The challenges of successfully introducing digital health

BOSTON—“We have to think of digital health as a public good,” said Brennan Spiegel, MD, MSc, director of health services research at Cedars-Sinai Health System, speaking at the Connected Health Symposium held by Partners HealthCare.

That’s one reason his organization is the only medical school with a mandatory digital health curriculum.

Cedars-Sinai has an outstanding information services group, Speigel said. Earlier this year, they connected their Epic EHR to the Apple HealthKit and Fitbit and other devices. “Now we have patients that can stream their data directly to doctors through Epic. It’s a tremendous opportunity to do research.”

When the capabilities were announced, however, doctors asked who is in charge of all the data. And, what would be their liability if a patient had a problem that potentially could have been predicted with the data? That launched a discussion about how to use data in their health system. They realized they need to bring together patient-reported data and outcomes with their treatments.

Spiegel also talked about the use of virtual reality for patients. “In the hospital, you’re either bored or you’re having punctuated moments of terror, horror and pain.” Specialized glasses can transport patients to the beach, a musical performance and other scenarios, which can lower their pain scores.

Patients have very intense experiences and “devices are great. We think we’re getting it right but it’s really hard work.”

Ochsner Health System in New Orleans has created digital health programs over the past two years, said Richard Milani, MD, chief clinical transformation officer. One effort focused on the problem of readmissions. The most common cause is heart failure. Ochsner tried several initiatives for about three years, he said, but, if anything, readmissions were trending upwards.

They started collecting patient-entered data outside of routine clinical information, such as social circumstances, transportation and behavior characteristics. They tried to address these issues and “rigged our own interface. We created a dashboard for the care team to monitor daily.”

Ochsner has been live for almost two years and seen a 45-50 percent reduction in readmissions. The single biggest predictors of readmissions were the social aspects, Milani said. So, in their build they tried to connect patients with various resources and got them on patient assistance funds. Transportation became a nonissue because they could intervene over the phone.

Ochsner also opened its O Bar two years ago—a take-off of Apple’s Genius Bar. With so many health and wellness apps available, “it’s incumbent on health systems to curate them,” said Milani. It’s been a big success, he reported, and a critical component in rolling out other programs. And, the people who need those self-help apps the most are older people with more disease and more likely to be technophobic.

Maulik Majmudar, MD, is a cardiologist and serves as the associate director of the Massachusetts General Hospital’s Health Transformation Lab, which was launched in the heart center. The lab’s focus is new models of care delivery with spotlights on implementation, patient communication and coordination.

Since typical research grants are only eligible to faculty, they held an open contest. They had 138 submissions the first year and awarded three grants. It’s been so successful that they have repeated it annually. The lab explores technology that aims to improve care delivery and bring it into the clinic and introduce physicians to what’s available. Majmudar said they are working on understanding the clinical workflow and lower the administrative burden physicians have. They also work on business models to determine the financial incentives for the project or device to make it sustainable and scalable. “A lot of pilots die because no one’s thought about the sustainability part.”

Spiegel said providers sometimes skip the step of making sure these types of interventions are effective. A team of people evaluates patient experiences and writes a paper to submit to peer-reviewed journals. “That’s how we decide if something is effective. It takes too long. We’re inventing faster than we can approve them.”

Milani said CIOs are intimidated by thinking about opening up portals to patient-generated health data because of the liability issues. “Those are real impediments to many of these successes.” He said he can also see the data for patients with chronic conditions becoming overwhelming.

Speigel said provider organizations need a digitalist to mine the data in real time. The clinicians in the trenches don’t have the time to do that. The role requires someone who understands how to take in all the biosensor data, social media analytics and clinical medicine. “Until we have that, we’re going in circles about false or broken promises about who’s looking at the data and acting on it.”