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E-patient Update: Remote Monitoring Leaves Me Out of The Loop

Posted on May 24, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As some readers may recall, I don’t just write about digital health deployment — I live it. To be specific, my occasional heart arrhythmia (Afib) is being tracked remotely by device implanted in my chest near my heart. My cardiac electrophysiologist implanted the Medtronic device – a “loop recorder” roughly the size of a cigarette lighter though flatter — during a cardiac ablation procedure.

The setup works like this:

  • The implanted device tracks my heart rhythm, recording any events that fit criteria programmed into it. (Side note: It’s made entirely of plastic, which means I need not fear MRIs. Neat, huh?)
  • The center also includes a bedside station which comes with a removable, mouse shaped object that I can place on my chest to record any incidents that concern me. I can also record events in real time, when I’m on the road, using a smaller device that fits on my key ring.
  • Whether I record any perceived episodes or not, the bedside station downloads whatever information is stored in the loop recorder at midnight each night, then transmits it to the cardiac electrophysiologist’s office.
  • The next day, a tech reviews the records. If any unusual events show up, the tech notifies the doctor, who reaches out to me if need be.

Now, don’t get me wrong, this is all very cool. And these devices have benefited me already, just a month into their use. For example, one evening last week I was experiencing some uncomfortable palpitations, and wondered whether I had reason for concern. So I called the cardiac electrophysiologist’s after-hours service and got a call back from the on-call physician.

When she and I spoke, her first response was to send me to my local hospital. But once I informed her that the device was tracking my heart rhythms, she accessed them and determined that I was only experiencing mild tachycardia. That was certainly a relief.

No access for patients

That being said, it bugs me that I have no direct access to this information myself. Don’t get me wrong, I understand that interacting with heart rhythm data is complicated. Certainly, I can’t do as much in response to that information as I could if the device were, say, tracking my blood glucose levels.

That being said, my feeling is that I would benefit from knowing more about how my heart is working, or failing to work appropriately in the grand scheme of things, even if I can’t interpret the raw data of the device produces. For example, it would be great if I could view a chart that showed, say, week by week when events occurred and what time they took place.

Of course, I don’t know whether having this data would have any concrete impact on my life. But that being said, it bothers me that such remote monitoring schemes don’t have their core an assumption that patients don’t need this information. I’d argue that Medtronic and its peers should be thinking of ways to loop patients in any time their data is being collected in an outpatient setting. Don’t we have an app for that, and if not, why?

Unfortunately, no matter how patients scream and yell about this, I doubt we’ll make much progress until doctors raise their voices too. So if you’re a physician reading this, I hope you’re willing to get involved since patients deserve to know what’s going on with their bodies. And if you have the means to help them know, make it happen!

The Power Of Presenting Health Data In Context

Posted on May 23, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Today I read an interesting article on the 33 charts blog, written by the thoughtful pediatrician Bryan Vartabedian. In the article, Dr. Vartabedian describes an encounter with data at Texas Children’s Hospital:

When I walked into the patient’s room, I found this: A massive wall-mounted touchscreen at the foot of the bed with all of the patient’s critical data beautifully displayed…All of the patient’s Epic data is right there in real-time. Ins and outs, blood gases and trending art line readings in beautiful graphic display. And what isn’t there is accessible by with the poke of a finger.

He goes on to suggest that by displaying the data in this way, the hospital is changing how care is delivered:

The concept of decentralized, contextually-appropriate channeling of information is beginning to disrupt the clinical encounter. As ambient interfaces infiltrate the clinical environment, the right data will increasingly find us and our patients precisely at the point of care where it’s actionable.

I really enjoyed reading this piece, as it bottom-lined something I’ve had difficulty articulating. It made me realize that I’ve been wondering if the data that’s awkward to use on a laptop or PC can be used to greater effect elsewhere. After all, it’s not that doctors dislike access to EMR data — it’s just that they dislike the impact EMRs have on their work habits.

It’s not just workflow

Much of the discussion about fostering EMR adoption by physician focuses on improving user interfaces and workflow. And that is a legitimate line of inquiry. After all, healthcare organizations will never see the full benefits of their EMR investment unless clinicians can actually use them.

But Dr. Vartabedian makes the useful point that putting such data in the right context is also critical. Sure, making sure clinicians can get to clinical data via smart phone and tablet is a step in the right direction, as it allows them to use it in a more flexible manner. But ultimately, the data is the most useful when it’s presented in the right form, one which also allows patients to consume it.

