David Lee Scher, MD

Much has been said about the failures of electronic health records. The shortcomings discussed have ranged from lack of cost benefits to interoperability with medical devices and security of interoperability with medical devices. We use IT via computers or smartphones daily for social, financial, or consumer aspects of lives. Health care has lagged behind other sectors of society in the adoption of digital technology because of regulatory issues, cost, and resistance to change. There are many positive aspects of EHRs, some more obvious than others.

They are what patients expect.

Patients live in the digital world. Seventy-eight percent of office-based physicians use an EHR, according to a study in the journal Health Affairs. Patients expect that their test results and records are easily accessible by all their providers. The promise of interoperability – the easy digital transfer of data from one data source or EHR system to another – has yet to be realized. This is one of the fundamental potential benefits of digital health technology. HIMSS, an advocacy organization focused on better health with information technology, has sent to Congress its recommendations on achieving interoperability within the next 3 years. This is a pivotal issue in creating the EHR envisioned by both patients and physicians.

They can be used to mitigate risk management.

Adoption of any significant change in health care practice presents challenges specifically with regards to risk management. HIPAA privacy regulations and security are of paramount importance. Most risk managers deal with legal issues after an incident has occurred. Digital health technologies can also potentially mitigate risk.

They can (Yes!) enhance the patient encounter.

While many physicians believe that EHRs destroy the patient encounter, there is another way of viewing the interaction. It all depends upon how it is presented in the office. The computer screen may impede the all-important eye contact between the physician and patient (either because of the physical presence of the screen or the physician’s persistent gaze at it). This is a surefire recipe for disengagement and subsequent destruction of the patient-physician relationship. However, the introduction of the computer (asking permission to use it) with physician and patient triangulated with the screen produces a care team atmosphere. Demonstrating the EHR’s functionality while highlighting pertinent clinical information provides a positive experience for both participants.

They brought health care into the digital age.

EHRs are not the face of all of digital health technologies. They do represent the hub around which other technologies need to flow, because this is where the patient interfaces (pun intended) with the physician. Digital technologies will enhance patient engagement. EHRs are the first experience many physicians have with digital health technologies, and they have yet to fulfill their intended goals. They are in their first iteration. Physician groups and health care enterprises have made themselves heard to the EHR vendors and change is coming. Other digital health technologies are here and will improve health care on many fronts. They themselves will transform the EHR into a more useful clinical tool, which will increase patient education, engagement, and connectivity.

They will be much different and better in the near future.

The American Medical Association got it right, in my opinion, with respect to its recommendations for design overhaul of EHRs. The organization outlined an extension of its study with the Rand Corp. and listed priorities of what should constitute design overhaul of the EHR. These include the incorporation of tools that support team-based care, promotion of care coordination among providers, product modularity and ability for configuration, the reduction of cognitive workload, the promotion of data liquidity, the facilitation of digital and mobile patient engagement, and the ability to expedite user input into design and postimplementation feedback.

As digital technology becomes a more substantive part of health care, there will be a need for physician IT champions who can make this process easier and more fulfilling for others. I look forward to seeing this happen.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

Much has been said about the failures of electronic health records. The shortcomings discussed have ranged from lack of cost benefits to interoperability with medical devices and security of interoperability with medical devices. We use IT via computers or smartphones daily for social, financial, or consumer aspects of lives. Health care has lagged behind other sectors of society in the adoption of digital technology because of regulatory issues, cost, and resistance to change. There are many positive aspects of EHRs, some more obvious than others.

They are what patients expect.

Patients live in the digital world. Seventy-eight percent of office-based physicians use an EHR, according to a study in the journal Health Affairs. Patients expect that their test results and records are easily accessible by all their providers. The promise of interoperability – the easy digital transfer of data from one data source or EHR system to another – has yet to be realized. This is one of the fundamental potential benefits of digital health technology. HIMSS, an advocacy organization focused on better health with information technology, has sent to Congress its recommendations on achieving interoperability within the next 3 years. This is a pivotal issue in creating the EHR envisioned by both patients and physicians.

They can be used to mitigate risk management.

Adoption of any significant change in health care practice presents challenges specifically with regards to risk management. HIPAA privacy regulations and security are of paramount importance. Most risk managers deal with legal issues after an incident has occurred. Digital health technologies can also potentially mitigate risk.

They can (Yes!) enhance the patient encounter.

While many physicians believe that EHRs destroy the patient encounter, there is another way of viewing the interaction. It all depends upon how it is presented in the office. The computer screen may impede the all-important eye contact between the physician and patient (either because of the physical presence of the screen or the physician’s persistent gaze at it). This is a surefire recipe for disengagement and subsequent destruction of the patient-physician relationship. However, the introduction of the computer (asking permission to use it) with physician and patient triangulated with the screen produces a care team atmosphere. Demonstrating the EHR’s functionality while highlighting pertinent clinical information provides a positive experience for both participants.

They brought health care into the digital age.

EHRs are not the face of all of digital health technologies. They do represent the hub around which other technologies need to flow, because this is where the patient interfaces (pun intended) with the physician. Digital technologies will enhance patient engagement. EHRs are the first experience many physicians have with digital health technologies, and they have yet to fulfill their intended goals. They are in their first iteration. Physician groups and health care enterprises have made themselves heard to the EHR vendors and change is coming. Other digital health technologies are here and will improve health care on many fronts. They themselves will transform the EHR into a more useful clinical tool, which will increase patient education, engagement, and connectivity.

They will be much different and better in the near future.

The American Medical Association got it right, in my opinion, with respect to its recommendations for design overhaul of EHRs. The organization outlined an extension of its study with the Rand Corp. and listed priorities of what should constitute design overhaul of the EHR. These include the incorporation of tools that support team-based care, promotion of care coordination among providers, product modularity and ability for configuration, the reduction of cognitive workload, the promotion of data liquidity, the facilitation of digital and mobile patient engagement, and the ability to expedite user input into design and postimplementation feedback.

As digital technology becomes a more substantive part of health care, there will be a need for physician IT champions who can make this process easier and more fulfilling for others. I look forward to seeing this happen.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

Much has been said about the failures of electronic health records. The shortcomings discussed have ranged from lack of cost benefits to interoperability with medical devices and security of interoperability with medical devices. We use IT via computers or smartphones daily for social, financial, or consumer aspects of lives. Health care has lagged behind other sectors of society in the adoption of digital technology because of regulatory issues, cost, and resistance to change. There are many positive aspects of EHRs, some more obvious than others.

They are what patients expect.

Patients live in the digital world. Seventy-eight percent of office-based physicians use an EHR, according to a study in the journal Health Affairs. Patients expect that their test results and records are easily accessible by all their providers. The promise of interoperability – the easy digital transfer of data from one data source or EHR system to another – has yet to be realized. This is one of the fundamental potential benefits of digital health technology. HIMSS, an advocacy organization focused on better health with information technology, has sent to Congress its recommendations on achieving interoperability within the next 3 years. This is a pivotal issue in creating the EHR envisioned by both patients and physicians.

They can be used to mitigate risk management.

Adoption of any significant change in health care practice presents challenges specifically with regards to risk management. HIPAA privacy regulations and security are of paramount importance. Most risk managers deal with legal issues after an incident has occurred. Digital health technologies can also potentially mitigate risk.

They can (Yes!) enhance the patient encounter.

While many physicians believe that EHRs destroy the patient encounter, there is another way of viewing the interaction. It all depends upon how it is presented in the office. The computer screen may impede the all-important eye contact between the physician and patient (either because of the physical presence of the screen or the physician’s persistent gaze at it). This is a surefire recipe for disengagement and subsequent destruction of the patient-physician relationship. However, the introduction of the computer (asking permission to use it) with physician and patient triangulated with the screen produces a care team atmosphere. Demonstrating the EHR’s functionality while highlighting pertinent clinical information provides a positive experience for both participants.

They brought health care into the digital age.

