In advance of this week’s #HITsm chat on the topic of “Physicians Driving Healthcare Innovation in Technology”, I asked a few physicians – leaders who regularly engage with me on social media – for their thoughts on some of the questions. Physicians included: Dr. David E. Albert (@drdave01), Dr. Eric Topol (@EricTopol), Dr. Howard Luks (@hjluks), Dr. Brian Stork (@storkbrian), Dr. Rafael Grossmann (@ZGJR), and Dr. James Legan (@jimmie_vanagon). More details on the individual physicians at the end of the post.
Join in, and add your thoughts to the #HITsm conversation on Twitter, this Friday, October 23 at 11 am CT!
1. What qualities do physicians need for an innovation mindset in the 21st century?
Dr. Albert: Physicians need to be flexible, try new things, and be open to change. That may mean trying a new device, staying on top of the news, and doing research into new ways of doing things. Physicians should make sure that they understand that healthcare is changing. On my mind recently has been the “how” and “who” of healthcare payment will change from “reimbursement” to personal “payment” and that will be disruptive and will create great new opportunities just as it will threaten old business models.
At AliveCor, we learned that there are two phases to building a company like ours. We had to pave the way as there have been almost no complete company stories in the field of digital and data-driven healthcare, so there is no real playbook for how to build a company as there is in the hardcore medical device industry.
Dr. Luks: Communication skills, empathy, the ability to listen, engage and interact with patients who are seeking advice/care are time tested skills that a physician requires … Our High tech-Low Touch healthcare environment leads to over-diagnosis, over-testing and over-treatment.
That being said, technology or platforms that provide timely communication/workflow tools – Twistle, Orca, Vidscrip, Doximity (enables me to ask my network a question behind a firewall) – all serve a very important role.
The 21st century physician will understand the context in which technology can enhance and improve the patient physician relationship. They will understand that our interaction with the patient will not end when they leave the office after a visit.
Physicians must recognize that patients are more informed and must be engaged and empowered with knowledge, options, communications tools, and a functioning feedback loop. The 21st century physician will maintain the skills sets initially mentioned, they will not withdraw from the time-tested History and Physical, they will not rely on high cost, high tech alone to arrive at a diagnosis and treatment plan specific to the patient who sits before them. Every injury has a personality, each injury will behave in a different way in each patient. Surgery is not the answer for all.
Dr. Stork: Physicians need to first “believe” they can innovate. This is becoming harder and harder as health systems become larger and larger, and the various levels of management and administration grow bigger and bigger.
In my experience with StomaCloak, we first needed to believe we could innovate. You can’t just be on the receiving end of someone else’s vision for healthcare innovation. You need to have a clear plan, be fully committed, and have a long-term approach. It’s also about having the leadership skills to put together and maintain a great team of other professionals that, historically, we might not have a lot of experience working with.
Dr. Grossmann: I think that the main quality is to be “open to change, to break paradigms of care.” “Disrupt” is the word I would use!
Think, Imagine, disrupt and connect with those who are able to make ideas become a reality, to make them happen. When I first saw Facetime, for example, I thought it would be a fantastic idea to connect to our remote, acute trauma consults. Everyone thought I was crazy, HIPAA would not allow it. Within months, there were several apps that were “medical grade-HIPAA compliant” – the industry provided, filling a need.
Dr. Legan: I think being curious and flexible, but most of all being receptive to change to meet the needs of patients. But also a stubbornness to not change the basic fundamental doctor patient relationship. As Paracelsus, The Great says, “In short, whoever desires to act as a true physician should first of all study to be a Samaritan…”.
