While health policy and health services continue to be dynamic domains, advances in digital health are coming at a breakneck pace.  Many thought that, in the post-HITECH era, the digital health domain might quiet down a bit.  Instead, the array of federal policy efforts targeting health IT and digital health have exploded with new provisions in MACRA, 21st Century Cures, and the revamped meaningful use program (now Promoting Interoperability Program) to name just a few. It feels as though we have entered a second era of health IT in which we are tackling the unintended consequences of the meaningful use era while also expanding into new domains.  Indeed, the four Digital Technologies and Health Sessions at AcademyHealth’s Annual Research Meeting (ARM) later this month reflect this new era. 

The first critical topic in this new era is interoperability, or the lack thereof.  While the original HITECH legislation clearly called out interoperability as a required capability of federally subsidized electronic health records (EHRs), the staged meaningful use program did not appreciate or accommodate the complex legal, regulatory, economic, and clinical dynamics that are distinct to making interoperability happen.  It is therefore not surprising that the program has shifted to have a singular focus on interoperability and new regulations are targeting emergent barriers to make interoperability a reality.

The ARM session - From Practice to Policy: Emerging Complexities in Exchanging Health Data – directly addresses issues relevant to current interoperability challenges and associated policy efforts. The research presented reveals how interoperability is not occurring between hospitals that most routinely share patients, likely due to competitive dynamics. The research also reveals that Accountable Care Organizations are not extensively leveraging interoperability to deliver more coordinated care to their patient population, despite the fact that they have an incentive to do so. Another finding shows targeted interoperability solutions – in particular, frontline clinician access to a prescription drug monitoring program database for controlled substances – are not always widely used. As we look towards the future of interoperability, the final presentation addresses the complex set of factors that shape consumer sentiments about the sharing of their data, which makes designing a “one-size-fits-all” approach to consent and access untenable.    

The second critical topic is the impact of health IT on health care delivery and communication, which is addressed in the ARM session - Using and Improving EHRs for Care Delivery and Communication. The first presentation in this session reveals the amount of time physicians spend in the EHR – with an average 35 minutes working before the start of patient care each day, 1 hour 16 minutes after the last visit of the day, and 1 hour 7 minutes working from home each day. A second presentation reveals communications challenges between physicians and nurses as a result of one-way communication devices. Despite these challenges, panelists also provide novel insights about opportunities to use EHRs to improve care, including a study that uses nursing notes to identify patient falls and the contributors to them while another study describes the potential for patient reported outcomes to be integrated into the EHR and inform clinical decision making.

Moving into novel digital health domains, a third ARM session – Engaging Patients in New Models of IT Enabled Care – addresses the rise of the consumer and consumer mediated health IT solutions. While few solutions exist at scale, presentations in this session show the potential for using digital health solutions to engage consumers in tackling important clinical problems including colorectal cancer screening, diabetes prevention, family planning counseling, and weight loss in obese patients with serious mental illness. Research findings also reveal challenges such as competing priorities, lack of resources, developing new workflows, and changing commonly held conceptions of patient roles.

Last but not least, is the sleeping giant of digital health – telemedicine. Recent regulatory changes have loosened regulatory restrictions on delivery and compensation of telemedicine, opening the floodgates of approaches that use remote solutions. Presentations in this ARM session – Telemedicine - Is it Delivering? – address diverse telemedicine topics. One panelist  found that video visits were highly integrated with ongoing clinical care, and that patients had a positive experience due in part to an offset in in-person visits that required taking time away from work or other responsibilities. A second and related presentation used an all payer claims database to reveal that telemedicine may be able to displace non-telemedicine services, but follow-up utilization and costs may be higher. In the FQHC context, a third presenter found that a mobile health intervention can improve patient outcomes related to substance use disorders, and enabled patients to support each other in ways that partially offloaded the burden of addiction treatment from primary care clinicians. Finally, the fourth panelist examined safety net clinics that offered an eConsult program, and found that access to specialty care increased but also created more work for already burdened primary care clinicians.

These themes – of technology-related benefits and challenges – are those that persist across time and technologies, and highlight the critical need for rigorous research that helps us continue to harness the power of digital health.

Julia Adler-Milstein Headshot
Committee Member

Julia Adler-Milstein, Ph.D.

Professor of Medicine - UCSF Department of Medicine

Dr. Adler-Milstein is a leading researcher in health IT policy, with a specific focus on electronic health rec... Read Bio

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