EHRs are not the face of all of digital health technologies. They do represent the hub around which other technologies need to flow, because this is where the patient interfaces (pun intended) with the physician. Digital technologies will enhance patient engagement. EHRs are the first experience many physicians have with digital health technologies, and they have yet to fulfill their intended goals. They are in their first iteration. Physician groups and health care enterprises have made themselves heard to the EHR vendors and change is coming. Other digital health technologies are here and will improve health care on many fronts. They themselves will transform the EHR into a more useful clinical tool, which will increase patient education, engagement, and connectivity.

They will be much different and better in the near future.

The American Medical Association got it right, in my opinion, with respect to its recommendations for design overhaul of EHRs. The organization outlined an extension of its study with the Rand Corp. and listed priorities of what should constitute design overhaul of the EHR. These include the incorporation of tools that support team-based care, promotion of care coordination among providers, product modularity and ability for configuration, the reduction of cognitive workload, the promotion of data liquidity, the facilitation of digital and mobile patient engagement, and the ability to expedite user input into design and postimplementation feedback.

As digital technology becomes a more substantive part of health care, there will be a need for physician IT champions who can make this process easier and more fulfilling for others. I look forward to seeing this happen.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

All current health care initiatives, whether overseen by providers, insurers, Pharma, or other industries, are focused on patient engagement. This overused but important term implies the active participation of patients in their own care. It implies that patients have the best means and educational resources available to them. Traditionally, patient education is achieve via face-to-face discussions with the physician or nurse or via third-party, preprinted written materials. Even now, 70% of patients report getting their medical information from physicians or nurses, according to a survey by the Pew Internet Research Project.

That said, more and more patients are seeking health information online – 60% of U.S. adults reported doing so within the past year, the Pew survey found.

Patients and caregivers are now becoming mobile. Baby boomers are becoming “seniors” at the rate of 8,000 per day. Mobile health digital tools can take the form of apps, multimedia offerings of videos, printable patient instructions, disease state education, and follow-up appointment reminders. These can be done with proprietary third-party platforms, or SAAS (software as a service), or practice developed and available via a portal on a website. The reason for this lies in its relevancy and the critical need for education at that corner the patient and caregiver are turning. I will discuss five touch points that are important to the patient and optimal for delivering digital health tools.

• Office encounter for a new medical problem. When a patient is seen for a new clinical problem, there is a seemingly overwhelming amount of new information transmitted. This involves the definition and description of the diagnosis; the level of severity; implications for life expectancy, occupation, and lifestyle; and the impact on others. Often patients focus on the latter issues and not the medical aspects including treatment purpose, options, and impact. Much of what was discussed with them at the encounter is forgotten. After all, how much can patients learn in a 15-minute visit? The ability to furnish patients with a digital replay of their encounter, along with educational materials pertinent to a diagnosis or recommended testing/procedure, is appealing. A company with the technology to do that is Liberate Health. (Ed. note: This publication’s parent company has a relationship with Liberate Health. Dr. Scher leads Liberate’s Digital Clinician Advisory group.) Of course, not all patients learn the same way. Guidelines on how to choose the most effective patient education material have been updated by the National Institutes of Health.

• Seeing a new health care provider. Walking into a new physician’s office is always intimidating. The encounter includes exploring personalities while discussing the clinical aspects of the visit. Compatibility with regards to treatment philosophy should be of paramount concern to the patient. Discussion surrounding how the physician communicates with and supports the patient experience goes a long way in creating a good physician-patient relationship. The mention of digital tools to recommend (apps, links to reliable website) conveys empathy, which is critical to patient engagement.

• Recommendation for new therapy, test, or procedure. While a patient’s head is swimming thinking about what will be found and recommended after a test or procedure is discussed, specifics about the test itself can be lost. Support provided via easy-to-understand digital explanation and visuals, viewed at a patient’s convenience and shared with a caregiver, seem like a no-brainer.

• Hospital discharge. The hospital discharge process is a whirlwind of explanations, instructions, and hopefully, follow-up appointments. It is usually crammed into a few minutes. In one study, only 42% of patients being discharged were able to state their diagnosis or diagnoses and even fewer (37%) were able to identify the purpose of all the medications they were going home on (Mayo Clin. Proc. 2005;80:991-4). Another larger study describes the mismatch between thoroughness of written instructions and patient understanding (JAMA Intern. Med. 2013;173:1715-22). Again, digital instructions reviewed at a convenient time and place would facilitate understanding.

• Becoming a caregiver. No one teaches a family member how to become a caregiver. It’s even harder than becoming a parent which is often facilitated by observation while growing up. Caregiving is often thrust upon someone with an untimely diagnosis of a loved one. There is upheaval on emotional, physical, and logistical levels. Caregivers are critical in the adoption of mobile health technologies. They need to be included in the delivery of these tools for a couple of reasons: They will likely be more digital savvy than the elderly patient is, and they need to have accurate information to be a better caregiver. They are the “silent majority” of health care stakeholders and probably the most critical.

It is not difficult to see how digital technology tools can help the physician-patient relationship by making the patient a better partner in care. While adoption of these tools will not happen overnight, it will happen.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

All current health care initiatives, whether overseen by providers, insurers, Pharma, or other industries, are focused on patient engagement. This overused but important term implies the active participation of patients in their own care. It implies that patients have the best means and educational resources available to them. Traditionally, patient education is achieve via face-to-face discussions with the physician or nurse or via third-party, preprinted written materials. Even now, 70% of patients report getting their medical information from physicians or nurses, according to a survey by the Pew Internet Research Project.

That said, more and more patients are seeking health information online – 60% of U.S. adults reported doing so within the past year, the Pew survey found.

Patients and caregivers are now becoming mobile. Baby boomers are becoming “seniors” at the rate of 8,000 per day. Mobile health digital tools can take the form of apps, multimedia offerings of videos, printable patient instructions, disease state education, and follow-up appointment reminders. These can be done with proprietary third-party platforms, or SAAS (software as a service), or practice developed and available via a portal on a website. The reason for this lies in its relevancy and the critical need for education at that corner the patient and caregiver are turning. I will discuss five touch points that are important to the patient and optimal for delivering digital health tools.

• Office encounter for a new medical problem. When a patient is seen for a new clinical problem, there is a seemingly overwhelming amount of new information transmitted. This involves the definition and description of the diagnosis; the level of severity; implications for life expectancy, occupation, and lifestyle; and the impact on others. Often patients focus on the latter issues and not the medical aspects including treatment purpose, options, and impact. Much of what was discussed with them at the encounter is forgotten. After all, how much can patients learn in a 15-minute visit? The ability to furnish patients with a digital replay of their encounter, along with educational materials pertinent to a diagnosis or recommended testing/procedure, is appealing. A company with the technology to do that is Liberate Health. (Ed. note: This publication’s parent company has a relationship with Liberate Health. Dr. Scher leads Liberate’s Digital Clinician Advisory group.) Of course, not all patients learn the same way. Guidelines on how to choose the most effective patient education material have been updated by the National Institutes of Health.

• Seeing a new health care provider. Walking into a new physician’s office is always intimidating. The encounter includes exploring personalities while discussing the clinical aspects of the visit. Compatibility with regards to treatment philosophy should be of paramount concern to the patient. Discussion surrounding how the physician communicates with and supports the patient experience goes a long way in creating a good physician-patient relationship. The mention of digital tools to recommend (apps, links to reliable website) conveys empathy, which is critical to patient engagement.

• Recommendation for new therapy, test, or procedure. While a patient’s head is swimming thinking about what will be found and recommended after a test or procedure is discussed, specifics about the test itself can be lost. Support provided via easy-to-understand digital explanation and visuals, viewed at a patient’s convenience and shared with a caregiver, seem like a no-brainer.

