How to make health IT help--not hurt--clinical practice, doc satisfaction

Healthcare is a fun and rewarding field, says Steven Steinhubl, M.D., director of the Digital Medicine program at the Scripps Translational Science Institute (STSI). But with pressure to see more and more patients in a fee-for service world and an abundance of new technologies that can improve care but also disrupt workflow, doctors don't always feel that way.

"It's understandable but I find it very depressing," he told FierceHealthIT in an exclusive interview at the STSI offices in La Jolla, Calif.

"It's just one symptom of a broken healthcare system. We definitely have the tools to fix it but we have to figure out exactly how. And the healthcare system is so recalcitrant to change that we have to supply the evidence that will help move that."

To that end, STSI's research projects examine the clinical and financial benefits of mHealth.

"There are so many unmet needs and so many ways you can do things better. There are just incredible opportunities. We try to design trials that will convince patients, providers and payers that this is the right way to do it," says Steinhubl, who will be speaking at FierceHealthIT's live panel discussion on mHealth's role in patient engagement at the mHealth Summit in Washington, D.C. next month.

So how to create time for digital medicine when reimbursement rewards productivity, seeing patients and performing procedures and keep clinicians satisfied at the same time?

On the face of it, Steinhubl's ideas hardly sound revolutionary. Give docs more time to practice high-level medicine. Use technology to intervene before patients end up in the emergency room or urgent care center. Use data analytics to improve care across systems.

And yet: "It's changing the way we think about medicine," he says.

Give docs time to learn new systems

When doctors complain about technology, they're often talking about electronic health records, Steinhubl notes. EHRs are difficult to implement, even though everybody feels it's the right thing to do, he says.

Doctors "don't feel like they have the time to do what they went into medicine to do as it is," he says, such as spending face-to-face time with patients rather than typing notes into a medical records system they're not used to.

"And we don't say 'To make it easier for you, we're going to decrease your schedule so that you have an extra 15 minutes every two hours,'" he says. "For physicians to embrace digital technology, it can't be one little thing and another little thing added to their day. We have to completely restructure their day."

And here's a radical idea: Free up doctors from worrying about capturing billing data or maintaining productivity while they're learning new systems.

Focus on patient care

In an ideal world, the focus would be on what's best for patients rather than productivity, billing and paperwork.

"Let's develop a system for diabetic and hypertension patients, for example, or arthritis patients or depression patients," Steinhubl says. "Do they really need to come in every three months just to see how they're doing? Honestly, they may be feeling fine in three months but not feeling well at one month, but not bad enough to do a walk-in appointment. How do we monitor them in real time? Why can't they just check their own blood pressure at home and send us the information?"

Fix the financial incentives

"Most doctors would say 'Well, I don't get paid for that. I get paid if they come back in and we measure it.' All of the fixing will require fixing the financial incentives. We have to be financially incentivized to take care of patients the best we can as opposed to now, where it's quality versus quantity."

Like it or not, healthcare is a business. And sometimes the best patient care is at odds with the bottom line.

"The best way to be successful in business for a doctor is to care the least about your patients. Just move them in and out. Talking to a patient takes 10 times longer than just sending them down the hallway to get a stress test or an echo or a heart catheterization and you get paid a whole lot more for that," Steinhubl says.

Let docs practice medicine

"We need to get to a clinic where physicians are diagnosticians and educators--less, if at all, taking care of precision and algorithmic medicine, things you can measure exactly such as blood pressure. You don't need to go to medical school--I don't think you even need to go to college--to manage hypertension."

The medical home model shows promise for enabling a new, more streamlined clinical setting where docs spend more time practicing medicine and less time worrying about billing and paperwork. It's better for patients and more satisfying for docs, Steinhubl says.

Passive remote monitoring and real-time data that is fed directly into the health record complete the picture.

Share the data

And then there's the real sticking point: Gathering and analyzing data across systems and using it to improve patient care.

One of the benefits of digital medicine is that you can create a system that's continually learning, Steinhubl says. So Scripps can get a good medical history for every hypertension patient who comes into the system, track what medicines they take and how they responded to those medications to improve care.

Now imagine if San Diego-based Sharp HealthCare and Oakland-based Kaiser Permanente joined in, and all three organizations collected and shared data from every patient they treat for chronic diseases.

"It wouldn't take very long to get a whole lot better and take better care of patients," he says.

"We could track in passive method, the data streams in, and we have a strong analytic capability. Maybe on the first couple hundred patients you would just track that and you'd see how they're doing. But for each patient the data analytics would learn a little bit more, it would be better refined ... If there's a system that can really collect the data and individualize it and we will keep making our medical care better and better over months and years."

Editor's note: Heading to Washington, D.C. for the annual mHealth summit? Join FierceHealthIT for an exclusive breakfast panel, mHealth's Role in Patient Engagement on December 10. Our panel of experts includes Steinhubl and David Levin, M.D., CMIO of the Cleveland Clinic Health System. Register for the event here.  

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