Dr. Donald Casey, president, American College of Medical Quality, highlights the most thought-provoking insights from the Clinical Executive Summit at Liberation 2019.

By Donald E. Casey Jr. MD, MPH, MBA, FACP, FAHA, FAAPL, DFACMQ, President, American College of Medical Quality (ACMQ)

In October 2019, I had the privilege to moderate the Clinical Executive Summit at Liberation 2019, where an incredible team of clinically focused thought leaders contributed their knowledge and expertise on the topic of digital health innovations. This session discussed the impact that these cutting-edge technologies have today—and could have in the future—on the quality of care, especially regarding the improvement of clinical health outcomes. Here are some thought-provoking insights from these clinical experts, who gathered to discuss the evolving intersection of medicine and technology.

What Is Digital Health?

New market forces are rapidly creating a burning platform for disruptive and breakthrough innovations in healthcare delivery, especially in the digital health arena. However, there is currently no clear consensus on a standard definition of digital health, especially when this term is used differently across many contexts—encompassing wearable devices, electronic health records, implanted biometric sensing devices, artificial intelligence or the ubiquitous “the internet of things” (IoT). In fact, in January of this year, thousands of healthcare executives gathered for the annual J.P. Morgan Healthcare Conference in San Francisco to discuss the future of the industry. Many attendees expressed confusion over “digital health” and suggested that the lack of a clear definition could actually be hurting the industry.

We need to better understand the distinctions between the specific wants and needs of patients, providers and payers when it comes to deploying digital health strategies. Consumers seek easy access to their own medical records, direct communication with their care team and easy-to-use devices to help monitor their health status, including factors such as weight, blood pressure, sleep patterns and diet. For the healthcare team, there’s also a critical need to motivate healthy behaviors, promote medication adherence and encourage the appropriate use of health services that engage individual patients. In the era of value-based care, providers and payers are now collecting routine health indicator “big data” and discovering new clinical management insights at the population level through sophisticated “advanced analytics.”

Identifying Real-World Potential

Our team of clinical and technology experts also explored the potential of digital interventions by discussing a recent formal literature review in the Journal of Hypertension, which assessed 5,606 papers and found only eight meaningful studies using seven interventions meeting criteria designed to promote self-management in patients with high blood pressure. This included preventive e-counseling (advice via the web or email) designed to modify exercise or diet as a means of improving blood pressure control. The results showed that digital interventions had greater effect on lowering blood pressure if they were long-term (more than 6 months in duration) and enabled five or more behavior change methods. So, long-term and multi-modal, high touch, evidence-based strategies are clearly key when it comes to driving meaningful behavior change to improve blood pressure control.

Remote Monitoring in Digital Health

Steven Goldberg, MD, MBA, vice president of the Medical Affairs division at Quest Diagnostics, shared how he is cautiously optimistic about the potential of remote monitoring via digital health. He emphasized how vital it is to provide actionable data to avoid overwhelming clinicians with information that doesn’t point to a specific and effective health improvement intervention.

Roderick McVeety, MD, a physician with the DaVita Medical Group, raised another important question: How can the growing number of digital sources for data lead to greater continuity of care? Again, pointing providers to the most important aspects of these real-time insights will be critical in our mission to improve care coordination, especially for complex patients with multiple chronic illnesses and significant social determinants of health.

Terri Steinberg, MD, MBA, chief health information officer at Christiana Care, pointed out how important it is that systems of care include patient-centered data, such as relevant biometrics, patient-reported outcomes and personal preferences to fill in the “white space” between clinical visits.

Each of our Clinical Executive Summit participants agreed on the following key points:

  • What gets measured is of critical importance in determining the Impact on Quality (“IoQ”) through effective digital-health strategies.
  • How and when information from digital health tools is delivered to the people who need it is absolutely essential.
  • Getting accurate, relevant and actionable digital health information to providers and consumers is the best way to achieve effective and meaningful improvements in patient-centered care.
  • Delivering the right information, in the right format, to the right end-users will help break through the noise of today’s information overload.

The State of Digital Health

Our moderators and panelists also agreed that the digital health industry isn’t making progress fast enough. The industry is flooded with too many small players twisting lots of “little dials” while being ineffective at moving the “big dials” (e.g. controlling high blood pressure, obesity rates, maternal and fetal mortality, social and behavioral determinants of health, etc.). In order to make a more significant and widespread IoQ, digital health innovations must generate meaningful scientific evidence showing how best to give consumers and providers the actionable insights they really need from these innovations. Some of the key takeaways supporting this theme included:

  • There is a legitimate concern from providers that we’re racing into this technology while largely forgetting about the most critical touchstone: accurate physical diagnosis.
  • We need to be prepared to see the value of technology. But this can’t erode what our medical schools are teaching or the importance of high-touch clinical interaction. Technology cannot replace this element.
  • Technology doesn’t take the place of clinical care management. But emerging digital health technologies have significant potential to enable and enhance the impact of that care on quality.
  • As an industry, we must ensure digital health solutions that more address the needs of the underserved, where our high-tech and high-touch efforts can have a deep and lasting impact on healthcare disparities and social determinants of health.

This session’s attendees represented some of the leading experts in their respective fields: Dr. Joseph Gonnella of the Center for Research in Medical Education and Health Care and Jefferson Medical College, Dr. Alex Antoniou of CareFirst BlueCross BlueShield, Dr. Laura King of Health Care Service Corporation, Dr. Mack Mitchell of UT Southwestern, Dr. Matthew Fontana of Health Care Service Corporation, Dr. Roderick McVeety and Beth England, RN, of DaVita Medical Group, Dr. Steven Goldberg of Quest Diagnostics, Dr. Terri Steinberg of Christiana Care, and Dr. Terry McInnis of Blue Thorn Consulting. A special thank you goes out to all of these engaging participants as well as the other moderators from Medecision including Drs. Richard Popiel, Paul Handel and Tamara Cull.

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