Zach Watson

Technology hype in the medical industry has been well distributed and plentiful for the last several years. Predictive analytics, personal health records, and other 

 have all enjoyed copious amounts of analysis, but none has garnered the attention that wearables currently enjoy.

And it's easy to see why: gathering biometric data directly from the patient and using that information to create more accurate treatment plans, deliver alerts, and generally improve population and individual health is a compelling use case.

remains stuck to the wrists of a particular young, affluent population

, while patients who could truly benefit from wearable technology have yet to gain access to these devices.

If that access becomes viable on a broad scale though, it could invoke meaningful change.

A recent study by the Pew Foundation revealed that about 19 percent of people without chronic conditions track their health (with or without software). This is arguably the main demographic that use wearable devices or fitness trackers right now.

In contrast, 40 percent of people who have one chronic condition track their health, and 62 percent of people with two or more chronic conditions track their health.

Logically, these numbers may not be surprising - these people must monitor their health to avoid staying out of the hospital. What is surprising is the lack of penetration health wearables have made in this market. Patients with chronic diseases make up a huge portion of total healthcare expenses, and theoretically, their health tracking could be made substantially easier with the help of wearables.

Yet wearables have not reached this demographic, although there are industry stakeholders trying to change that. Here's a look the most prominent forces at work.

proposed rules for meaningful use Stage 3

, CMS has eliminated the rigid view, transmit, and download requirement for patient engagement. Now, at least 25 percent of unique patients must engage in some way with their personal health information within the provider's EHR.

This can be accomplished in a couple of ways: view, transmit, and download, or syncing the EHR with a personal health record (PHR) or health wearable device. Both of the more complex data transfer scenarios bring health wearables directly into play. Even if the data is transferred from a personal health record to an EHR, it's still possible to use the PHR as a repository for wearable data, before it travels to the provider's system.

Though the lines are not yet clearly drawn, insurers would surely like to begin using biometric data from wearable devices to make their risk profiles for patients more accurate, and more influential.

Data gathered from fitness trackers would provide a realistic picture of a patient's lifestyle, especially if more complex trackers are used to record glucose levels that indicate caloric intake.

The relationship between insurers could be critical, because wearables have a short track life in the consumer market. It turns out, most people stop using them after a few months. However, insurers can offer incentives that other stakeholders can't.

For example, UK-based Vitality Health has been 

encouraging patients to use wearable technology since 2006

. In exchange for the data produced by these devices, Vitality offers life insurance customers points that can be spent on movie tickets and coffee, as well as reduced premiums.

Of course, the downside to insurers having this much information is that they could use the wearable data to increase premiums for patients who don't meet certain criteria (which may or may not actually indicate health risks).

Either way, this offer appeals to the people: 57 percent of respondents in a TechnologyAdvice survey said that the possibility of 

lower premiums would make them more likely to use a fitness tracking device

The final group in the equation is stuck in an interesting position. Though 66 percent of physicians 

would prescribe an app to help patients manage chronic diseases

 like diabetes, it's well-documented that physicians worry about receiving too much (read: irrelevant) data from wearable health devices. Although physicians are likely excited by the possibilities of wearable devices, it will likely take some for them to decide on exactly how (or if at all) they want to incorporate such data into their diagnoses.

As it stands now, the industry is rapidly adopting new medical software to fix processes like information exchange and chronic disease management that have made for such obstinate opponents over the years. Of the proposed technology, wearables seem most likely to catch fire, in part because of their consumer appeal and obvious use cases. They certainly have the stakeholder support.

Articles

Patients with chronic diseases consume a huge portion of healthcare expenses. The use of health tracking devices could change that.

Will Patients Embrace Wearable Health Technology?

Starting a private practice requires a heavy dose of entrepreneurial spirit. Keeping one afloat requires a keen mind for business operations.

Rather than shrugging his shoulders at an overly complex healthcare system, internal medicine physician Tom Lee founded a practice that focused on fixing some of the glaring flaws in healthcare delivery at the practice level.

One Medical, a large concierge practice, epitomizes what’s required to succeed in private practice: ambition, innovation, and efficiency. Even if you’re not pursuing a concierge model for your practice, this practice's success still has several lessons to offer healthcare providers looking to maintain some autonomy through a private practice. It may also offer a window into the future of the physician-patient relationship.

Here are three things private practice providers can take from Lee’s success.

Despite seeing an average of 35 percent fewer patients per day than the average practice, One Medical already boasts patient numbers in the thousands as well as a 

Can seeing fewer patients while growing at a meteoric rate be anything other than a paradox?

The answer seems to be yes. This coupling of rapid growth without tortuous physician hours and work flows is best explained by the practice’s effective use of technology to increase the operational efficiency.

