Forum: Digital health turns the corner

While the promise of digital health care has been advertised for many years, its actual implementation has been slow. However, recent advances have begun to demonstrate that the use of contemporary digital tools is changing the foundations of health care delivery in the United States.

The digital advance in health care has been slow due to a number of barriers. First, most medical records were in a paper form until about 10 years ago, and the conversion to electronic health records has been slow and awkward. It is still not complete — witness the continued use of fax machines. The second restraining factor is the basic rule of technology implementation — the new technology must improve outcomes for the customer (patient) as well as make the work easier and more satisfying for the professional.

In many cases the implementation of electronic health records has actually made clinical work more bureaucratic and time consuming for professionals. Health care also imposes a third requirement in that any new technology must preserve the essential human characteristics of caring and empathy. Computers are increasingly useful, but most patients still want the reassuring hand of a nurse or doctor when they are sick.

These barriers are starting to be overcome. The recent Opus College of Business Future of Health Care Conference at University of St. Thomas provided three examples of new technology applications that are successfully meeting all of these criteria. These technologies include: big data analysis with machine learning; speech recognition and processing; and cellphone apps and wearables.

At the conference, the representatives of the national firm Radiology Partners described their use of advanced analytical tools to examine their extensive clinical database. They sought to identify variations in clinical care provided by the firm's radiologists and, especially, the outcomes of treatment based on their recommendations.

Radiology Partners discovered that many patients were not receiving the appropriate care based on their radiologists' findings. Because most of the findings were transmitted to surgeons, the radiologists did not include specific recommendations for surgery, as surgeons were experienced in receiving these reports and determining the needed surgical procedures. As Radiology Partners looked intensively at their data, it discovered that many of the requests for imaging were from advanced-practice nurses and physician assistants. These professionals were now in new roles and lacked the training to correctly determine the best therapy based on the radiology finding. This was causing the variation in outcomes.

Radiology Partners then implemented a new natural language-processing component to their dictation system that prompted the radiologists to make sure that they made specific recommendations based on the training of the referring professional. This improved the rate of best-practice patient care in these cases from 50% to 90%.

At the conference, Wisconsin-based Inception Health presented its new program for "digital therapeutics." Digital wearables and cellphone apps have begun to enter the clinical mainstream and are prescribed by physicians in a manner similar to lab tests, imaging and physical therapy.

Inception Health staff are using these tools in their digital therapeutics program for diabetes, mental health, maternity care, medication management, hypertension, hospital discharge follow-up and more. The data from these apps are preprocessed and summarized by Inception Health algorithms, and the results entered into the patient's electronic health record. The result is highly individualized, high quality, detailed data monitoring for clinical care in a manner that is convenient for both the patient and the professional.

Kaiser Health, from California, presented a leading-edge example of digital health in its prototype of a comprehensive language understanding, machine learning system for the exam room. Using this system, the doctor walks into the exam room, has a tablet with patient data, and interacts directly with the patient throughout the whole exam, while being listened to by a computer system that's doing natural language processing.

The computer then analyzes the conversation, turns it into a note that goes into the medical record, and then documents any prescriptions that are then transmitted to the pharmacy. As patients leaves, they receive a recap e-mail. The Kaiser Health system is a clear example of digital health meeting all of the criteria for success: effective use of electronic records, improved patient care and professional satisfaction, and the preservation of the human connection in the provisions of care.

New digital technologies are emerging daily, and the American health care system has now begun to embrace them. Dramatic changes in the process of health care delivery are just around the corner.