• Hospital discharge. The hospital discharge process is a whirlwind of explanations, instructions, and hopefully, follow-up appointments. It is usually crammed into a few minutes. In one study, only 42% of patients being discharged were able to state their diagnosis or diagnoses and even fewer (37%) were able to identify the purpose of all the medications they were going home on (Mayo Clin. Proc. 2005;80:991-4). Another larger study describes the mismatch between thoroughness of written instructions and patient understanding (JAMA Intern. Med. 2013;173:1715-22). Again, digital instructions reviewed at a convenient time and place would facilitate understanding.

• Becoming a caregiver. No one teaches a family member how to become a caregiver. It’s even harder than becoming a parent which is often facilitated by observation while growing up. Caregiving is often thrust upon someone with an untimely diagnosis of a loved one. There is upheaval on emotional, physical, and logistical levels. Caregivers are critical in the adoption of mobile health technologies. They need to be included in the delivery of these tools for a couple of reasons: They will likely be more digital savvy than the elderly patient is, and they need to have accurate information to be a better caregiver. They are the “silent majority” of health care stakeholders and probably the most critical.

It is not difficult to see how digital technology tools can help the physician-patient relationship by making the patient a better partner in care. While adoption of these tools will not happen overnight, it will happen.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

All current health care initiatives, whether overseen by providers, insurers, Pharma, or other industries, are focused on patient engagement. This overused but important term implies the active participation of patients in their own care. It implies that patients have the best means and educational resources available to them. Traditionally, patient education is achieve via face-to-face discussions with the physician or nurse or via third-party, preprinted written materials. Even now, 70% of patients report getting their medical information from physicians or nurses, according to a survey by the Pew Internet Research Project.

That said, more and more patients are seeking health information online – 60% of U.S. adults reported doing so within the past year, the Pew survey found.

Patients and caregivers are now becoming mobile. Baby boomers are becoming “seniors” at the rate of 8,000 per day. Mobile health digital tools can take the form of apps, multimedia offerings of videos, printable patient instructions, disease state education, and follow-up appointment reminders. These can be done with proprietary third-party platforms, or SAAS (software as a service), or practice developed and available via a portal on a website. The reason for this lies in its relevancy and the critical need for education at that corner the patient and caregiver are turning. I will discuss five touch points that are important to the patient and optimal for delivering digital health tools.

• Office encounter for a new medical problem. When a patient is seen for a new clinical problem, there is a seemingly overwhelming amount of new information transmitted. This involves the definition and description of the diagnosis; the level of severity; implications for life expectancy, occupation, and lifestyle; and the impact on others. Often patients focus on the latter issues and not the medical aspects including treatment purpose, options, and impact. Much of what was discussed with them at the encounter is forgotten. After all, how much can patients learn in a 15-minute visit? The ability to furnish patients with a digital replay of their encounter, along with educational materials pertinent to a diagnosis or recommended testing/procedure, is appealing. A company with the technology to do that is Liberate Health. (Ed. note: This publication’s parent company has a relationship with Liberate Health. Dr. Scher leads Liberate’s Digital Clinician Advisory group.) Of course, not all patients learn the same way. Guidelines on how to choose the most effective patient education material have been updated by the National Institutes of Health.

• Seeing a new health care provider. Walking into a new physician’s office is always intimidating. The encounter includes exploring personalities while discussing the clinical aspects of the visit. Compatibility with regards to treatment philosophy should be of paramount concern to the patient. Discussion surrounding how the physician communicates with and supports the patient experience goes a long way in creating a good physician-patient relationship. The mention of digital tools to recommend (apps, links to reliable website) conveys empathy, which is critical to patient engagement.

• Recommendation for new therapy, test, or procedure. While a patient’s head is swimming thinking about what will be found and recommended after a test or procedure is discussed, specifics about the test itself can be lost. Support provided via easy-to-understand digital explanation and visuals, viewed at a patient’s convenience and shared with a caregiver, seem like a no-brainer.

• Hospital discharge. The hospital discharge process is a whirlwind of explanations, instructions, and hopefully, follow-up appointments. It is usually crammed into a few minutes. In one study, only 42% of patients being discharged were able to state their diagnosis or diagnoses and even fewer (37%) were able to identify the purpose of all the medications they were going home on (Mayo Clin. Proc. 2005;80:991-4). Another larger study describes the mismatch between thoroughness of written instructions and patient understanding (JAMA Intern. Med. 2013;173:1715-22). Again, digital instructions reviewed at a convenient time and place would facilitate understanding.

• Becoming a caregiver. No one teaches a family member how to become a caregiver. It’s even harder than becoming a parent which is often facilitated by observation while growing up. Caregiving is often thrust upon someone with an untimely diagnosis of a loved one. There is upheaval on emotional, physical, and logistical levels. Caregivers are critical in the adoption of mobile health technologies. They need to be included in the delivery of these tools for a couple of reasons: They will likely be more digital savvy than the elderly patient is, and they need to have accurate information to be a better caregiver. They are the “silent majority” of health care stakeholders and probably the most critical.

It is not difficult to see how digital technology tools can help the physician-patient relationship by making the patient a better partner in care. While adoption of these tools will not happen overnight, it will happen.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

When technology is mentioned in the context of health care, it is often received as an impersonal, profit- or regulatory-driven interface between a provider and patient. If designed – hopefully with a clinician involved – with the purpose of actually solving a problem, digital technology will ultimately gain favor. Examples of such tools include links and apps which provide reference information. Epocrates and doximity on the provider side and WebMD on the consumer/patient side are prime examples. There are increasingly more digital tools for patients and caregivers to help them improve self-participation in their health care as well as to navigate the system. The challenge in the health care technology space is to make people (both providers and patients) aware of them, to facilitate use, and to incorporate relevant and actionable data seamlessly into the patient’s electronic record. Technology needs to be designed in a way in which it conforms to the clinical work flow between the patient and provider. I will give examples of available tools that can improve a patient’s daunting journey. I do not have any financial or other affiliation with any companies mentioned.

1. They can help prepare for the office visit.

I don’t know why, but patients have evolved a belief that they need to present a self-diagnosed condition at the office visit. They often feel guilty not providing the diagnosis. I believe firmly (and tell patients) that their responsibility is to know when something isn’t right and to call the provider. Notwithstanding this, I encourage patients to do online research into their symptoms. Tools found at FamilyDoctor.org, the Mayo Clinic Symptom Checker, or iTriage can help frame thoughts or prompt a discussion with a caregiver prior to a visit, which can then serve as a foundation for the office encounter.

2. Patient education content.

The term “patient engagement” is used commonly today. It implies the active participation of the patient in health care and disease management. Many believe that patient engagement should be focused on medication adherence. While this is critical, it remains a reflection of a patient’s understanding of diagnosis; long-term treatment goals (which need be personalized per a discussion about them); and the components of the treatment itself, which include lifestyle changes and nontraditional pharmacologic therapies as well. Seeing disease through a patient’s eyes (empathy) is the key to good relationships that in turn promote engagement. Excellent digital patient education tools are now available for download and review by patients and caregivers. They explain diagnoses, tests, procedures, and medications. Some are proprietary and made by pharmaceutical and medical device companies, while others are produced by third-party companies that allow the provider to white label the product or even customize the content. One excellent example is Liberate Health. (Ed. note: This publication’s parent company has a relationship with Liberate Health.)

3. Social media.

This is where the patients and caregivers are. It follows then that social media is where providers should be. There are some excellent online patient communities that contain disease-specific groups. Examples are Smart Patients and Treatment Diaries. Social media is a big part of motivating patients and giving support to them and to caregivers. It allows for information exchange in a convenient, relaxing, and nonthreatening setting. While skeptics might question the validity of medical information and advice on these sites, I would say that encouraging patients to participate shows empathy. If a disclaimer is offered stating that this is not a substitute for a health care provider, it can be a significant source of support.

