Whereas the bigger networks and health systems may have the resources for mHealth adoption, those in a much smaller environment have to make do with less — or be more creative.
To try to understand how independent and small practice doctors might be approaching mHealth, mHealthIntelligence.com spoke with four physicians in very different settings. The advice they offer makes it clear that success – and failure, for that matter – isn’t the same for everyone.
While survey after survey indicates consumers want their doctors to make more use of mHealth, those same doctors aren’t seeing the value in the new technology.
Source: The Council of Accountable Physician Practices
One of the latest research organizations to cite this is The Council of Accountable Physician Practices. Drawing upon a Nielsen Strategic Health Perspectives survey released last November, the group notes that while roughly 40 percent of physicians feel that telemedicine is good for both patients and the healthcare industry, between 19 percent and 31 percent say it’s not worth the effort.
Tom Giannulli, MD, MS, is a California-based practicing physician and a well-known mHealth advocate, having helped create the first iPhone-based EHR with Caretools. He then became the chief information officer for Epocrates, and is now the chief medical information officer for Kareo, an EHR developer for small physician practices.
Giannulli says today’s healthcare landscape is geared more toward the large practices and health systems, who are under the gun to move from fee-for-service to value-based payment models like ACOs and patient-centered medical homes. The incentives aren’t there, he says, for smaller practices and solo doctors to change their workflows and their habits.
“It’s going to take about five years for that to happen,” he says.
But there is pressure — from the consumer market, where wearables are rampant and a busy businessman or stay-at-home parent would just as soon visit a retail clinic or a virtual visit as trek to the doctor’s office.
That’s why Giannulli says doctors should start now with mHealth, and start slowly. Adopt or launch a messaging app that lets you communicate with your patients when and where they want, or open a patient portal for quick and easy access to their medical records. Integrate that with a scheduling system that enables patients to make their appointments online. Get comfortable with tablet and smartphone-based platforms.
The biggest mistake a newly mHealth-enables doctor makes? To Giannulli, it’s data dumps that don’t affect clinical outcomes. Forget collecting all that data from wearables and other devices if you don’t have the means of sorting it out and finding what you need.
But don’t ignore the trend.
“There are a lot of products out there that aren’t fully baked,” he says. “But eventually they’ll get (more sophisticated). It may be wellness we’re talking about now, but soon they’ll have more sensor data, and you’ll start seeing (data) you’ll care about.”
Likewise, Giannulli says payment models are slowly coming around to the idea of care management, rather than crisis management, “all based on the idea of doing the right thing at the right time.” That doesn’t mean calling a patient every half-hour to check up, but it does mean finding the means to keep tabs on patients in between their visits.
“Continuous care relies on mHealth,” he says.
Ali Sadrieh, DPM, is all about apps — and not the complicated apps developed by healthcare titans who charge thousands of dollars for a license to use it. There are plenty of free apps and simple platforms out there, he says, than can make a doctor’s life easier.
Sadrieh is a UCLA-trained aesthetic foot surgeon with a practice in Beverly Hills and a 15-year career as a small-practice doctor. He launched his Evofoot practice on the Apple iPad platform, incorporating drchrono’s EHR, and feels the doctor of the future will make full use of the consumer-facing online app network — because that’s where the consumers are.
“There is no barrier for entry,” he says. “Paying license fees is the wrong way of doing things. There’s plenty out there that you can download and try out. And I can pretty much say I’m one of the doctors that has tested all of them.”
Sadrieh’s philosophy hews more to the idea that every doctor is an independent businessman, and the online app stores are his or her workshop. He started with mock patients and simple user interfaces, and gradually built a platform that fit his needs. “Intrinsically, a doctor will understand what is comfortable and what isn’t,” he says.
His advice? Stay away from the so-called “big box stores” that focus on the business of healthcare rather than the concept of caring for people – “because they’re driven from the wrong end; they’re driven (by) bureaucratic development and filling too many shoes.” Also, avoid the so-called platform-agnostic apps, “because a thing that does everything does not do one thing well.”
