About the Author
Dr. Jeff Livingston is an Obgyn practicing in Irving, Texas, in the US. He is the CEO of MacArthur Medical Center, a founder of Medika Life, and EIC of BeingWell. He is an eager adopter of new technology and holds interests in various medical startups.
The More Things Change in Digital Health, the More They Stay the Same
Sharing my 20-year experience in private practice
Will 2021 be a remarkable year for health innovation? Healthcare needed a shove to throw out our fax machines and use new tools to improve our lives and the care we provide.Covid-19 converted digital health into a necessary survival tool. It’s no longer a luxury.
The pandemic forced many technology companies to tap the brakes, but digital health innovators and entrepreneurs are finding opportunities to make meaningful change and impact healthcare.
Will digital health pioneers launch us into the next generation of innovation, or will developers fall into the same old traps of nonintegrated data silos and apps filled with features but devoid of purpose?
I am a full-time practicing Obgyn in Irving, Texas, and also serve as the MacArthur Medical Center CEO. Innovation is one of our companies core values and helped expand our home base in Irving, Texas office from three providers in 2003 to our now 32 providers spread across five locations in Dallas/Fort Worth. We were also able to develop a pediatric service line to continue caring for our brand new little Texans.
No medical practice can be successful without some basic integration of health technology. That being said, the digital health landscape is complex and expensive, making it almost impossible for independent practice to compete with large medical conglomerates and integrated health systems.
While technology is an essential aspect of providing care, the reality is practicing physicians are often emotionally disconnected from the technology touching their fingertips.
Doctors do not want to become technologists. We want to see patients and provide care. But to even open the office doors, a complex mix of disparate technology must be in place and maintained.
Physicians must learn these systems or pay the high price of outsourcing the management to third-party companies.
Basic technology needs for a medical practice
- Communication platform and phone system
- Practice management system
- Electronic Health Record
- Cloud storage
- Revenue cycle management system
- Internet Security system
Without these baseline systems, a medical practice can not function. Also, most medical practices need a:
- Patient portal
- Local laboratory interface for direct physician order
- Electronic prescription system
- Online scheduling system
- State vaccine authorities interface like ImmTrac.
- State narcotic monitoring systems interface
- Telehealth system
These baseline office technologies lay the foundation for a functional practice. While essential, most of these systems operate in the background. Physicians generally only think about them when something is not working.
A forgotten password or an overnight software update makes physicians’ heads spin.
Electronic Health Records (EHR) needed a major reboot.
In 2005, we made the jump from mountains of paper charts to an electronic health record. EHRs are an essential tool for any private medical practice, but the costs of upkeep, cloud storage, and data security add frustrating overhead expenses.
Most major EHR systems have added minor upgrades over the last decade, but none have upended the entire paradigm to create a patient and provider-friendly user-interface. Instead, health providers spend most of their days as glorified data-entry clerks.
Upcoming requirements by the CURES act may make EHR documentation even worse. The current published guidelines will force health providers to spend even more time entering information instead of providing direct patient care. The CURES act acknowledges the time requirement by incorporating documentation time into the CPT coding level of service. A better approach would have been to improve the EHR experience allowing doctors to spend more face to face with patients.
A few companies offer services to trim around the edges and make marginal improvements for doctors and patients. M-modal offers front-end AI-driven voice recognition to assist in EHR documentation. Vital Interactions helps improve the patient experience by facilitating a HIPPA compliant messaging system that interacts with an office practice management system. Updox helps with automated document sorting of the endless flow of incoming forms, imaging results, and outside medical records.
We use all of these technology add-ons in our practice. While they improve our efficiency and experience, no technology company has changed the game. EHRs are clunky, poorly designed databases more equipped to facilitate billing and coding than to provide an enjoyable user interface for health providers.
Our phone is our most important piece of technology.
Despite all of the health technology innovations, our cell phone is still the most important technological tool we own. We log in to our various hospitals through interface apps like Haiku. We monitor patient progress in labor and delivery through Airstrip Ob. We send electronic prescriptions using dual authenticators. We perform HIPPA compliant virtual visits through Telehealth platforms like Healthtap or Doximity Dialer.
We cross-reference medications on Epocrates and study the latest research on Uptodate.com. We complete most hospital credentialing and peer review processes through Docusign, and hospital department meetings now take place virtually on Zoom.
While these apps are beneficial for practicing physicians, many patient-facing apps still have a long way to go.
Most health apps are not useful.
The explosion of health apps forced doctors into the health technology equation. Patients use apps for weight loss, calorie counting, exercise, ovulation calculation, meditation, and glucose monitoring.
The crazy thing is, in 2021, app developers have still not found a way to make this data available to physicians in a simple and actionable way. Disparate, closed data legacy systems prohibit the seamless integration of patient data. As a result, physicians can not utilize most of the health data collected by patients. Patients collect enormous amounts of data, and their doctors have no practical way of putting it to use.
Physician life was much simpler when all we had was a pager and a stethoscope.
Most health technology developers and companies fail to understand the physician workflow and mindset. Instead, developers focus on an app’s features saying, “Look what this app can do.” None of the features matter if the core purpose is unclear and the usability is not inherently intuitive. Health apps would be best served by focusing on the “Why” and “How.”
Every developer should answer the fundamental question of who the product helps and what problem it solves. Most companies forget this fundamental idea, and as a result, most health apps and health technology fail to gain traction.
Feature-filled products devoid of purpose lead to physicians’ resistance to new technology and health innovations. We love fancy new toys, but we have learned from years of experience to be skeptically cautious with sparkly and shiny objects.
We are exposed to new medications, therapeutics, surgical devices, and novel lab tests. Each “pitch” forces us to decide whether or not to integrate it into our practice. Decisions making involves analyzing safety, efficacy, cost, and utility.
My two rules for technology adoption are simple.
- The product needs to make physicians’ lives easier.
- The product needs to make the care we provide our patients better.
Any technology that does not meet these basic ideas gets tossed into the wastebasket.
Technology extends physicians’ care doctors beyond the four walls of the office.
Free tools on the internet house excellent tools physicians can harness to expand their reach. Instead of helping one person at a time, health providers can share knowledge, combat misinformation, and help others at scale.
Most private practices still fail to mobilize the internet’s power and take control of their digital footprint. Instead, their online reputation is created by others through third-party review sites.
Online reputation management is one of the most critical aspects of private practice success. If patients can not find you, you can not help them.
Integrating the creative use of social media as a patient outreach tool is a central element of our 20 years of practice growth. We started in the pre-HIPAA days, navigating our way through the Wild West of the internet. First, there was Myspace. Then, Facebook and Twitter joined the party. Few medical practices were using these platforms, but we found ways to leverage them into patient outreach, education, and new patient acquisition tools.
Now, the options for patient education and outreach have expanded beyond the old school social media platforms. Physicians are finding creating ways to use video through YouTube, Instagram, and Tik Tok. Blogging platforms like Medika Life, Medium, Vocal Media, and Newsbreak expand physician’s reach beyond their practice website.
2021 can be a digital health breakthrough year
The pandemic created a once-in-a-lifetime opportunity for health innovation. Everyone is looking for ways to improve care, cut costs and create a safe workplace. Private practice physicians and large health systems are ready and willing to invest the time and energy to integrate new technology to reach these goals.
I caution all to remember healthcare is about human connection.
When we strip away all the technology bells and whistles, we are left with a patient in need and a doctor to help.
Technology is only a tool to help us get to the powerful moment when a provider looks into a patient’s eyes and says, “How can I help you today?”
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