4. Connections to caregivers.

Caregivers are left out of many digital health tools. A good working definition of a caregiver is “an unpaid individual (a spouse, partner, family member, friend, or neighbor) involved in assisting others with activities of daily living and/or medical tasks.” About 29% of the U.S. adult population (65.7 million) provides care to someone who is ill, disabled, or aged. Other statistics about caregivers are more impressive. Health and medical apps are promising tools that can be offered to patients. The rubber has yet to fully meet the road in this arena for a few reasons, many of which are tied to the reputation, usability, and priorities of present electronic health record vendors who represent the face of digital health technology to most physicians and other health care providers. However, there is little denial that they (and other mobile health tools) will play an important role in health care’s future. Both patients and caregivers have expressed what is desired in a mobile app. As aging at home becomes a necessary goal of health care from social, financial, and societal standpoints, caregivers will assume an even greater portion of care.

5. Provide for better continuity of care.

Lack of continuity of care leading to medical errors is not a new topic of discussion. This is relevant in both the inpatient and the outpatient setting. Mobile digital technologies can reduce errors by improving communication to both providers and patients as well as among providers themselves. Use of digital tablets at the bedside by patients can improve provider-patient communication and decrease errors. Handoff of patients among providers is another opportunity for mobile health tools to decrease errors. One such app is Smart Sign Out. Ultimately, any tool that decreases errors is a patient advocate tool.

While some physicians believe that patient advocacy is distinct from patient care, I submit that patient advocacy is something any good physician does every day with every patient, including conveying empathy, providing easy to understand explanations of conditions, and offering advice to be considered in a shared decision-making process. We all enter the field of medicine because we want to contribute to the well-being of others. Let’s not lose sight of that, and let’s look to available and emerging technologies to assist us in this mission.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

When technology is mentioned in the context of health care, it is often received as an impersonal, profit- or regulatory-driven interface between a provider and patient. If designed – hopefully with a clinician involved – with the purpose of actually solving a problem, digital technology will ultimately gain favor. Examples of such tools include links and apps which provide reference information. Epocrates and doximity on the provider side and WebMD on the consumer/patient side are prime examples. There are increasingly more digital tools for patients and caregivers to help them improve self-participation in their health care as well as to navigate the system. The challenge in the health care technology space is to make people (both providers and patients) aware of them, to facilitate use, and to incorporate relevant and actionable data seamlessly into the patient’s electronic record. Technology needs to be designed in a way in which it conforms to the clinical work flow between the patient and provider. I will give examples of available tools that can improve a patient’s daunting journey. I do not have any financial or other affiliation with any companies mentioned.

1. They can help prepare for the office visit.

I don’t know why, but patients have evolved a belief that they need to present a self-diagnosed condition at the office visit. They often feel guilty not providing the diagnosis. I believe firmly (and tell patients) that their responsibility is to know when something isn’t right and to call the provider. Notwithstanding this, I encourage patients to do online research into their symptoms. Tools found at FamilyDoctor.org, the Mayo Clinic Symptom Checker, or iTriage can help frame thoughts or prompt a discussion with a caregiver prior to a visit, which can then serve as a foundation for the office encounter.

2. Patient education content.

The term “patient engagement” is used commonly today. It implies the active participation of the patient in health care and disease management. Many believe that patient engagement should be focused on medication adherence. While this is critical, it remains a reflection of a patient’s understanding of diagnosis; long-term treatment goals (which need be personalized per a discussion about them); and the components of the treatment itself, which include lifestyle changes and nontraditional pharmacologic therapies as well. Seeing disease through a patient’s eyes (empathy) is the key to good relationships that in turn promote engagement. Excellent digital patient education tools are now available for download and review by patients and caregivers. They explain diagnoses, tests, procedures, and medications. Some are proprietary and made by pharmaceutical and medical device companies, while others are produced by third-party companies that allow the provider to white label the product or even customize the content. One excellent example is Liberate Health. (Ed. note: This publication’s parent company has a relationship with Liberate Health.)

3. Social media.

This is where the patients and caregivers are. It follows then that social media is where providers should be. There are some excellent online patient communities that contain disease-specific groups. Examples are Smart Patients and Treatment Diaries. Social media is a big part of motivating patients and giving support to them and to caregivers. It allows for information exchange in a convenient, relaxing, and nonthreatening setting. While skeptics might question the validity of medical information and advice on these sites, I would say that encouraging patients to participate shows empathy. If a disclaimer is offered stating that this is not a substitute for a health care provider, it can be a significant source of support.

4. Connections to caregivers.

Caregivers are left out of many digital health tools. A good working definition of a caregiver is “an unpaid individual (a spouse, partner, family member, friend, or neighbor) involved in assisting others with activities of daily living and/or medical tasks.” About 29% of the U.S. adult population (65.7 million) provides care to someone who is ill, disabled, or aged. Other statistics about caregivers are more impressive. Health and medical apps are promising tools that can be offered to patients. The rubber has yet to fully meet the road in this arena for a few reasons, many of which are tied to the reputation, usability, and priorities of present electronic health record vendors who represent the face of digital health technology to most physicians and other health care providers. However, there is little denial that they (and other mobile health tools) will play an important role in health care’s future. Both patients and caregivers have expressed what is desired in a mobile app. As aging at home becomes a necessary goal of health care from social, financial, and societal standpoints, caregivers will assume an even greater portion of care.

5. Provide for better continuity of care.

Lack of continuity of care leading to medical errors is not a new topic of discussion. This is relevant in both the inpatient and the outpatient setting. Mobile digital technologies can reduce errors by improving communication to both providers and patients as well as among providers themselves. Use of digital tablets at the bedside by patients can improve provider-patient communication and decrease errors. Handoff of patients among providers is another opportunity for mobile health tools to decrease errors. One such app is Smart Sign Out. Ultimately, any tool that decreases errors is a patient advocate tool.

While some physicians believe that patient advocacy is distinct from patient care, I submit that patient advocacy is something any good physician does every day with every patient, including conveying empathy, providing easy to understand explanations of conditions, and offering advice to be considered in a shared decision-making process. We all enter the field of medicine because we want to contribute to the well-being of others. Let’s not lose sight of that, and let’s look to available and emerging technologies to assist us in this mission.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

When technology is mentioned in the context of health care, it is often received as an impersonal, profit- or regulatory-driven interface between a provider and patient. If designed – hopefully with a clinician involved – with the purpose of actually solving a problem, digital technology will ultimately gain favor. Examples of such tools include links and apps which provide reference information. Epocrates and doximity on the provider side and WebMD on the consumer/patient side are prime examples. There are increasingly more digital tools for patients and caregivers to help them improve self-participation in their health care as well as to navigate the system. The challenge in the health care technology space is to make people (both providers and patients) aware of them, to facilitate use, and to incorporate relevant and actionable data seamlessly into the patient’s electronic record. Technology needs to be designed in a way in which it conforms to the clinical work flow between the patient and provider. I will give examples of available tools that can improve a patient’s daunting journey. I do not have any financial or other affiliation with any companies mentioned.

1. They can help prepare for the office visit.

I don’t know why, but patients have evolved a belief that they need to present a self-diagnosed condition at the office visit. They often feel guilty not providing the diagnosis. I believe firmly (and tell patients) that their responsibility is to know when something isn’t right and to call the provider. Notwithstanding this, I encourage patients to do online research into their symptoms. Tools found at FamilyDoctor.org, the Mayo Clinic Symptom Checker, or iTriage can help frame thoughts or prompt a discussion with a caregiver prior to a visit, which can then serve as a foundation for the office encounter.

2. Patient education content.

The term “patient engagement” is used commonly today. It implies the active participation of the patient in health care and disease management. Many believe that patient engagement should be focused on medication adherence. While this is critical, it remains a reflection of a patient’s understanding of diagnosis; long-term treatment goals (which need be personalized per a discussion about them); and the components of the treatment itself, which include lifestyle changes and nontraditional pharmacologic therapies as well. Seeing disease through a patient’s eyes (empathy) is the key to good relationships that in turn promote engagement. Excellent digital patient education tools are now available for download and review by patients and caregivers. They explain diagnoses, tests, procedures, and medications. Some are proprietary and made by pharmaceutical and medical device companies, while others are produced by third-party companies that allow the provider to white label the product or even customize the content. One excellent example is Liberate Health. (Ed. note: This publication’s parent company has a relationship with Liberate Health.)

