In previous posts I have discussed imperatives of patient-centric healthcare, creating patient engagement, and potential value of various digital health technologies. Apart from these considerations are those involving roles of stakeholders and barriers they face in adopting technologies and optimal models of adoption. Not lost in the technical, regulatory, and clinical issues required to be addressed are business models which need to be created for this nascent industry. Significant strides have been made in all these areas. However, the farm to table process of digital health technology is not as easily achievable as its culinary counterpart. According to a recent survey, hospitals are either behind their schedule for adoption of a digital health strategy or lack one entirely. I would like to discuss essential elements of a successful enterprise which develops, purchases, and executes adoption in administrative and clinical best practice approaches.
- C-suite buy-in. The commitment to the development and adoption of a comprehensive digital health (including mobile) strategy must start with a vision and endorsement emanating from the highest level of administration. An assessment of ‘Ten Challenges and Opportunities for Hospitals in 2015’ by Becker’s Hospital Review cited population health, shifting volume to value-based payment, regulatory demands, demonstrating the value of M & A to consumers, and physician workforce issues as major concerns. I find it interesting how digital health technologies can be critical tools of solutions to all of these. Only with support from the C-Suite can an undertaking as far-reaching as digital health find success. The commitment of resources (see below) is dependent upon this support.
- Commitment of resources. There is no question that technology-enabled care has the potential to improve healthcare. However, the ability to deliver on promises of improved outcomes has been demonstrated by only a few products, some of which have deservedly been met with commercial success. Proving efficacy and safety is the cornerstone to adoption. Those who recognize the importance of participating as pioneer investigators in technologies which can address their own clinical needs (even at the expense of no immediate financial or other ROI) will benefit from the experience. Claiming population health is a priority (as most enterprises do today) or stating “We have a digital strategy” is not enough. Defining specific goals and committing resources (human, financial, and material) are necessary. All politics is local and the path to digital strategy success will differ from place to place. Some enterprises do not have the resources to undertake such commitment. Those who have the resources can either serve as blueprints for others or potentially commercialize/outsource them.
- Interdisciplinary team participation. Digital health technology must not be approached as a separate silo with regards to strategy or resources. It must become integrated into the enterprise’s overall strategy and function, developed with an interdisciplinary team. If better satisfaction (patient and provider) and care are to be realized, input from all stakeholders at all stages is necessary. IT personnel, clinician (students, clinicians in training, physicians, nurses, and others) champions, basic researchers, behaviorists, mental health professionals, engineers, patient advocates, organizations like HIMSS, and community leaders all can contribute to produce a far-reaching successful strategy. Approached in this manner, the benefits of this teamwork affect bench to bedside medicine, patient population strategies, aging at home initiatives, mental health and other mobile health needs, and ultimately the success of the enterprise itself.
- Clinician input. There is a necessary differentiation between the introduction and adoption of technology in healthcare which has to consider clinician input. UCSF has just received a grant from the NIH for an impressive long-term cardiac mobile health study. Projects like this will foster support from healthcare providers because they reflect evidence-based medicine. Clinicians are necessary because they are advocates for providers as well as patients. Nurses are the most trusted people in healthcare. As the interactive time between clinicians and patients decreases, tools which identify patients at risk, improve communication, increase patient self-management and decision-making, and potentially lead to improved patient safety and outcomes are indisputably desirable. Only with clinician input will strategies thrive. As long as the adoption of these tools is not mandated and designed well, the chances for success increase.
- As healthcare enterprises tackle issues like population health management and outcomes-based payments they should partner with both private business and public sectors. These partnerships arise out of shared objectives, complimentary resources, and a sense of community. Digital health initiatives have resulted in Partners Healthcare, Stanford Health Care and others partnering with public and private entities. The partnership of Apple, Mayo Clinic, and Epic EHR highlighted the consumer as patient concept. Partnerships with technology developers allows for the enterprise to potentially function as an incubator for tools deemed useful to it but requiring support. Ultimately an entity which can even commercialize these technologies can be established, becoming a revenue center. Examples of such a model include Montefiore Health System and Cleveland Clinic.
There remain substantial barriers to the achievement of digital strategies achieving positive patient outcomes and other laudable goals. They are not insurmountable. Basic issues such as privacy issues need to be addressed. A recent study demonstrating privacy risks of accredited health and wellness apps in the UK is an eye opener. For this reason the development of some digital health tools by healthcare enterprises themselves is attractive. Greater accountability in the development process in the context of an overall IT privacy and security framework is desirable. In addition, technologies developed (and/or vetted by a dedicated multidisciplinary team) will better address the specific needs of the institution. Most barriers exist as a result of lack of administrative commitment and defined strategy. I look forward to changes occurring because of increasing pressures to all stakeholders.