For some clinical settings, the large touchscreen display he describes may be appropriate. For others, it might be a bedside tablet that the patient and doctor can share. Or perhaps the best approach for presenting healthcare data contextually hasn’t been invented yet. But regardless of what technology works best, organizing health data and presenting it in the right context is a powerful strategy.

Creating context is possible

Of course, talking about providing contextual healthcare data and delivering it are two different things. The presentation that works for Dr. Vartabedian may not work for other clinicians, and developing the unified data set needed to fuel these efforts can be taxing. Not only that, developing the right criteria for displaying contextual data could a major challenge.

Still, the tools needed to create the right context for EMR data delivery exist now, including interactive health tracking devices, smartphone apps and tablets. Meanwhile, these devices and platforms are delivering an ever-richer data set to clinicians. Toss in data from remote monitoring devices in the options multiply. What’s more, phones with GPS functions can provide location-based data dynamically.

Sure, it may not be practical to tackle this problem while your EMR implementation is young. But it would be smart to at least turn your imagination loose. If Dr. Vartabedian is right, putting data in context soon be a requirement rather than an option, and it’s best to be prepared.

Telemedicine Rollouts Are Becoming More Mature

Posted on May 19, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

For a long time, telemedicine was a big idea whose time had not come. Initially, the biggest obstacles providing video consults was consumer bandwidth. Once we got to the point that most consumers had high-speed Internet connections, proponents struggled to get commercial insurers and federal payers to reimburse providers for telemedicine. We also had to deal with medical licensure which most companies are dealing with by licensing their providers across multiple states (Crazy, but workable). Now, with both categories of payers increasingly paying for such services and patients increasingly willing to pay out of pocket, providers need to figure out which telemedicine business models work.

If I had to guess, I would’ve told you that very few providers have reached the stage where they had developed a fairly mature telemedicine service line. But data gathered by researchers increasingly suggests that I am wrong.

In fact, a new study by KPMG found that about 25% of healthcare providers have implemented telehealth and telemedicine programs which have achieved financial stability and improved efficiency. It should be noted that the study only involved 120 participants who reported they work for providers. Still, I think the results are worth a look.

Despite the success enjoyed by some providers with telemedicine programs, a fair number of providers are at a more tentative stage. Thirty-five percent of respondents said they didn’t have a virtual care program in place, and 40% had said they had just implemented a program. But what stands out to me is that the majority of respondents had telehealth initiatives underway.

Twenty-nine percent of survey respondents said that one of the key reasons they were in favor of telehealth programs is that they felt it would increase patient volumes and loyalty. Other providers have different priorities. Seventeen percent felt that implement the telehealth with help of care coordination for high-risk patients, another 17% said they wanted to reduce costs for access to medical specialists, and 13% said they were interested in telemedicine due to consumer demand.

When asked what challenges they faced in implementing telehealth, 19% said they had other tech priorities, 18% were unsure they had a sustainable business model, and 18% said their organization wasn’t ready to roll out a new technology.

As I see it, telemedicine is set up to get out of neutral and pull out of the gate. We’re probably past the early adopter stage, and as soon as influential players perfect their strategy for telemedicine rollouts, their industry peers are sure to follow.

What remains to be seen is whether providers see telemedicine as integral to the care they deliver, or primarily as a gateway to their brick-and-mortar services. I’d argue that telemedicine services should be positioned as a supplement to live care, a step towards greater continuity of care and the logical next step in going digital. Those who see it as a sideline, or a loyalty builder with no inherent clinical value, are unlikely to benefit as much from a telemedicine rollout.

Admittedly, integrating virtual care poses a host of new technical and administrative problems. But like it or not, telemedicine is important to the future of healthcare. Hold it is at arms’ length to your peril.

Making Health Data Patient-Friendly

Posted on May 6, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Most of the efforts designed to make healthcare processes more transparent hope to make patients better shoppers. The assumption is that better-informed patients make better decisions, and that ultimately, if enough patients have the right data they’ll take steps which improve outcomes and lower the cost of care. And while the evidence for this assumption is sparse, the information may increase patient engagement in their care — and hopefully, their overall health.

That’s all well and good, but I believe too little attention has been paid to another dimension of transparency. To wit, I’d argue that it’s more than time to present patients with clinical data on a real- or near-real-time basis. Yes, shopping for the right doctor is good, but isn’t it even more important for patients to see what results he or she actually gets in their particular medical case?