3. Social media.

This is where the patients and caregivers are. It follows then that social media is where providers should be. There are some excellent online patient communities that contain disease-specific groups. Examples are Smart Patients and Treatment Diaries. Social media is a big part of motivating patients and giving support to them and to caregivers. It allows for information exchange in a convenient, relaxing, and nonthreatening setting. While skeptics might question the validity of medical information and advice on these sites, I would say that encouraging patients to participate shows empathy. If a disclaimer is offered stating that this is not a substitute for a health care provider, it can be a significant source of support.

4. Connections to caregivers.

Caregivers are left out of many digital health tools. A good working definition of a caregiver is “an unpaid individual (a spouse, partner, family member, friend, or neighbor) involved in assisting others with activities of daily living and/or medical tasks.” About 29% of the U.S. adult population (65.7 million) provides care to someone who is ill, disabled, or aged. Other statistics about caregivers are more impressive. Health and medical apps are promising tools that can be offered to patients. The rubber has yet to fully meet the road in this arena for a few reasons, many of which are tied to the reputation, usability, and priorities of present electronic health record vendors who represent the face of digital health technology to most physicians and other health care providers. However, there is little denial that they (and other mobile health tools) will play an important role in health care’s future. Both patients and caregivers have expressed what is desired in a mobile app. As aging at home becomes a necessary goal of health care from social, financial, and societal standpoints, caregivers will assume an even greater portion of care.

5. Provide for better continuity of care.

Lack of continuity of care leading to medical errors is not a new topic of discussion. This is relevant in both the inpatient and the outpatient setting. Mobile digital technologies can reduce errors by improving communication to both providers and patients as well as among providers themselves. Use of digital tablets at the bedside by patients can improve provider-patient communication and decrease errors. Handoff of patients among providers is another opportunity for mobile health tools to decrease errors. One such app is Smart Sign Out. Ultimately, any tool that decreases errors is a patient advocate tool.

While some physicians believe that patient advocacy is distinct from patient care, I submit that patient advocacy is something any good physician does every day with every patient, including conveying empathy, providing easy to understand explanations of conditions, and offering advice to be considered in a shared decision-making process. We all enter the field of medicine because we want to contribute to the well-being of others. Let’s not lose sight of that, and let’s look to available and emerging technologies to assist us in this mission.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

The influence of technology on the patient-physician relationship has been the subject of many discussions and publications. While a physician facing a computer screen throughout much of the office encounter is a vision no one believes is in the best interest of either the patient or the relationship, empathy as an admired professional trait and a successful tool in medicine is gaining support among the medical establishment. The question as to whether physicians can learn empathy has been examined. The benefits (real or potential) of digital technology in revitalizing this human interaction and technology’s potential to convey empathy must be considered. I will attempt to place some of these tools in a bit of a new light.

1. Encourage patients to utilize the patient portal.

Stage 2 of meaningful use requires that 5% of Medicare patients receive information via a patient portal; this has resulted in little less than an exercise in compliance. True interaction via the portal is not taking place. The catch-22 is that the portals provided by electronic health record (EHR) vendors are the least costly, but also the least useful. Providers are not enthusiastic about portals for good reason. Clinicians are fearful that office workflow cannot accommodate the potential volume of digital interactions. They also do not have the digital tools necessary to make the portal experience as beneficial as it can be.

Notwithstanding these barriers, I believe that a physician who encourages the use of the portal with conversations focused on patients’ participation in their own care will be seen as empathetic. Stressing the fact that the patient is being given a tool that delivers information (even if it is only a lab result) portrays the provider as a partner in care. The patient portal is the starting point of introducing patients to digital health technology. If it is the portal which is closest to the patient’s care touch point, other technologies will seem less intimidating and more relevant.

2. Prescribe apps and websites.

The days of a physician’s rolling eyes at a patient’s mention of information garnered on the Internet should be over. More than 90% of physicians use reference apps to treat patients. The power of digital technology to educate patients cannot be minimized. According to the Pew Research Internet Project (2013), one in three American adults have gone online to self-diagnose. Physicians agreed with that diagnosis 41% of the time. Is this reason to tout the Internet as a clinical diagnostician? I would hope not. However, it does demonstrate that the Digital Age of health care has arrived. It cannot be ignored. In the United Kingdom, the National Health Service will begin accrediting apps to be prescribed in 2015. If one thinks of patient education and self-monitoring instructions as important for patient care, then the natural extension of digitally delivering these tools should not send shock waves across the landscape. IMS Health offers technology for the prescribing of health apps and analytics for apps. Clearly, obstacles remain for app prescribing to enter mainstream medicine, the most significant being quality assurance regarding clinical effectiveness and data privacy and security. However, there are some excellent apps from which patients can benefit. In the nutritional arena, GoMeals and Fooducate are useful, as is Alivecor ECG for symptomatic heart rhythm monitoring. There are also several good smoking cessation apps. Further, there are text messaging programs which have proved not only popular but effective, specifically the smoking cessation offering SmokefreeTXT and the prenatal care program text4baby.

3. Participate in social media.

In 2010, the American Medical Association adopted guidelines for professionalism in social media. Among 22 other interesting statistics on health care in social media, are these two: More than 40% of consumers say that information found via social media affects the way they deal with their health, and 60% of social media users are the most likely to trust social media posts and activity by doctors over any other group.

4. Have your hospital start online patient support groups.

There are relative benefits to both in-person support groups and online patient support groups. My mother was a patient at a major cancer center, and I tweeted asking whether they had an online support group, as my mother enjoyed the in-person meetings, which she could no longer attend. The hospital account, having realized the importance of such outreach, responded with the establishment of an online group the following week. This type of patient service creates a sense of health care community, which is invaluable to both patient satisfaction and provider-patient relationships.

5. Utilize mobile technologies to facilitate patient engagement via self-monitoring.

The mere suggestion of recommending an app to have a patient log their blood pressure or follow their glucose is a signal of the importance of shared management and decision making. Apps that allow a person to track their activity or food consumption are simple yet meaningful. Patients are longing for tools they can use themselves or utilize as caregivers.

Empathy can be conveyed directly as emotional support or indirectly with actions described above. It is ironic that technology, cold and inhumane in a solitary context, can be transformed and seen as empathetic if it is offered in a humanistic way.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

The influence of technology on the patient-physician relationship has been the subject of many discussions and publications. While a physician facing a computer screen throughout much of the office encounter is a vision no one believes is in the best interest of either the patient or the relationship, empathy as an admired professional trait and a successful tool in medicine is gaining support among the medical establishment. The question as to whether physicians can learn empathy has been examined. The benefits (real or potential) of digital technology in revitalizing this human interaction and technology’s potential to convey empathy must be considered. I will attempt to place some of these tools in a bit of a new light.

1. Encourage patients to utilize the patient portal.

Stage 2 of meaningful use requires that 5% of Medicare patients receive information via a patient portal; this has resulted in little less than an exercise in compliance. True interaction via the portal is not taking place. The catch-22 is that the portals provided by electronic health record (EHR) vendors are the least costly, but also the least useful. Providers are not enthusiastic about portals for good reason. Clinicians are fearful that office workflow cannot accommodate the potential volume of digital interactions. They also do not have the digital tools necessary to make the portal experience as beneficial as it can be.

Notwithstanding these barriers, I believe that a physician who encourages the use of the portal with conversations focused on patients’ participation in their own care will be seen as empathetic. Stressing the fact that the patient is being given a tool that delivers information (even if it is only a lab result) portrays the provider as a partner in care. The patient portal is the starting point of introducing patients to digital health technology. If it is the portal which is closest to the patient’s care touch point, other technologies will seem less intimidating and more relevant.

