Both World War II and the race to the moon were events which pushed commercial development of technologies. I would submit that the ACA and HITECH have had the same effect on the development of many sectors of the digital health technology industry. I will cite five such areas.
Government mandates usually have unintended consequences and they certainly exist in healthcare. The rapid proliferation of some of these technologies has itself created some problems which need to be addressed. However, this is an expected phenomenon and hopefully technology itself can address them expeditiously.
1. Electronic health records (EHRs). The HITECH Act introduced requirements and standards for EHRs. Requirements are phased in (we are now at stage 2 of meaningful use or MU) and financial incentives and penalties (for non-compliance) are part of the process. As is any regulatory mandate, providers are under the gun to adopt EHRs and some have made bad or hasty decisions with regards to which system to buy. Both physicians (via survey by the American College of Physicians) and hospitals (via KLAS survey) are increasingly dissatisfied with their EHRs. Nevertheless, EHRs are here to stay. Problems exist with regards to interoperability, unintended safety problems, and usability in addition to decreasing the provider-patient human interactive experience. Many of the benefits of EHRs have yet to be realized because of the lack of technical integration among various healthcare IT systems.
2. Patient portals. Patient portals contain the patient health record (PHR), the patient-facing and interactive part of the EHR mandated in the HITECH Act, in addition to potentially other technologies. The problem is, it is required at this time (stage 2 of MU) to be executed for only five percent of patient records. Portals however, represent a solid first step in the over utilized ‘patient engagement’ part of healthcare. They have been used effectively with great patient satisfaction by Kaiser Permanente and other providers for a while. Patient portals are provided by EHR vendors but more robust third-party commercial platforms are available which allow integration of disparate EHR vendor data.
3. Secure messaging. This too is part of the stage 2 MU requirements. There is a flurry of activity in the commercial sector with many companies offering variations of platforms. Secure messaging both among providers as well as between provider and patients is something which will facilitate expedited care (who doesn’t play phone tag with physician offices these days?).
4. Remote patient monitoring. Section 3025 of the Affordable Care Act establishes the Hospital Readmissions Reduction Program which financially penalizes hospitals for readmission within 30 days of Medicare patients for specific disease states. This will expand to 90 days and cover more clinical categories over time. Remote patient monitoring is seen by most as a way to more closely observe patients at home in the post-acute care setting. Many small and large companies are in the remote monitoring space
5. Mobile apps. As providers, patients, and consumers embrace mobile technology for assistance in many activities of daily living, it is natural for healthcare to follow. While medical apps will never replace physicians, their utility as a vehicle of conveying information by pharma, employers, hospitals, and payers is the basis for all of the aforementioned technologies presently existing on mobile app platforms. Mobility will be the next technology focus of healthcare stakeholders, after MU and ICD-10 mandates are addressed. One challenge in this area is certainly quality control of health apps.
While regulatory mandates are usually seen as unnecessary and obstructionist, I believe that some (not most) of the HITECH provisions are pushing technology where it needs to be in healthcare.
David Lee Scher is a former cardiologist and a consultant, DLS Healthcare Consulting, LLC. He blogs at his self-titled site, David Lee Scher, MD.