Patients rarely get a well-developed look at their clinical data. Patient portals may offer access to test and imaging results from today through 10 years ago — my health system does — but offer no tools to put this data in context. If a patient wants to take a good look at their health history, and particularly, how test results correlate with their behavior, they’ll have to map the data out themselves. And that’s never going to work for your average patient.

Of course, there are obstacles to making this happen:

  • Physicians aren’t thrilled with the idea of giving patients broad healthcare data access. In fact, more than one doctor I’ve seen wouldn’t let me see test results until he or she had “approved” them.
  • Even if you set out to create some kind of clinical data dashboard, doing so isn’t trivial, at least if you want to see patients actually use it. Significant user testing would be a must to make this approach a success.
  • To my knowledge, no EMR vendor currently supports a patient dashboard or any other tools to help patients navigate their own data. So to create such an offering, providers would need to wait until their vendor produces such a tool or undertake a custom development project.

To some extent, the healthcare IT industry is already headed in this direction. For example, I’ve encountered mobile apps that attempt to provide some context for the data which they collect. But virtually all healthcare apps focus on just a few key indicators, such as, say calorie intake, exercise or medication compliance. For a patient to get a broad look at their health via app, they would have to bring together several sets of data, which simply isn’t practical.

Instead, why not give patients a broad look at their health status as seen through the rich data contained in an EMR? The final result could include not only data points, but also annotations from doctors as to the significance of trends and access to educational materials in context. That way, the patient could observe, say, the link between blood pressure levels, exercise, weight and med compliance, read comments from both their cardiologist and PCP on what has been working, and jump to research and education on cardiovascular health.

Ultimately, I’d argue, the chief obstacle to creating such an offering isn’t technical. Rather, it’s a cultural issue. Understandably, clinicians are concerned about the disruption such approaches might pose to their routine, as well as their ability to manage cases.

But if we are to make patients healthier, putting the right tools in their hands is absolutely necessary. And hey, after paying so much for EMRs, why not get more value for your money?

P.S. After writing this I discovered a description of a “digital health advisor” which parallels much of what I’m proposing. It’s worth a read!

Too Many Healthcare Apps

Posted on May 4, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As we all know, if we want something, there’s probably an app for that. From head to toe, from bank to restaurant to club, in most places in the world, there’s probably an app to meet your needs.

Apple is rightly lauded for its contribution in this area. While it didn’t invent the smart phone as such — early devices mashing together PDAs and connected computing preceded the march of i-Everything by some time — but obviously, it popularized this technology and made it usable to virtually everyone, and for that it deserves the kudos it has gotten.

But as we work to build mobile healthcare models, I’d argue, the notion of there being an app for each need is falling flat. Healthcare organizations are creating, and clinicians prescribing, targeted apps for every healthcare niche, but consumers aren’t showing a lot of interest in them.

Healthcare consumers have shown interest in a subsection of health app categories. According to a study completed last year, almost two-thirds of Americans would use a mobile app to manage health issues. The study, the Makovsky/Kelton “Pulse of Online Health” survey, found that their top interests included tracking diet/nutrition (47%), medication reminders (46%), tracking symptoms (45%) and tracking physical activity (44%).

But other research suggests that consumers aren’t that enthused about other categories of healthcare apps. For example, a recent study by HealthMine concluded that while 59% of the 500 respondents it surveyed had chronic conditions, only 7% used digital disease management tools.

I’ve made the following argument before, but I think it’s worth making again. From what I’ve observed, in talking to both providers and patients, the notion of developing a multitude of apps covering specialized needs is a failed strategy, reflecting the interests of the healthcare industry far more than patients. And as a result, patients are staying away in droves.

From what I’ve observed, it appears that healthcare organizations are developing specialized apps because a) that strategy mirrors the way they are organized internally or b) they’re trying to achieve specific outcomes (such as a given average blood sugar level among diabetics). So they build apps that reflect how they collect and manage data points within their business.

The problem is, consumers don’t care what a facility or clinician’s goals are, unless those goals overlap with their own. They certainly don’t want to open a new app every time they take on a new health concern. And that sucks the benefit right out of app-creation efforts by healthcare providers. After all, aren’t people with multiple conditions the expensive patients we’d most like to target?