2. Prescribe apps and websites.

The days of a physician’s rolling eyes at a patient’s mention of information garnered on the Internet should be over. More than 90% of physicians use reference apps to treat patients. The power of digital technology to educate patients cannot be minimized. According to the Pew Research Internet Project (2013), one in three American adults have gone online to self-diagnose. Physicians agreed with that diagnosis 41% of the time. Is this reason to tout the Internet as a clinical diagnostician? I would hope not. However, it does demonstrate that the Digital Age of health care has arrived. It cannot be ignored. In the United Kingdom, the National Health Service will begin accrediting apps to be prescribed in 2015. If one thinks of patient education and self-monitoring instructions as important for patient care, then the natural extension of digitally delivering these tools should not send shock waves across the landscape. IMS Health offers technology for the prescribing of health apps and analytics for apps. Clearly, obstacles remain for app prescribing to enter mainstream medicine, the most significant being quality assurance regarding clinical effectiveness and data privacy and security. However, there are some excellent apps from which patients can benefit. In the nutritional arena, GoMeals and Fooducate are useful, as is Alivecor ECG for symptomatic heart rhythm monitoring. There are also several good smoking cessation apps. Further, there are text messaging programs which have proved not only popular but effective, specifically the smoking cessation offering SmokefreeTXT and the prenatal care program text4baby.

3. Participate in social media.

In 2010, the American Medical Association adopted guidelines for professionalism in social media. Among 22 other interesting statistics on health care in social media, are these two: More than 40% of consumers say that information found via social media affects the way they deal with their health, and 60% of social media users are the most likely to trust social media posts and activity by doctors over any other group.

4. Have your hospital start online patient support groups.

There are relative benefits to both in-person support groups and online patient support groups. My mother was a patient at a major cancer center, and I tweeted asking whether they had an online support group, as my mother enjoyed the in-person meetings, which she could no longer attend. The hospital account, having realized the importance of such outreach, responded with the establishment of an online group the following week. This type of patient service creates a sense of health care community, which is invaluable to both patient satisfaction and provider-patient relationships.

5. Utilize mobile technologies to facilitate patient engagement via self-monitoring.

The mere suggestion of recommending an app to have a patient log their blood pressure or follow their glucose is a signal of the importance of shared management and decision making. Apps that allow a person to track their activity or food consumption are simple yet meaningful. Patients are longing for tools they can use themselves or utilize as caregivers.

Empathy can be conveyed directly as emotional support or indirectly with actions described above. It is ironic that technology, cold and inhumane in a solitary context, can be transformed and seen as empathetic if it is offered in a humanistic way.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

The influence of technology on the patient-physician relationship has been the subject of many discussions and publications. While a physician facing a computer screen throughout much of the office encounter is a vision no one believes is in the best interest of either the patient or the relationship, empathy as an admired professional trait and a successful tool in medicine is gaining support among the medical establishment. The question as to whether physicians can learn empathy has been examined. The benefits (real or potential) of digital technology in revitalizing this human interaction and technology’s potential to convey empathy must be considered. I will attempt to place some of these tools in a bit of a new light.

1. Encourage patients to utilize the patient portal.

Stage 2 of meaningful use requires that 5% of Medicare patients receive information via a patient portal; this has resulted in little less than an exercise in compliance. True interaction via the portal is not taking place. The catch-22 is that the portals provided by electronic health record (EHR) vendors are the least costly, but also the least useful. Providers are not enthusiastic about portals for good reason. Clinicians are fearful that office workflow cannot accommodate the potential volume of digital interactions. They also do not have the digital tools necessary to make the portal experience as beneficial as it can be.

Notwithstanding these barriers, I believe that a physician who encourages the use of the portal with conversations focused on patients’ participation in their own care will be seen as empathetic. Stressing the fact that the patient is being given a tool that delivers information (even if it is only a lab result) portrays the provider as a partner in care. The patient portal is the starting point of introducing patients to digital health technology. If it is the portal which is closest to the patient’s care touch point, other technologies will seem less intimidating and more relevant.

2. Prescribe apps and websites.

The days of a physician’s rolling eyes at a patient’s mention of information garnered on the Internet should be over. More than 90% of physicians use reference apps to treat patients. The power of digital technology to educate patients cannot be minimized. According to the Pew Research Internet Project (2013), one in three American adults have gone online to self-diagnose. Physicians agreed with that diagnosis 41% of the time. Is this reason to tout the Internet as a clinical diagnostician? I would hope not. However, it does demonstrate that the Digital Age of health care has arrived. It cannot be ignored. In the United Kingdom, the National Health Service will begin accrediting apps to be prescribed in 2015. If one thinks of patient education and self-monitoring instructions as important for patient care, then the natural extension of digitally delivering these tools should not send shock waves across the landscape. IMS Health offers technology for the prescribing of health apps and analytics for apps. Clearly, obstacles remain for app prescribing to enter mainstream medicine, the most significant being quality assurance regarding clinical effectiveness and data privacy and security. However, there are some excellent apps from which patients can benefit. In the nutritional arena, GoMeals and Fooducate are useful, as is Alivecor ECG for symptomatic heart rhythm monitoring. There are also several good smoking cessation apps. Further, there are text messaging programs which have proved not only popular but effective, specifically the smoking cessation offering SmokefreeTXT and the prenatal care program text4baby.

3. Participate in social media.

In 2010, the American Medical Association adopted guidelines for professionalism in social media. Among 22 other interesting statistics on health care in social media, are these two: More than 40% of consumers say that information found via social media affects the way they deal with their health, and 60% of social media users are the most likely to trust social media posts and activity by doctors over any other group.

4. Have your hospital start online patient support groups.

There are relative benefits to both in-person support groups and online patient support groups. My mother was a patient at a major cancer center, and I tweeted asking whether they had an online support group, as my mother enjoyed the in-person meetings, which she could no longer attend. The hospital account, having realized the importance of such outreach, responded with the establishment of an online group the following week. This type of patient service creates a sense of health care community, which is invaluable to both patient satisfaction and provider-patient relationships.

5. Utilize mobile technologies to facilitate patient engagement via self-monitoring.

The mere suggestion of recommending an app to have a patient log their blood pressure or follow their glucose is a signal of the importance of shared management and decision making. Apps that allow a person to track their activity or food consumption are simple yet meaningful. Patients are longing for tools they can use themselves or utilize as caregivers.

Empathy can be conveyed directly as emotional support or indirectly with actions described above. It is ironic that technology, cold and inhumane in a solitary context, can be transformed and seen as empathetic if it is offered in a humanistic way.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

It is clear at this point that physicians are not friends of electronic health records (EHRs). The predominant sentiment is that EHRs are costly (1/3 of providers are buying their second EHR system) and are poorly functional. Much has been said about the failures of EHRs. The shortcomings discussed have ranged from lack of cost benefits to interoperability with medical devices and security of interoperability with medical devices. Decreasing provider productivity and direct patient interaction time are also of concern. These opinions were raised in a ‘Medical Economics’ survey as well as a study by Rand Corporation. Interestingly, physicians do not desire to return to paper records. I will discuss what I call “The Five Important ‘I’s” of EHRs.

1. EHRs are not INTUITIVE. Navigating an EHR is akin to guessing what is behind Door Number 2 of “Let’s Make a Deal.” Documentation does not follow a provider’s thought process or the interaction workflow. It is built to meet regulatory and billing requirements. Many physicians are required to learn and be facile with different EHRs if they go to different hospitals. The AMA has called for a design overhaul of EHRs.

2. EHRs are IMPOSING. Providers are spending an inordinate amount of time with the EHR and less with patients. Most providers do not receive adequate training time, which is inversely related to privacy and security breaches. EHRs are inflexible and progressive practices with ambitious patient quality initiatives cannot implement them because of IT issues.

3. EHRs have limited INTEROPERABILITY. At a recent session of the Office of the National Coordinator at the annual conference of the American Health Information Management Association, Chief Science Officer Doug Fridsma laid out an ambitious vision of what he calls the “Learning Healthcare System” which comprises the building blocks of health IT systems. This will result in improved interoperability by way of the system adapting to change with encounters.

