A new study from the AMA shows physicians growing ever more comfortable with multiple forms of health care technology. The growth of telehealth is expected, but some tools that are also gaining fast, such as remote patient monitoring (RPM), may be less expected. Perhaps the biggest growth stock of all, though, is in the non-clinical area of price transparency and related data tools.
In September, the AMA issued its Digital Health Research report, subtitled “Physicians’ Motivations and Key Requirements for Adopting Digital Health Adoption and attitudinal shifts from 2016 to 2022.” It follows up on 2016 and 2019 reports that tracked attitudes toward, and the progress of, these digital tools in medical practice.
In the survey of 1,400 physicians from various practice types and specialties, the AMA found physician use of technology tools in seven categories growing over the six-year period: Remote patient monitoring (RPM) for efficiency; remote monitoring and management for improved care; apps and devices for use by chronic disease patients; clinical decision support; patient engagement; tele-visits/virtual visits; point of care/workflow enhancement; communication and sharing of electronic clinical data; and consumer access to clinical data.
Telehealth was the big gainer, which is a direct result of the pandemic; the AMA’s previous report showed the percentage of physicians using it doubling between 2016 and 2019 to 28%, but now 80% of them do. Physician “enthusiasm” for telehealth grew from 36% to 57%.
Usage in other categories climbed at slower rates. And while physician enthusiasm also grew in other categories, it was flat for clinical decision support and ticked slightly down for point of care/workflow enhancement, patient engagement, and consumer access.
Nonetheless, AMA President Jack Resneck, Jr., M.D., finds the general upward trend encouraging.
“Even on some of the technologies where the numbers were not as high as telehealth — where we just saw a massive increase in adoption with the pandemic and with new coverage — the [overall] growth was still impressive,” Resneck says. “[It’s also impressive] when you see something like remote monitoring [for improved care] use going from 13% to 34%, and when you see not just large health systems but also small and mid-sized practices having some of the biggest increases in their use of digital health.”
RPM set to grow
Remote patient monitoring — distinguished in the survey between RPM that records simple readings, such as blood pressure, and RPM that connects providers with “chronic disease patients for daily measurement of vital signs” — is an enigmatic case. Though use is up and a substantial 53% of physicians are “enthusiastic” about it, at 30% and 34% it’s still the least-used of the seven categories. However, nearly two in five physicians say they will adopt it in the next year.
Paul Brient, chief product officer of athenahealth, thinks RPM is going “to grow and will become standard of care,” driven in part by the increase in patients with chronic disease. “Specialized devices to monitor blood sugar or blood pressure or weight are already available and can be game-changing in terms of ensuring that patients with chronic conditions are managing those conditions as effectively as possible and to intervene when needed, not when scheduled,” Brient says.
“Virtual care management, including remote physiological and therapeutic monitoring, has matured significantly in just the past four years,” says Rebecca Gwilt, co-founder of the Nixon Gwilt law firm in Washington, D.C. To Gwilt, the AMA’s data “confirm what we’ve been observing as well – The fee-for-service codes for remote monitoring are as new as 2018, so the non-institutional market for them is still in its nascency. And yet we’re already at the point where the platforms are EHR- integrated and contain detailed dashboards and customized alerts that help clinicians and their clinical staff monitor hundreds of patients at once.”
Gwilt expects to see this evolve to encompass “remote therapeutic monitoring — that is, monitoring for the kinds of ailments that can’t be neatly captured in Bluetooth-enabled devices like scales and blood pressure cuffs,” such as self-reported pain and mental health status.
Over time, Brient sees these clinical-grade RPM devices and the sub-clinical-grade wearables like Apple watches and FitBits “coming together, with the necessary AI, to enable your providers to engage virtually with you constantly and intervene when it is most helpful.”
One big issue remains privacy. By and large, Resneck says, consumer health apps aren’t covered by HIPAA, and under current regulations medical information sent to them from EHRs may be misused by third parties (PBN 3/22/21). It may be that as the technology evolves, so will standards that protect that data.
Front end tech emerges, too
While technology to treat patients remains foremost in physicians’ regard, there are also plenty of innovations in the administration of medicine, spurred by new medical models, regulations related to transparency, and the seemingly limitless reach of algorithms and information science.
Inference Health, for example, was born out of the bundled-care revolution that started with CMS demonstration models and has evolved to encompass other insurers and even private companies (PBN 5/13/19). The company uses information technology to design packages to meet patient, provider and payer requirements.
“Bundling has traditionally focused on very sophisticated health care players such as Kaiser that can negotiate with CMS or United Healthcare, for example, because these packages can be really complex,” says Daniel Wu, founder and CEO of Inference. But thanks to advances that make it possible to run complex cost numbers on demand, as well as “laws and regulations that say anyone with an NPI has to disclose in all their prices and costs in machine readable files – bundling can work for smaller practices,” Wu says. “We primarily work with ambulatory surgical centers and orthopedic surgeons.”
Another health IT company, Arrive Health, works with data held by payers to make it actionable for providers and in electronic health records (EHR), explains Adam Rosenberg, Arrive Health’s senior director of marketing. He points to the panoply of recent federal regulations related to price transparency that require sophisticated data handling, including the “beneficiary real time benefit tool” rule that CMS implemented to require Part D plans to provide patient-facing price transparency tools starting in 2023.
“Complexity in health care data has become unmanageable,” Rosenberg says. “Every patient could be on a different plan and every plan could have a variety of factors that would make it literally impossible for a provider to understand what is covered for every patient … the opportunity for solution providers like Arrive Health is huge because that complexity is only going to get worse.”
Beware untried tech
In the current wild-west medical technology environment, some products and services, even those cleared by the FDA, may come onto the market with bugs. One reason the AMA keeps close tabs on this technology, Resneck says, is to assure physicians that as the medical technology advances, both patients and physicians get products and services that work the way they’re supposed to.
Resneck notes some cautionary tales. For example, he cites Impact Pro’s risk prediction program for chronic care, which drew criticism in 2018 because “it used a health care expenditures as a proxy for health care needs,” Resneck says, which ended up short-changing Black chronic care patients because they tended to spend less money on care for reasons unrelated to care needs. On the clinical side, Resneck cites an investigation by JAMA Dermatology of a convolutional neural network (CNN) used by dermatologists that had been inadvertently trained to read a physician’s clinical markings as evidence of melanoma, meaning it over-diagnosed images in which the clinician had marked a mole for other purposes.
But Resneck is confident the industry can work out those kinks and continue to improve the health care experience.
“We spend a lot of our time talking about the concerns, but it’s important to note that physicians are really enthusiastic about adopting these technologies,” Resneck says. “In the midst of this pandemic, digital health has really been a bright spot.”
Written by Roy Edroso for Part B News.
