Why Doctors Are Frustrated With Digital Healthcare
A large-scale survey of U.S. doctors conducted by Decision Resources Group tells us that doctors are using digital tools and willing to receive data feeds from their customers, but they are quite frustrated by poor usability of digital healthcare tools and difficulty getting measurable results[1].
The “meaningful use” incentives created by the ACA have caused most doctors to use electronic health records (EHRs). And, doctors are aware of the large amount of clinically relevant data that digital wearable devices can produce, and they are increasingly willing to engage with it, notwithstanding concerns about liability and accuracy. Doctors are using many other digital health resources too; they are not captive to EHRs. For example, primary care providers routinely use is RubiconMD (a start-up company) to obtain digital on-line specialist consults that are faster and less expensive. The meme “we will be rewarded for value, not volume” has become strong among doctors, causing them to rethink how they practice and try new tools to deliver better value.
A provider using a new system that allows doctors and nurses to access patient information on wireless laptop computers at bedside. (Photo by Joe Raedle/Getty Images)
But, doctors are frustrated because they do not see the digital health tools delivering value, in many cases:
• EHRs are typically hard to use. Many doctors I know complain of spending several extra hours each day entering data to EHRs. In some practices medical scribes have been added to help with data entry. As Bob Wachter of UCSF put it[2], “The fastest growing specialty in healthcare is scribes to feed the EHR: only in healthcare can we computerize and add FTEs.”
• EHRs are often local, island systems that do not provide access to other clinical resources, so doctors need to use multiple systems.
• Patient portals are often a dismal experience. HIPAA has motivated administrators to mandate defensive designs that are often so inconvenient for patients that they are seldom used, which I suppose makes them highly secure. For example, my doctor’s portal recently sent me an email informing me of an “important message” accessible only on the portal. I go to my computer, navigate to the portal, and dig out my log-in information, only to discover that the message is an appointment reminder. It’s a stretch to call that confidential clinical data requiring secure communications. And next time I receive an alert for an “important message” I’m likely to move on down my email stack, guessing it is trivial. Most consumer Internet designers will tell you this is “brain dead”. Portal designs like this one are not delivering on the promise of digital medicine: engaging patients more deeply in their care and fostering better communication between doctors and their customers.
• Doctors feel they have tons of data available to them, but few tools to use it to make intelligent and timely decisions.
• Digital health tracking is finding success in the medical world with focused populations of chronically ill people who have high risk of complications and high costs of care: diabetes, congestive heart failure, and similar[3].
• How to use digital health technology to help people who do not care for themselves but do not yet show symptoms of chronic disease is a huge unsolved problem. Consumers are interested, but want measurable impact, not just data. They want to control their data, know who is looking at it, and decide who should see. And, they want a tangible and immediate benefit or reward for behavior that cultivates health.
The last point above is the visible tip of an iceberg-sized social conundrum. The natural reward for healthy behavior is good health, of course, and what matters more than that? If adult individuals don’t care enough about their health to work on it, who is supposed to care on their behalf? Employers care up to a point, because health impacts productivity. The government cares, if you assume that the government is the unlimited payer of last resort. How much employers/government should do to change behavior of adults who won’t take responsibility for their health is an issue that we will wrestle with for a long time.
Digital technology offers a river of new data with potential clinical value, but much of it is not usable. Doctors say that 85% of their patients simply do not comply with medical advice. Patients are increasingly cranky: they know more, demand more transparency, and are less satisfied. Expectations of doctors’ ability to deliver value are rising. Rising doctor frustration makes sense to me.
However, digital health is creating value for people with some chronic conditions already, and entrepreneurs are using the lessons learned in consumer Internet and mobile applications to influence health behavior. EHRs are not polished or open systems, but the data is in electronic form at last. It’s probably the work of a generation to deliver the value of digital health, and that work has begun.
— — — — — — — — — — —
Disclosure: NAV.VC, in which I am a partner, is a venture capital fund. It has no financial interest in any of the companies mentioned in this post, however, it does invest in similar companies.
Notes:
[1] The data in this post regarding doctor’s use of digital health tools and systems is derived from an interview with Monique Levy of Decision Resources Group, unless otherwise indicated.
[2] From Dr. Robert Wachter’s remarks at the 2015 World Healthcare Congress.
[3] From Dr. Joseph Kvedar’s remarks at the 2015 World Healthcare Congress.
I’m an investor with New Atlantic Ventures, where I help launch early-stage companies that have new technologies and new takes on how to win in business. I’m inspired every time entrepreneurs prove there’s a better way to solve big problems, make life better or disrupt comfy clubs. I’m skeptical, however, when start-ups get too trendy or raise too much money before the business is proven. Before becoming an investor, I had a great run building Boston Consulting Group’s Technology, Media, and Telecommunications Practice. Away from work, I ski, mess around in boats, spoil my grandchildren, and tinker with digital toys.
The author is a Forbes contributor. The opinions expressed are those of the writer.
Originally published at www.forbes.com on May 28, 2015.