2. The average physician is overwhelmed by their EHR? What choices do they have to drive change?
Dr. Luks: The EHR has dumbed down the SOAP note. Cut/Paste/Macros and two button complete visit solutions produce notes that meet all government directives, yet they read poorly and say nothing. They mean very little for the patient who sits before you. How does this injury impact upon this patient? Are they a couch potato or a 60-year old IronMan? Any other specifics which could impact upon our decision? These variables and thoughts require a lot of time to input into the current EMR platforms. This is where a platform like BetterDayHealth (voice-recognition) can make a huge splash. By passively acquiring data and populating a record, I can spend my time speaking with a patient and feel comfortable that the record will reflect the individual’s issues, effect on their quality of life, and treatment options specific to them which we had reviewed.
Dr. Stork: Physicians need to continue to speak out about how unhappy they are with the current EHR platform choices, the lack of interoperability, and how data breaches are hurting patients.
Once data is entered, we are repeatedly finding, neither the patient, nor the physician, have any real control over it. – Dr. Stork, “Physician Storytelling”
Normally, free market choices drive technology adoption. In our case, it was mandated by the government … with EHR vendors who, in my opinion, just wanted to sell as many hastily put together, mediocre platforms as they could that met only the most basic criteria for certification – my experience has been that the customer service has been terrible and terribly expensive.
I can’t think of any other business that would voluntarily spend all this money on platforms that don’t communicate, are billing rather than patient focused, slow down productivity, and take a company’s most highly trained, and arguably most expensive, asset and turn that person into a data entry technician – it’s nuts!
But there is an opportunity here. I think physicians and patient leaders could work together to really help develop innovative EHR platforms that make sense to everyone. If physicians and patients were to work together and succeed in this manner, who knows what else might be possible?
Dr. Legan: It really depends on where the physician finds himself. I think driving change may be a bit more difficult for a physician in a large multi-specialty group or hospital setting where he may have little or no choice in choosing an EHR.
For all the disadvantages of being in a small office, one huge advantage is being able to choose an EHR that best fits one’s workflow.
By choosing an easy to use, intuitive EHR and combining with a Health CRM, the essential function of the EHR is dramatically improved with visual sharing at the point of care. The EHR becomes a visual educational tool fine tuned with all of the pertinent, personal information shared, instead of a mysterious documenting task with the physician’s nose stuck in the computer screen.
3. How can physicians form technology partnerships?
Dr. Dave: When physicians are forming technology partnerships, they should think about how or what they could be providing patients and/or doctors today to save time and money, and provide a better, more efficient tool or treatment option.
One area I think has a lot of potential and need is around long-term big data in order to carry out advanced analytics.
Physicians should remember that when working with a medical company or medical technology company, they should be mindful to approach things in a very responsible way.
Dr. Luks: Physicians are notorious for fighting change of any sort. We all know the world around us is changing. The wise physician will understand that there are technological advances that could improve upon our patients knowledge, informed decision making, recovery and outcome.
Many more will realize that the companies that are pushing the technology envelope require our help. They need boots on the ground to assist with their next iteration. Now that the goal of a tech platform has become to push out a Minimally Viable Product – and Iterate Iterate Iterate is upon us – these companies will require willing participants to help shape these platforms into something we as physicians will find useful.
When physicians are forming technology partnerships, they should think about how or what they could be providing patients and/or doctors today to save time, and money and provide a better, more efficient tool or treatment option.
Dr. Stork: This is a very difficult question. I have worked with startups before. Startups are usually under incredible financial pressures. Meanwhile, physicians have to “produce” more and more to make ends meet.
In today’s world, new innovations that require tremendous amounts of intellectual time, talent and treasure can literally be stolen, copied or modified, and mass-produced in seconds. Just like many hospitals find success by putting physicians in key leadership roles, perhaps HIT needs to do the same.
Dr. Grossmann: The best way is to connect, physically, at conferences and through HCSM (healthcare social media.) Depending on the interests, things will materialize.
Dr. Legan: The best way is to freely share solutions that impact or resonate the best for patient care. These new ways of shifting how we use the technology, will permeate to others, if indeed patients find the solutions helpful.