4. EHRs need INSIGHTFUL analytics. Data without good analytics is almost useless. Clinical decision support tools make EHRs pertinent insomuch as they can incorporate accepted practice guidelines as well as customized “best practice” decision support. These follow provider workflows and make the tool more intuitive. Add to this proscribing analytics that actually recommend (not prescribe) tests or treatment plans, and one ends up with a physician’s friend.

5. EHRs must INCLUDE robust portals. Robust patient portals will be critical in creating a true patient-centric health care system. Most portals used today are proprietary to the customer’s EHR vendor because of its low cost. There are some excellent third-party portals that have the ability to corral data from different providers who might have different EHR vendors. In addition, they are places to communicate multimedia content including video consultations.

While this list is not inclusive of all issues regarding EHRs, it serves as a focal point for discussion by clinicians about them. A 6th ‘I’ might be ‘IMMOBILE.’ A physician running back and forth to computer stations from patient beds creates self-evident inefficiencies. Presently available (not offered by most all vendors) mobile versions of EHRs have their own drawbacks. The small screen on a smartphone is a severe limitation, though many physicians do use tablets. That being said, in a 2013 cited survey by Black Book, only 8% of physician responders used the mobile EHR for purposes of ePrescribing, accessing records, ordering tests, or viewing results. As a champion of digital health technologies, I can only be frustrated about the vision I and many others have for their use. However, as with most technologies (and few have been as disruptive as EHRs) adoption in health care is slow. I look forward to leaders like Doug Fridsma and organizations like HIMSS, which has excellent representation by clinicians to help bring about necessary changes.

It is clear at this point that physicians are not friends of electronic health records (EHRs). The predominant sentiment is that EHRs are costly (1/3 of providers are buying their second EHR system) and are poorly functional. Much has been said about the failures of EHRs. The shortcomings discussed have ranged from lack of cost benefits to interoperability with medical devices and security of interoperability with medical devices. Decreasing provider productivity and direct patient interaction time are also of concern. These opinions were raised in a ‘Medical Economics’ survey as well as a study by Rand Corporation. Interestingly, physicians do not desire to return to paper records. I will discuss what I call “The Five Important ‘I’s” of EHRs.

1. EHRs are not INTUITIVE. Navigating an EHR is akin to guessing what is behind Door Number 2 of “Let’s Make a Deal.” Documentation does not follow a provider’s thought process or the interaction workflow. It is built to meet regulatory and billing requirements. Many physicians are required to learn and be facile with different EHRs if they go to different hospitals. The AMA has called for a design overhaul of EHRs.

2. EHRs are IMPOSING. Providers are spending an inordinate amount of time with the EHR and less with patients. Most providers do not receive adequate training time, which is inversely related to privacy and security breaches. EHRs are inflexible and progressive practices with ambitious patient quality initiatives cannot implement them because of IT issues.

3. EHRs have limited INTEROPERABILITY. At a recent session of the Office of the National Coordinator at the annual conference of the American Health Information Management Association, Chief Science Officer Doug Fridsma laid out an ambitious vision of what he calls the “Learning Healthcare System” which comprises the building blocks of health IT systems. This will result in improved interoperability by way of the system adapting to change with encounters.

4. EHRs need INSIGHTFUL analytics. Data without good analytics is almost useless. Clinical decision support tools make EHRs pertinent insomuch as they can incorporate accepted practice guidelines as well as customized “best practice” decision support. These follow provider workflows and make the tool more intuitive. Add to this proscribing analytics that actually recommend (not prescribe) tests or treatment plans, and one ends up with a physician’s friend.

5. EHRs must INCLUDE robust portals. Robust patient portals will be critical in creating a true patient-centric health care system. Most portals used today are proprietary to the customer’s EHR vendor because of its low cost. There are some excellent third-party portals that have the ability to corral data from different providers who might have different EHR vendors. In addition, they are places to communicate multimedia content including video consultations.

While this list is not inclusive of all issues regarding EHRs, it serves as a focal point for discussion by clinicians about them. A 6th ‘I’ might be ‘IMMOBILE.’ A physician running back and forth to computer stations from patient beds creates self-evident inefficiencies. Presently available (not offered by most all vendors) mobile versions of EHRs have their own drawbacks. The small screen on a smartphone is a severe limitation, though many physicians do use tablets. That being said, in a 2013 cited survey by Black Book, only 8% of physician responders used the mobile EHR for purposes of ePrescribing, accessing records, ordering tests, or viewing results. As a champion of digital health technologies, I can only be frustrated about the vision I and many others have for their use. However, as with most technologies (and few have been as disruptive as EHRs) adoption in health care is slow. I look forward to leaders like Doug Fridsma and organizations like HIMSS, which has excellent representation by clinicians to help bring about necessary changes.

It is clear at this point that physicians are not friends of electronic health records (EHRs). The predominant sentiment is that EHRs are costly (1/3 of providers are buying their second EHR system) and are poorly functional. Much has been said about the failures of EHRs. The shortcomings discussed have ranged from lack of cost benefits to interoperability with medical devices and security of interoperability with medical devices. Decreasing provider productivity and direct patient interaction time are also of concern. These opinions were raised in a ‘Medical Economics’ survey as well as a study by Rand Corporation. Interestingly, physicians do not desire to return to paper records. I will discuss what I call “The Five Important ‘I’s” of EHRs.

1. EHRs are not INTUITIVE. Navigating an EHR is akin to guessing what is behind Door Number 2 of “Let’s Make a Deal.” Documentation does not follow a provider’s thought process or the interaction workflow. It is built to meet regulatory and billing requirements. Many physicians are required to learn and be facile with different EHRs if they go to different hospitals. The AMA has called for a design overhaul of EHRs.

2. EHRs are IMPOSING. Providers are spending an inordinate amount of time with the EHR and less with patients. Most providers do not receive adequate training time, which is inversely related to privacy and security breaches. EHRs are inflexible and progressive practices with ambitious patient quality initiatives cannot implement them because of IT issues.

3. EHRs have limited INTEROPERABILITY. At a recent session of the Office of the National Coordinator at the annual conference of the American Health Information Management Association, Chief Science Officer Doug Fridsma laid out an ambitious vision of what he calls the “Learning Healthcare System” which comprises the building blocks of health IT systems. This will result in improved interoperability by way of the system adapting to change with encounters.

4. EHRs need INSIGHTFUL analytics. Data without good analytics is almost useless. Clinical decision support tools make EHRs pertinent insomuch as they can incorporate accepted practice guidelines as well as customized “best practice” decision support. These follow provider workflows and make the tool more intuitive. Add to this proscribing analytics that actually recommend (not prescribe) tests or treatment plans, and one ends up with a physician’s friend.

5. EHRs must INCLUDE robust portals. Robust patient portals will be critical in creating a true patient-centric health care system. Most portals used today are proprietary to the customer’s EHR vendor because of its low cost. There are some excellent third-party portals that have the ability to corral data from different providers who might have different EHR vendors. In addition, they are places to communicate multimedia content including video consultations.

While this list is not inclusive of all issues regarding EHRs, it serves as a focal point for discussion by clinicians about them. A 6th ‘I’ might be ‘IMMOBILE.’ A physician running back and forth to computer stations from patient beds creates self-evident inefficiencies. Presently available (not offered by most all vendors) mobile versions of EHRs have their own drawbacks. The small screen on a smartphone is a severe limitation, though many physicians do use tablets. That being said, in a 2013 cited survey by Black Book, only 8% of physician responders used the mobile EHR for purposes of ePrescribing, accessing records, ordering tests, or viewing results. As a champion of digital health technologies, I can only be frustrated about the vision I and many others have for their use. However, as with most technologies (and few have been as disruptive as EHRs) adoption in health care is slow. I look forward to leaders like Doug Fridsma and organizations like HIMSS, which has excellent representation by clinicians to help bring about necessary changes.

