Like you, I thought I’d read everything about the reasons some doctors struggle with adopting digital health. Then, the following article showed up on my radar. While it covers some familiar ground, it’s a fairly nuanced take on physician objections to integrating digital health into their practice.
The article, “Top 10 Reasons Doctors Fear Digital Health,” comes from Brennan Spiegel, MD, MSHS, a gastroenterologist and co-creator of the MyGiHealth app. Given his digital health involvement, he obviously has a dog in the fight, but to my mind, that doesn’t detract from the value of what he had to say.
All ten of his observations make sense, but in the interests of brevity I’ll pick out a few that I found particularly interesting. Below, I’ve summarized some of the concerns expressed by his colleagues, then shared a condensed version of his responses:
* “Use digital health devices in my practice? How the world will I have time to check all the data?”
His response: We need to train a new type of specialist called a “digitalist” who will monitor, interpret and act upon remote patient data. They will reside in an e-coordination facility and remotely track data from biosensors, portals, apps and social media. (EDITOR’S NOTE: To see how an e-coordination center works today, check out this piece on the Mercy Virtual Hospital.) Their job will be to combine the data with clinical parameters and knowledge about the patient’s medical history then act on what they’ve learned.
* “What is my legal liability here? What if remote data show that somebody is doing poorly, but nobody checks it? What if the patient dies when there was clear evidence something bad was going to happen?”
His response: Until you have a digitalist watching your back, you cannot take responsibility – including legal responsibility – for monitoring, interpreting and acting upon the data. As I see it, that will be the digitalist’s responsibility.
* “Digital devices are cool, but most people quit using them before long. How could digital health make any difference if our patients refuse to use the stuff?
His response: To make inroads with chronic illnesses like diabetes, heart failure or obesity, we need to change behavior. One way to achieve this comes from Joseph Kvedar at Partners HealthCare. Dr. Kvedar’s team not only personalizes its apps but hyper-personalizes them. By integrating everything from the time of day, step counts, local weather and levels of depression or anxiety, these apps can send pinpoint messages to patients at the right time and place. This approach may work to foster behavioral change.
* “How will digital health improve the value of care? Can it both improve outcomes and lower costs? Until it can prove that it can, insurance won’t pay for it.”
Proving that digital health solutions provide economic value to health systems is the toughest and yet most important obstacle to taking digital health into the mainstream. As more and more digital health solutions roll off the assembly line, we need to see them subjected to formal health-economic analysis as with any other medical innovation.
I don’t know about you, but I found this to be an intriguing discussion, especially the notion of a “digitalist” responsible for remote data management and response. I look forward to talking to Dr. Spiegel someday (perhaps at the Connected Health show!) and getting more of his insights.