The Benefits and Limits of Technology in Medical Practices

August 30, 2014

Patient portals and telemedicine can improve efficiency and patient access to care, but in-person interaction with providers should always be a top priority.

My young adult daughters used to phone me and say, “Hey Dad, how are you?” That has now been replaced by a text: “Hey Dad, how r u?”

Mobile technology continues to impact and affect numerous day-to-day activities and it is a prevalent and expected component of consumerism.

Online banking and bill paying, which was once viewed with trepidation, is now encouraging us to tip our babysitters electronically. Mobile apps such as Uber and Lyft, are providing curbside pick-ups, potentially replacing the ubiquitous yellow cabs that patrol our large cities. Amazon is now testing drones to deliver purchases to the front door of consumers - will the scene of paperboys tossing newspapers across green lawns exist only in a Normal Rockwell painting?

For healthcare consumers, the increasing demand for access and timely information between providers and patients has produced medical apps and patient portals. Most EHR vendors include an online component and can efficiently and effectively replace some tasks done traditionally in person or over the phone, such as prescription renewals. In addition, portals can, in some cases, enable online patient visits. CPT code 98969 (online assessment and management service), for instance, has been established by the AMA as a potentially reimbursable code.

Similar e-visits may be offered through vendors such as Doctors on Demand, of which the ubiquitous Dr. Phil is an investor; and Relay Health, a product of McKesson. These new entities allow online evaluations between providers and patients, typically addressing more common components such as back pain, sore throats, etc.

Also included in this category is telemedicine, which may include a "skype" component, as well as mechanisms and technologies for viewing images, taking blood pressure, heart rates, etc. Telemedicine is most effective in remote settings where distance can be a realistic barrier to quality healthcare. It is also effective for “the aged” and “shut ins” as it enables the handling of non-emergent services such as blood pressure, medication, and diabetes monitoring.

Whatever the mechanism for patient communication, providers and practices must continue to be vigilant in adhering to HIPAA privacy and security concerns.

An additional concern for practices and providers is the comprehension of the medical information that patients view online, such as through a portal. Some practices may submit or allow access to normal/benign clinical information, such lipid levels and cholesterol information. But do patients truly understand what they are viewing? If not, will this generate additional patient calls/messages to the practice?

When that occurs, the efficiency gains the portal offers are lost. A team at the University of Michigan discovered that people with low literacy skills and low numerical comprehension had difficulty understanding if a lab result was within the standard range.

They were also less capable of determining whether they should contact their doctor.

In a release regarding the findings, Brian Zikmund-Fisher, associate professor of health behavior and health education at the university said,   "We can spend all the money we want making sure that patients have access to their test results, but it won't matter if they don't know what to do with them."

Medical practices should enthusiastically embrace any and all technologies that improve patient care; however, they should do so remembering that medicine is an intimate and personal experience. The late/long-time Massachusetts Congressman Thomas “Tip” O’Neill is noted for coining the phrase, “All politics are local.” The same is true of medicine - it can be remote and in cyberspace, but the healing hand and physical touch of a physician can never be replaced.