Sadrieh says the healthcare industry’s dissatisfaction with EHRs may be the best thing to happen to the mHealth movement – eventually. Instead of investing thousands of dollars in platforms that are more complicated and less productive, doctors are pulling out their own iPhones or tablets and looking for the smaller, more nimble tools, developed by start-ups, that they can adapt and use.
“There’s many of me out there,” he says. “We all use iPads and iPhones. We’re empowered as doctors to build our own workflows, and … we’re better doctors because of it.”
Some doctors know just what they want from mHealth. For William C. “Chuck” Thornbury, MD, it’s the four-minute interaction.
Thornbury, whose impressive healthcare career includes education at Kentucky, Louisville and Harvard and a five-year stint in Virginia’s rugged Appalachian region, settled down in Glasgow, Ky., roughly two decades to run the Medical Associates Clinic in Glasgow, Ky.
As a family practice doctor, his goal was to offer convenience and access to families who often have neither, so he developed his own virtual visit app. Called Me-Visit, it’s a gateway to his office that enables patients to get the care management they need and gives him the “touches” he needs to make sure his patients aren’t sliding down the slippery path toward a serious medical condition.
This platform, Thornbury says, targets the “cough and cold” crowd (roughly 40 percent of a clinic’s foot traffic) without tying up a doctor’s time or resources – which can be better spent on the chronic care population, where most of the nation’s money is spent and clinical outcomes are delivered. “You need to get chronic disease care online, which is where the money is,” he says.
It’s all a matter of simplicity.
“A lot of the technology out there is just noise,” says Thornbury, and doctors are tied in knots trying to make sense of it. “They need to understand the value proposition for them and their patients.”
Thornbury, noting that healthcare stands alongside the nuclear industry as the two most heavily regulated industries, says today’s solo or small practice doctor is handcuffed. “All of their intellectual capital is invested in trying to conform to … mandates,” he says, referring to ICD-10, meaningful use and EHR implementation, the latter of which he feels reduces the average’s doctor’s efficiency by some 20 percent.
The idea is to invest time and effort only in platforms that improve efficiency and don’t add to the bottom line. During a HIMSS presentation three years ago highlighting his then-new app, Thornbury noted almost 90 percent of his patients use smartphones, and almost 30 percent use them to access information instead of communicating with a doctor. So a simple virtual visit app was, in essence, an easy sell.
One of the recurring debates in healthcare revolves around the role of the doctor in health and wellness. Some believe the doctor should focus solely on doing what he or she was taught to do – provide healthcare when needed, and leave the health coaching and wellness to others, either in the office or elsewhere. Others feel the doctor should take a more active – even proactive – role in a patient’s health management.
That was goal of Steve Willey, MD, when he launched the YouPlus Health mobile coaching platform. After 10 years of practicing internal medicine through a local hospital, the St. Louis-based Stanford graduate restructured his practice to offer concierge medicine.
In doing so, his idea of personalized care evolved to include fitness and nutrition guidance, creating a preventive medicine and lifestyle platform that focuses on care management.
“In my 20 years [of practicing medicine] I’ve seen too many things happen that never should have happened,” he says.
Willey’s focus is on patient engagement, a popular and somewhat enigmatic concept in today’s healthcare ecosystem. He wants to engage his patients in conversations before they actually need a doctor, giving them access to information and guidance that help frame their lifestyle.
“Getting people to understand they need to make changes in their lifestyle (to live healthier lives) is the easy part,” he says. “The hardest part is getting them to actually do it. Obviously, what we’re doing now isn’t working.”
Where some might see a pain point for solo or small-practice doctors, Willey sees a niche. His goal with YouPlus Health is to collate and deliver reliable information to his patients and to be their coach. If they’re collecting all this data about themselves, he wants to be the one to pull value from it and make it useful to them.
“That data needs to be put into context,” he says. “What does it mean to you? What do you want to do with it?” A doctor who can answer those questions stands to be more effective than any website or self-improvement app on the market.
This article was originally published on January 26, 2016.