4. What is your view of the future of healthcare?
Dr. Topol: We generally don’t appreciate the power of smartphones for their ultimate, transformative impact on medicine and healthcare. They are providing—and will do so much more in the short term—the ability for patients to generate their own data. That includes sensor data for most physiologic metrics (blood pressure, glucose, heart rhythm, oxygen concentration in the blood, etc), performing routine lab tests, and many components of the physical exam. Furthermore, these devices provide a conduit to immediate medical attention by either telemedicine or ubering a doctor to one’s home at any time.
Some features contrasting old and new medicine pic.twitter.com/HuB83AIRzD
— Eric Topol (@EricTopol) February 28, 2015
Dr. Dave: There has always been disruption inside medicine, and that’s where some of the biggest breakthroughs have come from.
Healthcare in the U.S. has to get less expensive on a per patient basis. There is no way that cannot happen, so technology which may be disruptive to current solutions will inevitably become the norm, if it can deliver what is needed at a lower cost.
Dr. Luks: The future depends on a team effort. I will continue to work from within, to find other physicians who think similarly, as well as administrators and hospital executives who understand the role of technology – to improve the care that we seek to provide. So that we can provide patients with more information, more choices, more involvement in their own care, more incentives, and hopefully, better quality care at a lower cost.
Dr. Stork: With change, they say things always get worse before they get better … That being said, I think the long-term future of healthcare is really bright.
The future of healthcare is going to move from a physician-patient relationship to a real team model where the patient is truly the center of all of our efforts.
Technology will eventually really facilitate communication between patients and physicians – this really isn’t happening in our practice right now even though we have a portal.
I’ve resigned myself to the fact that I’m losing the healthcare information race. So I am excited about the possibility of using cognitive computing in my practice. Robotics is only going to continue to play a bigger role in healthcare. I really hope, however, in the future, humanity will play as much of a role in medicine as science. Bottom line, I’d like to leave healthcare better than I found it. I’m planning to stick around long enough to see it happen.
Dr. Grossmann: Fantastic! Better connectivity and communication between providers and patients, and with patients among themselves – on one side. On the other, technology (the smart use of technology) improving every step of the way: from prevention, to treatment to recovery. Telemedicine, AI, AR, nanotechnology – working together in all of those steps – I’m sure it will be amazing.
The best physician is the one who is able to cultivate and practice humanity, the human touch-the art of medicine- along with gaining expertise in the smart application of exponential technologies to enhance the abilities to provide the best possible patient care, not just to restore health, but more importantly, to prevent sickness. That is what the future of medicine ought to be.
Dr. Legan: I am very excited about the future of health care especially when the technology accentuates or exemplifies the basic doctor patient relationship, making the bond stronger, not weaker.
Please add your voice, and join #HITsm, this Friday! We will update this post with the transcript.
David Albert, MD, is a physician, inventor, and serial entrepreneur who has founded three companies including AliveCor – a mobile ECG to instantly detect serious heart conditions via smartphone, tablet, or Apple Watch.
Howard Luks, MD, is an orthopedic surgeon and sports medicine specialist who practices in New York. Dr. Luks is also an early adopter of healthcare social media, technology, and shared decision making.
Rafael Grossmann, MD, is a trauma surgeon who practices in Maine. He is also a pioneer in the use of telemedicine, Google Glass in live surgery, and new augmented and AI technologies.
James Legan, MD, is an internal medicine physician in Montana. He is also an avid blogger, pioneer in the use of new social tools (currently, Periscope) and ideator for the Projected EHR.
Brian Stork, MD, is a community urologist in Muskegon, Michigan, and active participant in the Michigan Urological Surgery Collaborative. He is also an avid blogger, and engaged member of the healthcare social media community for urology and StomaCloak.
Eric Topol, MD, is a cardiologist, geneticist and digital medicine researcher who serves in various roles with Scripps. He is also editor-in-chief of Medscape and theheart.org. He authored “The Creative Destruction of Medicine” in 2012, and “The Patient Will See You Now” in 2015.
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