It’s no secret that One Medical receives significant backing from venture capital firms - much of which is likely due to Lee’s success with Epocrates, which he cofounded. But instead of exclusively spending those assets on new office buildings and advertising, Lee 

As part of the annual $199 membership fee, One Medical patients receive access to 

 from which they can book online appointments, renew prescriptions, and even get a review of their medical information and have subscriptions sent to a pharmacy or tests scheduled.

This same functionality can be found in many patient portals, though these features are less common on mobile devices at the moment.

Instead of worrying about how the patient portal-esque app would fulfill meaningful use requirements, Lee seized the opportunity to automate all the clerical processes he could. As a result, One Medical employs half as many office staffers per provider as the normal practice.

One Medical’s emphasis on technology streamlines the way the practice functions, and improves the patient experience. Creating a useful mobile application wasn’t done for reimbursement purposes, but rather to create a more intuitive experience for patients.

Many practices lack this focus on the patient experience. Instead of taking the time to make sure the patient is comfortable with a diagnosis, providers must rush the examination in order to move on to the next patient.

This directly contradicts the mindset of the modern consumer, and it only feeds healthcare’s reputation for anachronistic operating models. 

Consumers now use their experience with a service provider

 as validation for continuing to choose that provider. Failing to focus on experience is a surefire way to lose patients - perhaps driving them to competitors who do seem to have the time to talk longer in the exam room.

Remember that One Medical physicians see less patients? That’s so they can dedicate more time with each individual.

To be sure, technology powers the customer experience by making the healthcare provider more efficient and enabling him to prioritize the patient. But using the lack of technology as an excuse for the poor engagement is self-defeating.

Patients now expect a holistic experience from providers, 

beginning with digital access to health information

 and ending with follow-up after the appointment.

Physicians have a reputation for being resistant to change. However, the current reimbursement system mire and the myriad of new regulations aren’t asking physicians to change; these forces are demanding it.

Doing things the same old way simply won’t suffice. A concierge model may not be the answer for every practice, but it does serve as an example of what’s possible with technology and the right priorities. Luckily for independent practices, there’s an expansive market of 

 that supplies the raw materials for building a more effective, patient-centered practice.

A concierge model may not be the answer for every practice, but it does serve as an example of what’s possible with technology and the right priorities.

Lessons All Practices Can Learn from the Concierge Model

When analyzing the evolving healthcare landscape, it’s easy to only consider the requirements of regulatory agencies rather than the patient needs that are responsible for such requirements.

Currently, two major shifts are taking place: Millennials or Generation Y are rapidly coming to the fore in the workforce, and Baby Boomers are moving past middle age, expanding the elderly population.

These changes will significantly alter the traditional patient/physician relationship, often in different ways, and practices need to be prepared for what that will entail.

Here are some of the most prominent changes to expect.

 of physician respondents expected mHealth apps to improve their relationship with patients. This same number also expected to integrate mHealth in some form into their practice within the next five years.

mHealth apps, or more specifically fitness app usage, is experiencing a meteoric rise that’s 

than the overall mobile application market. Millennials have a well-worn reputation for being tech savvy, and 25 year olds to 34 year olds are 41 percent more likely to use fitness apps than the average mobile user. However, 35 year olds to 54 year olds were 47 percent more likely.

Because the market for fitness apps and healthtrackers is still relatively narrow, it’s encouraging that middle-aged patients are beginning to use these applications at a comparable rate to their younger counterparts. Health apps will eventually become a prominent source of data for providers to reference when treating patients with chronic conditions, and when retrospectively analyzing an acute condition.

#2 Proliferation of Patient-Generated Data

Speaking of data from mHealth apps, patient-generated health data (PGHD) also has a huge rule to play in future physician/patient relationships. Though the data entry obstacles prevent many patients from using a health application for longer than six months, advanced technology should make data capture more intuitive, which will provide doctors with an objective history of what’s happening with each patient in between office visits.

This type of data can be harnessed for population health management and fed into analytics systems that generate risk scores for patients who are particularly vulnerable to adverse events or acute conditions. These programs can also account for factors such as past behavior.

The new Stage 3 proposed rules for meaningful use reflect the importance of PGHD. In the proposal, providers would be required to incorporate data produced in a non-clinical setting into their EHR for 

Despite the potential of such information, all data is not created equal. Providers will need to establish protocols with their patients about what signifies meaningful data, and what data isn’t clinically valuable.

In an effort to better engage patients in their well-being, expect changes in the dialogue between patients and physicians at the point of care. Colloquially referred to as shared decision making, giving patients greater leeway to decide the course of their treatment (within logical bounds) is becoming the norm.

Shared decision making has become more common because both Millennials and Baby Boomers are gathering more information from their own research (likely via the Internet), and presenting it to their physicians. Regardless of whether the information is valid or invalid, it behooves the physician to use it as an educational opportunity.

