Healthcare Apps Could Be Doctor's Best Friend - InformationWeek
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David Voran
David Voran
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Healthcare Apps Could Be Doctor's Best Friend

Consumer health apps and gadgets could help improve patient care and reduce physicians' workloads. It's time for the healthcare industry to change a system that rewards disease.

8 Wearable Tech Devices To Watch
8 Wearable Tech Devices To Watch
(click image for larger view and for slideshow)
You can't change a lifestyle in 10 minutes from a jail-cell exam room. Yet every day we physicians willingly step into these cramped interrogation rooms and, like well-paid hamsters on wheels, churn through 20, 30 or more patients. We spend these 10-minute visits nibbling around the edges of lifestyle-related conditions and ailments, with little lasting effect.

The results of these rushed visits may include "decreased patient satisfaction, increased patient turnover, or inappropriate prescribing." Reimbursement formulas encourage physicians to perform much more lucrative procedures. They enable physicians to bypass the time required to really help patients make the changes needed and move quickly on to another patient.

Undoing years of unhealthy lifestyle practices requires deep involvement in a patient's life -- much more than is possible from a 10-minute visit in a cramped exam room. It also requires orders of magnitude more data than is entered into electronic medical records. Physicians need more granular "big data" in order to establish more meaningful relationships with patients and help them undertake lifestyle changes to improve health, reduce disease and lower healthcare costs.

[ Patient generated data could lower costs and improve the quality of care, but it needs to be done right. Read How Patient Generated Data Changes Healthcare. ]

It also requires much more frequent contact than these brief encounters in claustrophobic boxes can provide. (Besides, who wants to work in a jail cell?) In fact, one study showed that doctors spent on average 1.3 minutes conveying crucial information to patients about their condition and treatment during visits.

Meanwhile, a huge wave of smartphone apps and self-tracking devices could help us move toward the goal of improving health and managing diseases. These apps and devices are beginning to empower individuals with tools that make it easier to change. They generate exactly the type of data physicians need to help patients navigate necessary lifestyle changes -- the same changes we recite at the end of each office visit, often just as the patient is leaving. Yet physicians, healthcare organizations and EMR vendors almost universally reject the very idea of incorporating this data -- let alone the notion of letting their patients contribute directly into the same EMRs providers spend hours pecking information into.

doctor hamster wheel
Illustration by Jason Lee

Most physicians detest the volume of strokes and clicks required by EHRs and scoff at the very idea that these systems could actually help them reduce their workload. But ironically, these same physicians are also very reluctant to provide appropriate access to medical records, and are even more skeptical of letting patients directly enter information into their medical records.

Providers cough up numerous reasons to explain why they don't want patients contributing the data needed to improve health care, but they all boil down to one: It doesn't pay.

We, as a nation, have chosen not to pay for healthcare, but we handsomely reward disease care. The resulting fee-for-service system penalizes efficiency and rewards work.

The healthcare industry isn't ready for innovation. Unlike most other industries, which are leveraging technology by pushing as much transaction processing to the consumer, healthcare insists on doing all of the heavy lifting. Healthcare is happy to surf on the back rather than the front side of the technology wave.

Physicians and healthcare bureaucracy are slaves to the fee-for-service model and the related work Relative Value Unit (wRVU) used to calculate physician productivity. RVUs are not awarded to managing devices, apps or patient-generated data. Very few organizations leverage reimbursable telemedicine consults or apply them to patient data management. A face-to-face visit is simply too lucrative compared to a virtual visit.

Further, the typical 8 x 10 jail-cell-style exam room is not designed for the collaborative communication required for optimum care and leads to a cattle call approach to patient care.

This same system also discourages time spent developing relationships with patients. It is heavily weighted against the cognitive effort required to help patients attain optimum health and favors doing procedural tasks that haven't really been shown to improve a patient's health. Our entire "healthcare" industry is, in fact, focused on "disease care." For the most part, the third-party payers -- including the government -- will not reimburse healthcare providers for health promotion or optimization in the absence of a disease.

Because many physicians are competitive, they can be easy prey to administrative and peer pressure that exalts big RVU numbers -- it's not unusual for physicians to reference their RVU production in conversions. Accordingly, administrators disparage activity that does not produce an RVU as "wasted time." In fact, they base the majority of incentives on this definition of productivity. This leads to exhaustion, dissatisfaction and burnout for physicians, along with a total lack of interest in the very tools that have the most potential to affect real change in their own patients' health and in the burden of disease nationwide.

One striking irony in all this is many physicians are themselves proudly wearing these devices and using apps to improve their own health. A few are even prescribing them to their patients. But the industry as a whole refuses to leverage these advances and seems incapable of breaking out of the claustrophobic exam rooms that confine our doctors as they spin through one patient after another. They will stay there until the reimbursement system changes.

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User Rank: Apprentice
10/25/2013 | 2:56:02 AM
re: Healthcare Apps Could Be Doctor's Best Friend
Thanks for the comment. There's innovation if you want to call iterative improvement innovation. My own definition of innovation is more along the lines of Kurzweil's destructive innovation concepts. The problem we have in medicine is we're really slaves to what pays. Everyone is working hard to get better at what we do but if we were really innovative we'd be helping people shop, cook, exercise and do much better end-of-life planning that would suck the wind out of most organizations profits.
I'm really trying hard not to be cynical but it's not unusual for me to be told to my face that if even a 3rd of the physicians practiced "the way you do" we'd all be out of business.
Innovative changes in payment would accomplish more innovation that we ever could do from the provider side. I've seen some evidence in this with our own organizations involvement in an at-risk ACO. The problem is we have a window of maybe 2-3 years and if during that time a majority of payers do not drop fee-for-service and move to value-based reimbursement we won't be able to make enough from the ACO savings to cover the losses in our fee-for-service world.
Change the payment and you'd see a wholesale dramatic change in healthcare. Question would be would it be for the better or worse?
User Rank: Apprentice
10/9/2013 | 5:07:48 PM
re: Healthcare Apps Could Be Doctor's Best Friend
It's a long time coming, I would say a we really need to be able to take responsibility for our health and I think this use of technology would enable use (not to mention the overburdened health care system) to understand where we are failing ourselves.
Alex Kane Rudansky
Alex Kane Rudansky,
User Rank: Author
10/1/2013 | 3:02:26 PM
re: Healthcare Apps Could Be Doctor's Best Friend
While I agree that the healthcare industry is lagging behind other industries in terms of technological innovation and consumer-focused care, I disagree that "the healthcare industry isn't ready for innovation." There are barriers, yes. Regulatory and financial hurdles can delay and even halt innovation. But at the same time, it's important to consider the health organizations that have managed to innovate within this environment. Hospitals like Boston Children's and Miami Children's are ahead of the curve. Health systems like Intermountain and Penn Medicine devote time and resources to creating an innovative environment. The list goes on -- the industry is ready. The question now is how to overcome the challenges that come along with innovating and creating a culture of innovation.
David F. Carr
David F. Carr,
User Rank: Author
9/30/2013 | 9:47:52 PM
re: Healthcare Apps Could Be Doctor's Best Friend
By the way, our invitation to David Voran to write a column for us was based on his participation in this LinkedIn discussion of another InformationWeek story

Yes, we are listening to your feedback, wherever it appears, and we're interested in having more contributions from people working in healthcare and health IT who have something interesting to say.
User Rank: Author
9/30/2013 | 5:16:09 PM
re: Healthcare Apps Could Be Doctor's Best Friend
To one of your points, I recently met a healthcare CIO, and he was wearing a Fitbit gadget.
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