What’s more, apps designed to capture data aren’t terribly motivating. Clinicians may live or die on the numbers, but unless those numbers come with a realistic path to action, they will soon be ignored, and the app discarded. Consider the humble bathroom scale. For most people, that one data point isn’t particularly helpful, as it says nothing about where to go from there. So people generally give up when they’re neither motivated nor taught by the apps they download.

To be successful with mobile healthcare, providers and clinicians will need to back the development of apps which guide and sustain users, rather than turn them into data entry clerks.  It’s not clear what should replace the current generation, but we need to turn to a more patient-centric model. Otherwise, all our efforts will be wasted.

Health Organizations Failing At Digital Health Innovation

Posted on May 3, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Few healthcare providers are prepared to harvest benefits from digital health innovations, a new study suggests. The study, by innovation consultancy Enspektos LLC, concludes that digital health innovation efforts are fairly immature among healthcare organizations, despite the enormous wave of interest in these technologies.

While this should come as no surprise to those of us working in the industry, it’s a little depressing for those of us — including myself — who passionately believe that digital health tools have the potential to transform the delivery of care. But it also reminds providers to invest more time and effort in digital health efforts, at least if they want to get anything done!

The study, which was sponsored by healthcare IT vendor Validic, chose 150 survey participants working at health organizations (hospitals, pharmaceutical firms, payers) or their partners (technology firms, startups and the like) and asked them to rate digital health innovation in the healthcare industry.

The results of this study suggest that despite their high level of interest, many healthcare organizations don’t have the expertise or resources needed to take full advantage of digital health innovations. This tracks well with my own experience, which suggest that digital health efforts by hospitals and clinics are slapdash at best, rolling out apps and doling out devices without thinking strategically about the results they hope to accomplish. (For more data on digital health app failures see this story.)

According to Enspektos, only 5% of health organizations could demonstrate that they were operating at the highest level of proficiency and expertise in digital health innovation. The majority of health organizations worldwide are experimenting with and piloting digital health tools, researchers concluded.

Apparently, digital health is moving slowly even with relatively mature technologies such as mobile platforms. One might think that mobile deployments wouldn’t baffle IT departments, but apparently, many are behind the curve. In fact, health organizations typically don’t have enough technical expertise or large enough budget to scale their digital health efforts effectively, Enspektos researchers found.

Of course, as a digital health technology vendor, Validic is one of many hoping to be the solution to these problems. (It offers a cloud-based technology connecting patient-recorded data from digital health apps, devices and wearables to healthcare organizations.) I’m not familiar with Validic’s products, but their presence in this market does raise a few interesting issues.

Assuming that its measures of digital health maturity are on target, it would seem that health organizations do need help integrating these technologies. The question is whether a vendor such as Validic can be dropped into the technical matrix of a healthcare organization and bring its digital health program to life.

My guess is that no matter how sophisticated an integration platform they deploy, healthcare organizations still have a tremendous amount of work to do in thinking about what they actually want to accomplish. Most of the digital health products I’ve seen from providers, in particular, seem to be solutions in search of a problem, such as apps that have no bearing on the patient’s actual lifestyle and needs.

On the other hand, given how fluid digital health technology is at this point, perhaps vendors will be creating workflow and development models that healthcare organizations can adapt. It remains to be seen who will drive long-term change. Honestly, I’m betting on the vendors, but I hope more healthcare players step up, as I’d like to see them own this thing.

Bill Could Cut Meaningful Use Reporting Period Drastically

Posted on April 25, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A bill has been filed in Congress that would slash the Meaningful Use reporting period from one year to 90 days. This seems to be a challenge to CMS, which has reportedly held firm in the face of pressure to cut the reporting period on its own.

Supporters of the bill, which is backed by a broad coalition of industry trade groups, argue that a 365-day reporting period is unduly burdensome for providers, and will become even more awkward as MACRA requirements fall into place. Cutting the reporting period “will continue the significant progress providers are making to harness the use of technology to succeed in new payment and care delivery models,” argued a coalition of such groups in a letter sent to CMS last month.

That being said, it’s not clear how the structure of Meaningful Use incentives will play out under MACRA. So the reporting period change may or may not be as relevant as it might have been before the MACRA rules were set to be announced.

CMS leaders have said that the upcoming Merit-Based Incentive Payment System (MIPS) – which will probably fall in place under MACRA in 2017 — is designed to unify incentive payments. Specifically, it integrates existing MU, PQRS and Value-Based Payment Modifier programs. MIPS payments will be based on a weighted score rating providers on four factors: quality (30%), resource use (30%), Meaningful Use (25%) and clinical practice improvement activities (15%). This suggests that a focus on reporting requirements is probably a matter of closing the barn door after the horse has left the stable.

