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Take two apps and call me in the morning


What physicians need to know about the rise of home health technology.

Medical technology in the home will grow from a $6 billion industry in 2018 to $30 billion in 2025, according to predictions from Global Market Insights. If this prediction comes to fruition, the old joke of “Take two pills and call in the morning,” may soon be replaced by “Take two apps and call me in the morning.”

Whether its email or patient portals, consumer wearables, virtual care offerings or remote patient monitoring, the most important question healthcare providers must answer before they introduce technology into their practice is, “What problem are you trying to solve?” Home technology is often touted as a way to scale the efforts of a healthcare provider to help manage multiple patients remotely.

However, many providers as well as health systems can offer case studies of how elegantly designed interventions incorporate the use of home technology to ostensibly improve clinical outcomes only to realize the technology remains unused in the home.

What problem are you trying to solve?

Are you using technology to improve access to care, improve patient satisfaction, communicate with patients and their caregivers, improve long term clinical outcomes or improve health behaviors? Understanding what your patients want or expect from engaging with medical technology and then developing and implementing the right solution is critical for success.  

Using an online scheduling app to improve access may appeal to busy Millennials and those facile with technology, but it may fall flat with elderly patients with chronic diseases and who have limited social support. Similarly, if you make decisions based on just who is using the technology you may miss opportunities to engage patients on why they are not engaging with it.

I can vividly remember seeing a digital marketing employee of a health system excitedly give a live demonstration to a patient advisory council of the functionality of a redesigned app that would allow appointments to be scheduled, bills to be paid and allow one to review their labs and x-rays. When the question was asked to this group of diverse senior citizens whether or not they would use it, less than 10% of the attendees said they would use it by a show of hands.

Push or pull?

Are you “pushing” technology to patients or are your patients “pulling” technology from you?

Practices and healthcare organizations risk a failed initiative if they design a program that is meant to improve the quality of care while reducing the overall cost of care without understanding the patients’ beliefs and attitudes toward technology in the home. In strong physician-patient relationships, the impact of a physician’s care plan extends beyond the hospital, office or clinic room and influences behaviors, attitudes and actions at home.

Therefore, thinking about technology as an extension of how you personally deliver care, just as you would if you were hiring an individual in your office for any patient-facing role, can offer valuable insights on how well technology is doing in strengthening the doctor-patient relationship. 

Do patients understand what role technology will play in managing their health? Now that another element is being introduced in their care, how does this impact what they should be doing on a day-to-day basis?

Be careful about behavior change

Over the past several years I have been doing home visits for patients with limited health literacy who have been hospitalized for either an exacerbation of chronic obstructive pulmonary disease or congestive heart failure. The zip code where I work, compared to the state’s median, has a lower high school graduation rate, a lower income and a higher poverty rate. No one uses a phone or computer to manage their healthcare.

There is a belief that introducing technology in the home will either reduce the personal effort that is needed to self-manage their chronic condition or that a disease process that is complex and confusing to manage on a daily basis has become more complex with the introduction of technology. Many patients living in poverty expend a lot of cognitive energy just trying to navigate their daily lives and introducing technology they don’t fully understand may not produce the expected clinical benefit or behavioral change that physicians hope for when they recommend it.

There has been data that suggests where you live impacts how long you live; meaning that zip codes with concentrated poverty and challenging social determinants of health and the healthcare providers delivering care to these areas face real challenges improving healthcare equity.

If we think that just offering technology equitably to these patients will by itself improve outcomes, we may paradoxically see a further dichotomy between affluent areas and impoverished areas.  Patients who are affluent and have the resources to effectively utilize technology in the home may see greater benefits than impoverished patients who can’t easily incorporate this into their treatment plans.

Where I practice in Columbus, Ohio there is already a 26-year difference in expected age of death depending on where one lives. Therefore, technology can’t be the sole solution toward reducing healthcare inequities.

What are your own beliefs and what does the literature say about home technology?

Certainly, patients may be excited about the possibilities of technology and the regulatory and reimbursement environment is becoming more supportive of its implementation. This begins with the decision in April from the Centers for Medicare and Medicaid Services that finalized policies allowing Medicare Advantage plans to offer additional telehealth benefits by 2020.

But it’s important to examine the literature and your own beliefs about the role home technology will play in delivering patient care. Currently, there is more enthusiasm and potential of home technology than definitive improvement in health outcomes.

Therefore, physicians are not neglecting “standard of care” expectations if they don’t prescribe consume wearables and wire a patient’s home to give them every conceivable data point that emanates from their bodies. If you do feel that technology may play a role in enhancing patient care, say for providing virtual visits for patients with limited social support and are essentially homebound, how can you empower your staff to address any administrative or technical burden that may arise so it doesn’t lead to frustration whenever you have to engage with it?  

Also, is the data you are collecting leading to information that can help you make better clinical decisions, or is just “noise” that causes precious time to be wasted? 

Improving patient engagement with home technology

The most fundamental element when considering whether you should offer technology as part of a treatment plan is understanding how it will help patients achieve a practical goal.

In every one of my home visits, I ask the patient what is one thing your illness prevents you from doing? I then try to tailor my intervention so that the expected benefit of having improved cardiac or pulmonary lung function is having the patient achieve his or her goals. This allows patients to envision how their engagement with a treatment plan can lead to achievement of their goals.

Collectively, we are having a conversation of how health behaviors can allow them to have more control over their illness as evidenced by achieving important daily activities while the data generated from our interventions remain in the background. If technology can play a role in helping patients achieve what is important to them, then by all means look at including it your treatment plan. If the introduction of technology can’t be fully adhered to then there is no need to complicate the physician-patient relationship.

Joseph M. Geskey, DO, MBA, MS-PopH, is the Vice President of Medical Affairs at OhioHealth Doctors Hospital in Columbus, Ohio. He is currently working on a book about the health care experiences of patients with limited health literacy and challenging social determinants of health in the digital and technological era medicine is embracing.

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