But shared decision making isn’t all about coddling the patient or refuting false facts: Research suggests that shared decision making leads to greater patient satisfaction and 

 - an important factor in reducing the cost of care.

Due to the expensive nature of inpatient care, hospitals and health systems are referring more traffic to outpatient clinics and opening more clinics to meet the increased demand. These high traffic clinics can cannibalize independent physicians’ business because they’re designed for convenience, which is exactly what younger patients crave.

Millennials already frequent retail and acute-care clinics at nearly double the rate of their elders, and studies have shown that nearly 

25 percent of parents chose a retail clinic over a pediatrician

 when their child presents with certain symptoms.

The main reasons for going to the retail clinic were more convenient hours (36 percent) and a lack of availability of office appointments (25 percent).

To compete, independent practices will need to use all the 

 at their disposal to optimize work flows and make every patient’s interaction as convenient as possible.

The demographics are shifting, and expectations are changing. In the vast majority of scenarios, technology provides the key for independent practices to keep pace.

As Millennials and Generation Y join the workforce, and as Baby Boomers move past middle age, practices will need to meet changing expectations.

Four Ways to Adapt to Changing Patient Expectations

 and healthcare technology, telemedicine may be the tool that offers the most immediate value to physicians. Ranging from remote monitoring devices to patient visits over Internet video, this technology has the potential to improve affordability and access where it matters most: at the point of care.

And thanks to its low barrier of entry and popularity with patients, telemedicine is quickly becoming commonplace for independent practices and hospitals alike.

Though the capabilities for telemedicine have existed for several decades, it’s only in the last 10 to 15 years that technology has become ubiquitous enough to gain widespread acceptance.

Recent estimates of its use are encouraging:

 of all US hospitals use telemedicine in some form according to the American Telemedicine Association. Physicians are starting to get reimbursed for these services as well. 

require private insurers to reimburse for telemedicine services, and over 40 states have Medicaid policies that cover remote medical care.

The prominence of telemedicine can be linked to consumer (or in this context patient) demand. The modern consumer expects at least some degree of online, on-demand services, and the growing availability of online appointment scheduling with physicians has led many patients to take the next step and seek full-fledged online interactions.

These interactions mirror the demand for concierge medicine. But instead of patients having to pay a membership fee for on-demand access to in-person physicians, telemedicine supplies a more affordable method for receiving healthcare services.

What was once a government-subsidized tactic for delivering healthcare to underserved rural regions of the country is becoming a standard means of communication between patients and physicians - particularly through the use of video conferencing and telephone consultations.

Telemedicine is more than a victory for convenience. In 2014, RAND Corporation studied the 

by observing medical services consumption by patients who used Teledoc, a large telemedicine provider, versus patients who visited a physician’s office or emergency room department.

RAND’s study demonstrated that patients who consulted with a physician through streaming video or over the phone booked follow-up appointments 

 while patients who visited an office did so 13 percent. Emergency room patients did so 20 percent of the time.

These findings highlight how telemedicine services can help reduce the unnecessary consumption of medical resources, and consequently, lower medical costs as a whole.

Consider applying these results to patients with chronic conditions, such as diabetes, or hypertension. Patients with these conditions use a high amount of medical services, but telemedicine offers them a way to inexpensively receive such attention. Even limiting follow-up appointments to a telemedicine context could yield significant cost savings.

Telemedicine has great potential for all types of providers. Implementing more complex technology such as remote monitoring may not be easy for small practices, but video conferencing and phone services present attainable business opportunities.

Even if insurance plans don’t reimburse in your state, patients will usually pay an out-of-pocket fee for the convenience. Plus, setting up a telemedicine system is relatively simple. A web camera, HIPAA secure network portal, and software that connects EHRs cover most of what’s needed.

Given that the Affordable Care Act is expected to increase the number of patients seen by primary-care physicians, implementing telemedicine services can expand the reach - and conserve the time - of independent PCPs.

You can also join a telemedicine network like Teladoc and MDLive, if the demand isn’t there in your patient population. Licensing requirements are a concern if you receive calls from patients out of state, but the process isn’t so arduous that it diminishes the benefits of receiving patient calls on your schedule.

Telemedicine is growing rapidly, and will soon be available to the majority of patients in the US. In contrast to other healthcare initiatives and technologies that always seem to encounter organizational barriers or legal obstructions, telemedicine is poised to thrive due to its simplicity and obvious value.
 

Thanks to its low barrier of entry and popularity with patients, telemedicine is quickly becoming commonplace for independent practices and hospitals alike.

Author | Zach Watson

Articles

Will Patients Embrace Wearable Health Technology?

Lessons All Practices Can Learn from the Concierge Model

Four Ways to Adapt to Changing Patient Expectations

How Small Practices Can Get Involved in Telemedicine