On the other hand, since Meaningful Use isn’t going away completely, maybe cutting the reporting period required is necessary. If providers are being rated on a set of factors of which MU is just a part, reporting for an entire year could certainly impose an administrative burden. Why set providers up to fail by forcing them to overextend their resources on reporting?

I believe that reducing Meaningful Use requirements is a sensible step to take at this point. While there are probably those who would argue the point, I submit that MU has been pretty successful in motivating providers to rethink their relationship with HIT, and has even help a subset to completely rethink how they deliver care. Now, it’s time to move the ball forward, to a more holistic approach that goes beyond regulating care processes.

Admittedly, it’s possible that cutting the reporting period, or otherwise shifting the emphasis away from regulating HIT use, might cause some providers to slack off in some way. But to my way of thinking, that’s a risk we need to take. After investing many billions of dollars on promoting smart HIT use, we have to assume that we’ve done what we can, and focus on smart quality measures. With any luck, the new measures will work better for everyone involved.

New Payment Model Pushes HIT Vendors To Collaborate

Posted on April 20, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

CMS has launched a new program designed to shift more risk to and offer more rewards to primary care practices which explicitly requires HIT vendors to be involved at advanced stages. While the federal government has obvious done a great deal to promote the use of HIT in medical practices, this is the first I’ve seen where HHS has demanded vendors get involved directly, and I find it intriguing. But let me explain.

The new Comprehensive Primary Care Plus payment scheme – which builds upon an existing model – is designed to keep pushing risk onto primary care practices. CMS expects to get up to 5,000 practices on board over the next five years, spanning more than 20,000 clinicians serving 25 million Medicare beneficiaries.

Like Medicare payment reforms focused on hospitals, CPC+ is designed to shift risk to PCPs in stages. Track 1 of the program is designed to help the practices shift into care management mode, offering an average care management fee of $15 per beneficiary per month on top of fee-for-service payments. Track 2, meanwhile, requires practices to bear some risk, offering them a special hybrid payment which mixes fee-for-service and a percentage of expected Evaluation & Management reimbursement up front. Both tracks offer a performance-based incentive, but risk-bearing practices get more.

So why I am I bothering telling you this? I mention this payment model because of an interesting requirement CMS has laid upon Track 2, the risk-bearing track. On this track, practices have to get their HIT vendor(s) to write a letter outlining the vendors’ willingness to support them with advanced health IT capabilities.

This is a new tack for CMS, as far as I know. True, writing a letter on behalf of customers is certainly less challenging for vendors than getting a certification for their technology, so it’s not going to create shockwaves. Still, it does suggest that CMS is thinking in new ways, and that’s always worth noticing.

True, it doesn’t appear that vendors will be required to swear mighty oaths promising that they’ll support any specific features or objectives. As with the recently-announced Interoperability Pledge, it seems like more form than substance.

Nonetheless, my take is that HIT vendors should take this requirement seriously. First of all, it shines a spotlight on the extent to which the vendors are offering real, practical support for clinicians, and while CMS may not be measuring this just yet, they may do so in the future.

What’s more, when vendors put such a letter together in collaboration with practices, it brings both sides to the table. It gives vendors and PCPs at least a marginally stronger incentive to discuss what they need to accomplish. Ideally – as CMS doubtless hopes – it could lay a foundation for better alignment between clinicians and HIT leaders.

Again, I’m not suggesting this is a massive news item, but it’s certainly food for thought. Asking HIT vendors to stick their necks out in this way (at least symbolically) could ultimately be a catalyst for change.

Digital Disease Management Tools Aren’t Too Popular

Posted on April 19, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Despite having a couple of chronic illnesses, I don’t use disease management tools and apps, even though I’m about as digital health-friendly as anyone you can imagine. So I guess the results of the new survey, suggesting that I’m not alone, shouldn’t come as a surprise.

The study was conducted by HealthMine, which recently surveyed 500 insured consumers to find out whether they used digital health devices and apps. Researchers found that while 59% of respondents suffer from chronic conditions, only 7% of these individuals used a disease management tool.

This was the case despite the fact that 50% reported using fitness/activity trackers or apps, and that 52% of respondents were enrolled in a wellness program. Not only that, two thirds of those involved in a wellness program said their program offered incentives for using digital health tools.

