We are rightfully enamored with disruptive innovation. Smartphones, Uber, Twitter, Facebook, Expedia, Amazon, et al. have made our lives easier, more convenient, and often less expensive. So why haven’t we seen digital technology truly disrupt health care? If ever there was an industry that needed to become more efficient, safer, convenient and cheaper – it’s health care.
The answer lies in many familiar facets of health care – the complexity of the system, its perverse payment incentives, its inelastic demand, powerful incumbents and regulatory barriers.
We have achieved small successes around the edges as employers, insurers and private investors bet on tools such as online appointment scheduling, telemedicine, price transparency tools, clinical decision support, predictive modeling and more. Similarly, consumers are adopting wearables, accessing health information websites, and joining online patient support groups – all while demanding convenience and transparency. However, we have yet to experience real transformational change.
It is a challenge that defies simple answers, but here are a few thoughts on how disruptive digital technologies could become the catalyst.
- Focus on the Provider
It’s appealing to think consumers will drive change as they experience higher deductibles and desire more convenience. After all, it is consumers that have spurred the growth of other disruptive technologies in our economy. But the complexity of health care makes it different. It will be the integration of digital tools into provider practices and health systems that will lay the foundation for change.
When patients have a digital experience with their provider – whether through email conversations, online scheduling, e-prescribing, the option for a telemedicine visit, check-ins and insurance checks by kiosk, a suite of patient and caregiver engagement tools, real-time transparent information about treatment options (and their value), remote monitoring for chronically ill patients, follow up care after a hospital visit, and proactive outreach based on predictive modeling that identified a necessary intervention – then the old way of doing business will no longer be acceptable.
In a recent by the American Medical Association, 85% of physicians said they see the potential for digital tools to improve patient care. A majority of those surveyed felt that digital tools could improve efficiency, diagnostic ability, patient adherence, patient convenience and more. The part of the survey that measured enthusiasm for particular tools shed light on how physicians view them. On the enthusiasm meter, remote monitoring scored 45%, telehealth 36%, clinical decision support 45%, patient engagement 49%, point of care/workflow 49%, and consumer access to own data 53%. All but one have less than half of physicians reporting enthusiasm.
- Fit within the Existing System…Initially
Ironically, tools developed to disrupt the inefficient parts of healthcare have to fit into existing workflows or they won’t be adopted.
Our payment system has created a way of doing business that is starting to change, but the legacy of fee-for-service will endure for some time. Practices are set up to see patients in 15-minute increments with services ordered and recorded during the visit.
Today, the electronic health record (EHR) is a dominant part of that visit; according to one study in the Annals of Internal Medicine, physicians spend double the time on EHR and desk work than they do on patient care. Providers, like the rest of us, are busy. They need tools that fit into their natural way of working. The AMA study mentioned above showed that more than 70% of doctors want tools integrated into their EHR, and they don’t want any special training.
- Focus on Changes to Medicare
It is not sexy, and investors may shy away from Medicare because of its complexity and regulatory risk, but Medicare’s new payment models and performance requirements feature significant disruption opportunities.
New legislation and regulation are creating avenues for success for the digital health entrepreneur who has the patience to delve into the various ways that new regulations will push providers do business differently.
Health care is harder to change than many other sectors given the outsized influence of government regulation and payment, but providers are the link across commercial insurers, large employer plans and public programs. If they can successfully work digital tools into their workflow, we will be a lot closer to real transformation.