In the context of the HIMSS conference, which will take place from 19th to 23rd February 2017 in Orlando, Health & Tech has asked American health experts for their views on digital health in the US.
Dr. Nwando Olayiwola, director of the Center for Excellence in Primary Care at the University of California, shares her insight on digital health in primary care in the US.
What is the current role of digital health in primary care in the United States?
Digital health has historically been thought of as a tool to fix a problem. Digital health is now becoming part of a strategy, to provide more connection and allow patients to be in a preferred location. It’s been used to improve care to patients and improve connections while maintaining privacy and comfort for patients as they are receiving care. It has been extremely helpful in creating and connecting the larger medical neighborhood.
How can digital health improve primary care delivery in the United States?
For digital health to really improve how we do care, it needs to be part of what we do not a separate add on thing. We tend to focus on how a singular action will influence, so digital health should be part of care not just digital healthcare. People can have choices with digital opportunities or not as they choose, but there needs to be reimbursement strategies and schemes around this. This is where the short all is, recognition of change needed for digital care.
Do you think other organizations should create a Chief Clinical Transformation Officer role?
Most of my experience has been around bringing technology into primary care delivery and connecting and integrating this to the workflow. Thinking about how to create technology that meets the needs of physicians. Clinical transformation officers look at providing medical expertise on transforming care delivery with technology. It combines technology and delivery and how to use the technology to transform the care. I think this would be most beneficial in the digital health scene, to have someone thinking about the technology and medicine, and workflow.
What digital health innovations do you think would be most beneficial to primary care physician needs?
The electronic consultation. Shifting the paradigm from access to specialist visits to specialist expertise. This can create less expense in the medical neighborhood and can make a more meaningful experience for patient visits. The primary care physician would consult with the specialist with all the information and the specialist can review the patient file and advise the primary care physician on next steps of care for the patient. The electronic consultation can streamline the process of patients going to see the specialists, allowing those patients that really need the visits to get them and freeing up the schedule of the specialist. Insurance companies don’t necessarily pay for this consultation, so the primary care office is paying for the consultation. Reimbursement strategies are being developed in some places, currently primary care doctors do get some grants for $20-40 per consult. California is trying to make it a telemedicine visit or like Radiology interpretation billing models.
Where do you see primary care and digital health in 5 years?
Patients will be demanding digital health in 5 years, it’s exciting right now because physicians have been committed to the initiatives. Once patients start demanding the digital interaction it’ll change the expectation for care. Patients will not be sitting in waiting rooms in 5 years, the visits will be more judiciously managed in general. Technology will be used to manage the care more effectively from home. Giving care where people want it, in a timeline they want it in, and a more thoughtful expression of what is meaningful care to patients. The care will not be replaced with technology.
How can digital health create a more patient centered experience in primary care?
Digital health if used and set up correctly, it’s highly patient centered. Digital health can allow patients to move from a place of having to largely go somewhere to be able to be where they are when they need care. They can upload information and use an app to communicate with their doctor and get a quicker response. Meeting people where they are in their real lives and their challenges, providing more patient centered care through technology.
What are your views on the quadruple aim?
In 2008, the triple aim was developed and introduced to improve quality of healthcare and meeting population health. This was also focusing on the health care experience of patients, which is great. Primary care physicians were having a hard time meeting these tasks, the workforce needed to be focused on. The quadruple aim is focusing on the experience of those providing the care in addition to the triple aim, which is really important.
The role of digital health in the 4th arm of the quadruple aim. For primary care physicians, they are very busy and work very hard. There’s a lot of information that physicians are responsible for storing and organizing, and the patient medical home movement makes more information that the primary care physician is responsible for. If you give the physician the ability to get the information together and create a care plan they can create a good plan for patient care with confidence. This can create a great source of power and confidence for evidence based care using digital health and bringing the system out fragmentation.
Streamlining and improving the practice experience is one way to take care of primary care physicians. Creating care teams can help minimize the administrative tasks of primary care physicians. Allowing primary care providers to function at the top of their license, the enormous amount of administrative work has created a situation where physicians burnout. Give physicians more time to do what they are trained to do will decrease burnout.
Primary care physicians have a difficult job because they are the custodian of patient information and by necessity do a lot of administrative tasks with that information. Primary care physicians see patients and help them manage their medical conditions in addition to coordinating all the patient records from the specialists visits, and coordinating that care. These physicians can use digital health to improve their practice experience.