which would use a finger or face print to keep information secure.
“Security is based on three things: what you are, what you have, or what you know,” Kosiorek says. “What you know is the user name/password; what you have is the swipe card; what you are is biometrics. There is interest in increasing security to the point you have to be who you are rather than know information.”
3. Healthcare in the cloud
Client-servers continue to dominate the market, experts say. In 2011, 55% of office-based physicians were using EHRs, and 59% of them were using stand-alone systems, according to a July 2012 report from the Centers for Disease Control and Prevention.
“The big [trend] for this year is the cloud,” says healthcare consultant Mary Pat Whaley, owner of Manage My Practice. “It changes [EHRs] from an investment or capital expense to an operating expense. That’s a real game-changer, either for physicians going into practice or small practices getting ready to add an [EHR].”
Although many healthcare IT vendors are rolling out or working on cloud-based products, most practices need to evaluate purchasing decisions based on factors such as cost, functionality, convenience, security, applications, and the like.
4. Support staff needs
Technology also is allowing many practices to redesign their workflows and staff functions. It could allow some staff members and doctors to work remotely from home.
“Obviously, in a physician practice, a couple of people have to be there for the face-to-face with the patient,” Whaley says, “but more and more, you need less people on site.”
“Managers need to understand better and need to get a grip on blending on-site and remote employees and outsourcing services into a new kind of team,” Whaley said. “You want to use the smallest footprint possible, because medical space is very expensive. If you can keep people off-site, cut your expenses that way, and keep your really good employees who would love to work from home, it is a win-win.”
5. Remote monitoring
New developments in mHealth are fueling the growth of home-based remote monitoring services, with roughly 2.8 million patients worldwide using connected medical devices to monitor everything from sleep apnea to blood pressure and medication adherence, according to Berg Insight.
Yet the telecommunication business intelligence company says that the monitoring products currently on the market represent only the tip of the iceberg in mHealth innovation. The analyst firm forecasts that the number of home monitoring systems with integrated communication capabilities will grow at a compound annual growth rate of 26.9% between 2011 and 2017 to reach 9.4 million connections worldwide. The number of devices with integrated cellular connectivity increased from 730,000 in 2011 to about 1.03 million in 2012 and is projected to grow at a compound annual rate of 46.3% to 7.1 million in 2017.
All that technology will result in a different healthcare model than we see today.
“In the not too distant future, we envision all of us wearing sensors and having smart devices in our homes that talk to the cloud and create a big data problem,” Santalo says. “That [information] will need to be synthesized against the health record, the genome, etc.
“This is about keeping people healthy and keeping them out of healthcare,” he adds. “When you do bring them into the system, you know everything that has gone on with them, not only when they visited the doctor, but all the time in between.”
For physicians, another leap into the future of real-time remote monitoring of data and information was realized this past December when AliveCor’s iPhone-compatible heart monitor gained U.S. Food and Drug Administration (FDA) approval.
The product provides a patient or physician with an electrocardiography (ECG) monitor wherever he or she goes and allows for vital signs to be taken anywhere and read from any browser, says David McCaman, AliveCor’s marketing director. “Whereas the iPod was 1,000 songs in your pocket, now you have a clinical quality ECG in your pocket. The big opportunities revolve around providing value to the physician in making [his or her] job easier or saving time and providing the patient with more information and ownership of their health.”
Meanwhile, products such as AirStrip OB from AirStrip Technologies, which delivers fetal heartbeat and maternal contraction patterns in virtual real-time directly from the labor and delivery unit to a medical professional’s mobile wireless device, and Resolution MD from Calgary Scientific, an FDA-cleared (for iPhone and iPad) medical viewing product enabling instant access to radiology diagnostic images and reports from mobile devices, are turning doctors’ mobile devices into diagnostic decision-making tools as well.
Joseph Kvedar, MD, director of the Center for Connected Health, Boston, Massachusetts, says that remote-monitoring devices may provide another, less-widely discussed benefit by helping offset a shortage of physicians by allowing doctors to serve patients more efficiently.
“ResolutionMD, AirStrip-they are brilliant in a sense,” he said. “They are answering a need. Doctors will always want to be more efficient. There are never going to be enough of us. There is always going to be pressure to use our knowledge across more patients. These tools enable that.”
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