The digital transformation of healthcare has made significant progress and has accelerated during the COVID-19 pandemic, a pair of prominent panelists agreed at a Monday session at the 2022 convention of the Health Information Management and Systems Society (HIMSS), now underway in Orlando, Florida.
However, the “scaffolding” that was hastily erected to implement the new technologies during the pandemic needs considerable work, said Jodie Lesh, MBA, chief transformation officer of Kaiser Permanente, and John Glaser, MD, executive in residence at Harvard Medical School and a former executive of Cerner, Siemens and Partners Healthcare (now Mass General Brigham).
At issue: which new technologies are ready for prime time vs limitations and resistance to adoption. To continue the progress made thus far, Glaser said, the healthcare system must continue to move toward value-based care, and there must be incentives for health plans and healthcare providers to use the new technologies more effectively.
Kaiser, for example, is utilizing its vast fund of electronic health record data and analytics to improve what it does, Lesh said. That includes research on how to enhance Kaiser’s care model, how best to treat COVID, and how to understand the causes of health disparities. In addition, she noted, Kaiser is using its data to evaluate social determinants of health and what can be done about them.
Asked how many of the technology-related changes prompted by COVID-19 will last, Glaser said it will be a couple of years before that becomes evident. Glaser predicted that regulatory changes regarding Medicare telehealth coverage, such as allowing virtual care across state boundaries and permitting virtual visits to originate at home, will become permanent. For that and other reasons, he expects telehealth to become a more important facet of healthcare.
Lesh agreed with Glaser on telehealth, noting that about 15% of Kaiser’s primary care visits prior to the pandemic were virtual and that the percentage has risen to 40%. Kaiser is continuing to assess patient satisfaction and quality in telehealth and to track how many people have face-to-face visits after virtual encounters.
In addition, she said, “We started using remote patient monitoring in our hospitals to monitor COVID patients, because our staff was stretched thin.” In her view, “that saved a lot of lives due to early intervention. It also showed us what was possible.”
Kaiser also used telehealth to allow patients to connect with their families during the period when visitors were not permitted in its hospitals, she added.
Broader Impact Predicted
The new technologies will eventually have a broader impact on the healthcare system, Glaser said. He cited the “first order” and “second order” effects that all new technologies have. For example, when cars were invented, they replaced horses; after a while, when people realized they could live further from work, the availability of cars led to the building of suburbs.
“What’s the second order effect here?” he asked. “Is it hospital at home? A broader delivery of care at home? We’re moving from visit substitution to something different.”
Again Lesh agreed, noting that Kaiser has invested in the hospital-at-home trend. (Kaiser has bought a share of Medically Home, a hospital-at-home services company.) Hospital at home is difficult, partly because of supply chain problems, she said, but “it has a lot of promise.”
Another way in which the new digital technologies will both advance healthcare and make it more challenging is that they will “help enable a different ecosystem,” she said. “We have to support a more complex ecosystem with data coming in from many different places, helping people make choices, promoting consumer engagement and providing insights. As health IT gets more complicated, with more specialized outside applications, we have to create a new tech system in which data flows freely and delivers more insights for patients, providers and the health system.”
The panelists both cited Netflix as an example of a company that grew by adapting to new technologies and changing its business model. Netflix originally delivered DVDs by mail, Glaser noted; later, it moved to streaming and mobile phone delivery.
Digital Divide Is a Serious Issue
Moderator Casey Ross of STAT pointed out that a portion of the population has no access to digital health tools, and he asked whether these people might get left behind as the digital transformation of the industry progresses.
“Digital care does risk leaving some people behind,” Lesh responded. One reason, she said, is the digital divide: many people still lack internet access and computers or smartphones. But there are also issues of “digital literacy” and a need for tech support that healthcare organizations can help address. In addition, she said, “we need to build trust as we move to digital health. People have to learn to trust the system.”
To deal with these issues, she added, Kaiser has launched a digital equity initiative that touches on policy, systems design, patient choice, and patient involvement in systems design.
Patients’ data are being used to help companies make money, often without patients’ knowledge or consent, Ross noted. Is this something that must be addressed before digital health tools expand any further?
“It’s complicated,” said Glaser, owing to the trade-off between convenience and the right to be left alone. The debate over who owns the data is pointless, he argued, because health plans need some data to insure people, and providers need other data to treat people. He suggested that the Health Insurance Portability and Accountability Act (HIPAA) is in need of a reboot. He said that although this will be difficult for political and economic reasons, “we must find a solution that works for most people most of the time.”
The discussion turned to how doctors perceive the new digital health tools. “This is very challenging for doctors, and they’re already challenged by the pandemic,” Lesh said. “Not all of them are comfortable with the new technologies. Work is being done to reduce the burden, but it’s been tough. Some doctors love tech, some hate it.”
With so many physicians burning out, she added, healthcare organizations don’t want to make it harder for doctors. That’s why it’s so important that they be involved in the design and use of the new digital tools. Technology, after all, is only useful when it’s being used.
Ken Terry is a healthcare journalist and author. His latest book is “Physician-Led Healthcare Reform: A New Approach to Medicare for All.”
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