Disease management tools may not be in wide use, but that doesn’t mean that the consumers weren’t prepared to give digital health a try. When they drilled down further, HealthMine researchers learned that in addition to the half of respondents that used fitness trackers, consumers were interested in a wide variety of digital health options. For example, 46% used food/nutrition apps, 39% used weight loss apps, 38% used wearable activity tracker apps, 30% used heart rate apps, 28% used pharmacy apps, and 22% used patient portals or sleep apps.

To get consumers interested in disease management tools, it might help to know what motivates them to pick up any digital health app for their use. The biggest motivators cited were desire to know their numbers (42%), followed by improving their health (26%), the knowledge that someone on the other side of the app is tracking results (19%), and incentives for using the app (10%). (It’s worth noting that while incentives weren’t the biggest motivator to use digital health tools, 91% of respondents said that incentives would motivate them to use digital health tools more often.)

All that being said, I think I know what’s wrong here. In my experience, the apps consumers reported using are directed at helping consumers handle problems which, though complex, can be addressed in part by measuring a few key indicators. For example, achieving fitness is a broad and multifactorial goal, but counting steps is simple to do and simple to grasp. Or take food/dieting apps: eating properly can be a life’s work, but drawing on a database to dig out carb counts isn’t such a big deal.

On the other hand, managing a chronic illness may call for data capture, interaction with existing databases, monitoring by a skilled outside party and expert guidance. Pulling all of these together into a usable experience that consumers find helpful — much less one that actually transforms their health — is far more difficult than, say, tracking calories in and calories burned.

I’d argue that truly effective disease management tools, which consumers would truly find useful, calls for institutional commitment by vendors or providers that neither is ready to supply. But if disease management tools came with a particularly intuitive interface, a link to live providers and perhaps more importantly, education as to why the items being tracked matter, we might get somewhere.

Direct Primary Care Docs And EMRs

Posted on April 14, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

For those that haven’t stumbled upon it, direct primary care is an emerging model for changing the relationship between primary care docs and their patients. Under this model, patients pay primary care practices a flat fee per month which covers all services they use during that month. From what I’ve seen, fees are typically between $50 and $100 per month, depending on the patient’s age.

The key to this model — which borrows from but is emphatically not a concierge set-up — is taking insurance companies out of the relationship. And investors seem to be excited about this approach, with VC money flowing into DPC companies and startups like Turntable Health, which is backed by Zappos.com CEO Tony Hsieh.

I bring this up because I wanted to lay out a theory and see what you folks think. The theory doesn’t come from me; it was tossed out in a blog item by Twine Health, which makes a collaborative care platform. In the item, Twine blogger Chris Storer argues that the DPC movement is enabling doctors to junk their EMRs, which he suggests have been put in place to handle insurance documentation.

While the notion is self-serving, given that Twine seemingly wants to replace EMRs in the healthcare continuum, I thought it gave rise to an interesting thought experiment. Are EMRs mostly a tool to placate insurance companies? It’s worth considering. While Twine may or may not offer a solution, it’s hard to argue that existing EMRs “have empowered both physicians and patients in developing relationships that result in better healthcare outcomes.”

In the blog item, Storer argues that primary care practices largely use EMRs as a means of capturing data, and by doing so meeting insurance claims requirements. Though he offers no evidence to this effect, Storer suggests that DPC practices are dumping EMRs to focus better on patient care. There’s actually at least one direct-primary-care oriented EMR on the market (atlas.md, which is backed by a DPC practice in Wichita, KS), but that doesn’t prove the blogger wrong.

For Twine and its ilk, the question seems to be whether switching from EMRs to another care management model would actually improve the patient experience in and of itself. I’m sure that Twine (and others who consider themselves competitors) believe that it will.

As I see it, though, they’re talking around some key issues. no matter how user-friendly a platform is, No how laudable its goals are, I doubt that even a direct primary care practice unfettered by insurance requirements could seamlessly shift their practice to a platform such this. And no matter how good next-gen collaborative tools are — and I’m optimistic about them, as a category — the workflow issues which have alienated patients in the EMR age won’t go away entirely.

So while I’ll believe that DPC practices want to pitch their EMR, my guess is that the odds of their replacing it with an alternative platform are slim. Now, if collaborative care players catch practices when they’re being formed, that may be a different story. But for now my guess is that any practice that has an EMR in place is unlikely to dump it for the time being. The alternatives (including going back to paper charts) are unlikely to make sense.