The next wave of patient-centered health IT

Healthcare is moving past its earlier struggles with electronic health records (EHRs) and is now focused on how to leverage the next generation of healthcare IT to improve patient care and adherence.

The influx of these new technologies ranges from “smart” EHR systems that harness analytics to offer decision support tools, to apps that help patients better manage their day-to-day medical needs, to secure messaging that allows real-time physician collaboration from anywhere. 

The aim of these new high-tech tools, according to health IT experts, is to help physicians provide better care, work more efficiently and lower costs. “The most effective practices are those that engage with technology,” says Halee Fischer-Wright, MD, president and chief executive officer of the Medical Group Management Association.

However, barriers remain to adopting  these emerging technologies-among them, cost and the challenges of training staff to use them and integrating them into practice workflows. 

Opportunities on the horizon

Fischer-Wright, a former practicing primary care physician, acknowledges that much of the health IT put in place in the past decade hasn’t delivered significant clinical benefits. 

“Technology came in with a lot of promises that didn’t deliver,” she says, pointing to EHRs, with their roots in documentation and billing. “They weren’t engineered to be physician- or patient-friendly.”

As a result, many patients haven’t been enthusiastic users of health IT devices intended to help them take more ownership of their health. She notes, for instance, that studies show most patients can access their medical records via portals, yet only a small fraction actually do so, with fewer still scheduling appointments via a portal. 

However, Fischer-Wright believes the healthcare industry is at the start of a shift, with new technologies, designed to help patients better engage in their own healthcare, becoming available or under development. Vendors are listening to physician and patient demands for more intuitive, user-friendly tools, and they’re borrowing lessons from consumer tech companies-like Apple-who have mastered how to design easy-to-use technology.

“There are opportunities on the horizon,” says Peter Basch, MD, MACP, an internist and senior director for IT quality and safety, research and national health IT policy at MedStar Health, a nonprofit community-based healthcare system serving the Baltimore-Washington, D.C. area.

Basch, who also serves on the American College of Physicians’ Medical Practice and Quality Committee, says physicians welcome these tools because they can expand care into patients’ daily lives.

“We provide the best care we can during that visit, but we know statistically that only a percentage of our patients remember everything we say, whether it’s to adhere to a medicine regimen or a new diet,” he says. “So understanding there are technologies that are available, that can help patients care for themselves, I think it can be seen as something that’s helpful rather than one more thing to do.”

Tech available, and on the way 

Some of the available technologies supporting better patient care and adherence also help to connect patients with their physicians by enabling the patient to share data with clinicians. These include:

• apps that electronically organize a patient’s medication regimen with reminders of what to take when, along with explanations of what each one treats, its side effects and other such information;

• smart pillboxes, which use sensors and corresponding mobile apps to track whether and when patients take their medicines and to offer reminders (similar technologies exist for injectable drugs);

• and connected medical devices, such as glucose monitors and electronic scales, that can automatically send results to smartphones as well as organize and track the readings.

And more tech-based devices are on the way. One example is iSageRx, a mobile app   for the automated titration of basal insulin. The app, released in May from a new digital health company called Amalgram, lets physicians use algorithms for dosing support and gives patients behavioral, clinical and educational support so they stay on track with their insulin.

Large healthcare organizations also are  finding roles for technologies in patient care. For example, Beth Israel Deaconess Medical Center (BIDMC) in Boston is working on apps for intelligent personal assistants, such as Amazon’s Alexa and Google Home.

BIDMC has pilot programs in inpatient settings to determine how well the systems can respond to patient questions such as “What can I eat?” and “What’s my care plan today?”

And Boston’s Brigham and Women’s Hospital is studying how remote patient monitoring technology can be used to treat patients at home instead of in the hospital. 

Some patients diagnosed in the hospital’s emergency department with certain conditions, such as heart failure or pneumonia, receive high-tech monitoring equipment, including a biosensor that continuously streams patient vital signs for computer analysis. 

“At a high level, providers are interested in leveraging technologies to engage patients differently [than they could previously],” says Blain Newton, executive vice president of HIMSS Analytics, a healthcare IT research and standards organization affiliated with the Health Information and Management Systems Society.

Clinical & business returns

As healthcare moves further toward value-based reimbursement models, experts say using these technologies could have even greater potential to deliver both clinical and business returns. 

For example, the federal government will use its Merit-based Incentive Payment System (MIPS) to evaluate physicians based on quality measures and then provide financial bonuses or penalties in Medicare payments based on that score. The goal is to provide greater incentives to use technologies that help engage more in patients’ health outside the doctor office walls. 

A 2016 Kaiser Permanente study concluded that member patients who had online access to their health information were more likely to participate in preventive measures, such as mammograms, diabetes screening and Pap smears than members not registered to use the online Patient Action Plan (oPAP), its web-based system that provides access to  personalized health information and emails members with preventive care reminders.

In the meantime, physicians also can use technologies that help them reach out to patients, says Laurance Stuntz, director of the Massachusetts eHealth Institute at MassTech, a division of the Massachusetts Technology Collaborative.

One class of technologies uses analytics to help physicians identify patients that are due for checkups or tests and reminds those patients to schedule visits, he says. 

Another group of applications helps  practices run more efficiently. Stuntz cites the example of QueueDr, a system that works with EHRs to fill appointment cancellations either with patients waiting to schedule appointments or patients who can be moved up from appointments scheduled for later.

Intelligent solutions 

Fischer-Wright says physicians can anticipate a new generation of technologies that use artificial intelligence (AI) embedded in or added on to EHRs and other office-based software programs to help with various healthcare issues, from improving patient adherence to increasing patient satisfaction.

She says there are AI applications that could handle patient calls coming into the practice, using algorithms to direct them to the right people at the right time-for example, routing a caller with a question to a nurse on duty while sending a sick patient who needs to move up his or her appointment to the patient intake desk.

Other AI programs could integrate and analyze information to develop treatment regimens for patients based on each patient’s unique health background, conditions and requirements. Such a program could, for example, identify windows of time to administer specific medicines to ensure the best outcome.

“These systems will use AI to make sure that complex medical problems are handled properly and there are no conflicts in schedules,” she says.

Although health IT leaders expect AI and advances in software useability to strengthen the patient-provider connection, physicians can and should explore the applications available now. These applications can help physicians help patients better manage their conditions, and adhere to treatments. 

Such technologies are in line with the shift to value-based care, says Fischer-Wright. “What we’re really seeing now, is technology that helps patients and providers engage in ways they didn’t before,” she says.