Editor’s Note: The following article is a Guest Column from Thomas Morrow, MD, chief medical officer at Next IT. You can contact Dr. Morrow on Twitter @TommorrowMD. To learn more about submitting a Guest Column, Click Here.
According to the CDC,
“Meaningful Use is defined by the use of certified EHR technology in a meaningful manner (for example electronic prescribing); ensuring that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and that in using certified EHR technology the provider must submit to the Secretary of Health & Human Services (HHS) information on quality of care and other measures.”
The driving factors behind this act are numerous but include the desire to improve care coordination, quality, safety and efficiency of healthcare while reducing disparities. The law also requires significant physician involvement, not only in record keeping and coordination with other healthcare providers, but also in creating lists of patients who need additional care such as reminders, monitoring for adherence, etc., all to promote better patient engagement.
The government gives an example of how a busy physician, who sees 30 patients on a typical day (in six hours, per the article!), uses his EHR to provide meaningful use. I’m guessing that only the patient highlighted in the article required 20 minutes of the physician’s time, and that each of his other patients had transactional medical care, not the comprehensive medical care that they might benefit from.
We in medicine need much more than electronic connectivity and meaningful use. We need to allow technology to actually shoulder more of the burden of our healthcare delivery and adherence assurance: patients have only a few hours per year with a physician but spend the “other 5000 hours” making their own healthcare decisions. Often to their detriment.
Let’s look at diabetes and prediabetes. There are an estimated 120,000,000 people in the US with these two conditions. It is estimated that within my lifespan, one in three Americans will have diabetes. Can we expect physicians to engage this size of a population in a meaningful way given the current approach? Just this one group of patients is enough to totally consume every physician, nurse and diabetic educator in the US.
We (meaning the entire health care system) must engage not only the patient, but also technology, to enable us to fully reach meaningful use. The technology exists; it just needs to be deployed. Siri-likevirtual health assistants, under the control of physicians and other experts in medical engagement, can reside on the smartphone of patients and coordinate all of a patient’s healthcare needs.
The whole concept of a virtual health assistant became possible because of three factors: the development and widespread adoption of smartphones, the capability to not only recognize speech but also to understand its meaning (termed natural language processing) and the enormous power of cloud based computing.
To stay with the example of diabetes, a virtual health assistant can track exercise, calories used and consumed, blood glucose measurements, weight and drug adherence. It can provide reminders, create competition for groups to meet specific goals, report pre-defined healthcare issues back to the EHR, alert physicians of urgent or emergent issues, provide education, answer literally tens of thousands of questions, provide menu planning, assist with a grocery list, provide “push” education to the patient… the list goes on and on.
Since the virtual health assistant can talk to the patient, it can use motivational interviewing techniques to enter into conversations with people, breaking down resistance and helping them make sense of their disease and treatment. It can deal with the barriers to proper adherence.
These agents are capable of creating true relationships with people to aid them in their quest for health. In fact, there is evidence that people actually prefer a computer over a human.
Meaningful use is a good starting point, but the next step is to develop, using existing technology, an “intelligent engagement” approach through the use of virtual health assistants. Do we have any other viable, scalable, affordable options?