Mobile health technologies will become a part of the health care landscape for all stakeholders at some point. Other sectors of society currently cannot function without mobile; for example, retail and financial services consider mobile a vital component of their business models.

There are many reasons for lag in adoption of mobile technologies by health care. Regulatory issues, the need for a digital cultural shift, lack of business models, and lack of proof of efficacy are certainly barriers.

But what is underappreciated by app developers and industry analysts is the fact that physicians will be key players in the future of mobile health. Physicians are the most trusted stakeholder by patients with regard to care planning. Issues that are important to consider from a clinician’s standpoint are reimbursement for coordinating digital care; the fresh, negative experience of poorly performing electronic health records (which should not be the face of other digital tech); the present lack of commitment to the philosophy of participatory medicine and that most health apps are consumer (not patient) oriented, with little proof of efficacy via clinical studies.

That said, there remain fundamental reasons that mobile health app prescribing will occur:

• Patients are mobile. According to the Pew Research Center’s Internet and American Life Project, 91% of adults in the United States own a cell phone. Few older adults use smart phones (18% in 2013), but effective mobile health can take the form of text messages, as has been proven with prenatal care and smoking cessation, as well as more sophisticated disease management apps such as WellDoc. Even though older patients might not be smart phone users now, a baby boomer turns 65 every 8 seconds. Many in the sandwich generation today and all in the future will be mobile health tech ready.

• There is a perfect storm of necessity and opportunity. The number of patients participating in health care has increased because of the Affordable Care Act. There is a well-recognized physician shortage, especially in primary care. Americans today do not want to live out their last years in an institutional setting as 70% of them do today. Digital technology will be required for this aging at home. Sensor technology, whether environmental or wearable, will be fundamental. Mobile technology not only will facilitate new care models, but will create them.

• Useful information and data will be at patients’ fingertips. New technologies – such as IBM’s Watson and Apple’s HealthKit – will hopefully serve as frameworks for many disease-specific apps. EHRs are repositories of huge amounts of data. The key to better health care lies in applying analytics to harness the power of this data and make it useful for better care on both population and individualized patient levels. Analytics will improve patient safety, proscribe therapy based on individual and population data, and increase efficiency.

• It is how patient content will be delivered. Physicians and health policy experts recognize the need for better patient education with regard to their diagnoses and medications. A research2guidance report on the disappointing diabetes app market illustrates the pharmaceutical industry’s heretofore slow uptake of mobile health. In general, the pharmaceutical and medical device industries (with 250 of the approximately 100,000 health and fitness apps) have so far concentrated on disease-specific content. The challenge remains to design apps that center on the clinician-patient interaction, not just the disease state. Interoperability with EHRs via more robust patient portals will help close this loop.

• It will create the engaged patient. "Patient engagement" is as overused as "innovation" when discussing technology in health care today. However, the concept is paramount to improving health and promoting wellness. I like a definition of patient engagement from the Center for Advanced Health: "Actions individuals must take to obtain the greatest benefit from the health care services available to them."

I believe that the basis of patient engagement is the combination of an informed patient (and caregiver) and shared decision making. It is not surprising that a significant percentage of patients leave the hospital or physician’s office not knowing their diagnosis or why a medication was prescribed. Mobile health is the potential holy grail of patient engagement. Behavioral change by both patients and providers in the broad sense (which includes payers, clinicians, and institutions) is imperative to affect patient engagement.

Health care must, for the first time, be approached as a rightful partnership between the patient and physician. I believe that mobile technology can utilize trending patient-derived data, transforming it into a useful actionable tool, and create a multidirectional (patient, provider, caregiver) platform of communication leading to better shared decision making.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

Mobile health technologies will become a part of the health care landscape for all stakeholders at some point. Other sectors of society currently cannot function without mobile; for example, retail and financial services consider mobile a vital component of their business models.

There are many reasons for lag in adoption of mobile technologies by health care. Regulatory issues, the need for a digital cultural shift, lack of business models, and lack of proof of efficacy are certainly barriers.

But what is underappreciated by app developers and industry analysts is the fact that physicians will be key players in the future of mobile health. Physicians are the most trusted stakeholder by patients with regard to care planning. Issues that are important to consider from a clinician’s standpoint are reimbursement for coordinating digital care; the fresh, negative experience of poorly performing electronic health records (which should not be the face of other digital tech); the present lack of commitment to the philosophy of participatory medicine and that most health apps are consumer (not patient) oriented, with little proof of efficacy via clinical studies.

That said, there remain fundamental reasons that mobile health app prescribing will occur:

• Patients are mobile. According to the Pew Research Center’s Internet and American Life Project, 91% of adults in the United States own a cell phone. Few older adults use smart phones (18% in 2013), but effective mobile health can take the form of text messages, as has been proven with prenatal care and smoking cessation, as well as more sophisticated disease management apps such as WellDoc. Even though older patients might not be smart phone users now, a baby boomer turns 65 every 8 seconds. Many in the sandwich generation today and all in the future will be mobile health tech ready.

• There is a perfect storm of necessity and opportunity. The number of patients participating in health care has increased because of the Affordable Care Act. There is a well-recognized physician shortage, especially in primary care. Americans today do not want to live out their last years in an institutional setting as 70% of them do today. Digital technology will be required for this aging at home. Sensor technology, whether environmental or wearable, will be fundamental. Mobile technology not only will facilitate new care models, but will create them.

• Useful information and data will be at patients’ fingertips. New technologies – such as IBM’s Watson and Apple’s HealthKit – will hopefully serve as frameworks for many disease-specific apps. EHRs are repositories of huge amounts of data. The key to better health care lies in applying analytics to harness the power of this data and make it useful for better care on both population and individualized patient levels. Analytics will improve patient safety, proscribe therapy based on individual and population data, and increase efficiency.

• It is how patient content will be delivered. Physicians and health policy experts recognize the need for better patient education with regard to their diagnoses and medications. A research2guidance report on the disappointing diabetes app market illustrates the pharmaceutical industry’s heretofore slow uptake of mobile health. In general, the pharmaceutical and medical device industries (with 250 of the approximately 100,000 health and fitness apps) have so far concentrated on disease-specific content. The challenge remains to design apps that center on the clinician-patient interaction, not just the disease state. Interoperability with EHRs via more robust patient portals will help close this loop.

• It will create the engaged patient. "Patient engagement" is as overused as "innovation" when discussing technology in health care today. However, the concept is paramount to improving health and promoting wellness. I like a definition of patient engagement from the Center for Advanced Health: "Actions individuals must take to obtain the greatest benefit from the health care services available to them."

I believe that the basis of patient engagement is the combination of an informed patient (and caregiver) and shared decision making. It is not surprising that a significant percentage of patients leave the hospital or physician’s office not knowing their diagnosis or why a medication was prescribed. Mobile health is the potential holy grail of patient engagement. Behavioral change by both patients and providers in the broad sense (which includes payers, clinicians, and institutions) is imperative to affect patient engagement.

Health care must, for the first time, be approached as a rightful partnership between the patient and physician. I believe that mobile technology can utilize trending patient-derived data, transforming it into a useful actionable tool, and create a multidirectional (patient, provider, caregiver) platform of communication leading to better shared decision making.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

Mobile health technologies will become a part of the health care landscape for all stakeholders at some point. Other sectors of society currently cannot function without mobile; for example, retail and financial services consider mobile a vital component of their business models.

There are many reasons for lag in adoption of mobile technologies by health care. Regulatory issues, the need for a digital cultural shift, lack of business models, and lack of proof of efficacy are certainly barriers.

But what is underappreciated by app developers and industry analysts is the fact that physicians will be key players in the future of mobile health. Physicians are the most trusted stakeholder by patients with regard to care planning. Issues that are important to consider from a clinician’s standpoint are reimbursement for coordinating digital care; the fresh, negative experience of poorly performing electronic health records (which should not be the face of other digital tech); the present lack of commitment to the philosophy of participatory medicine and that most health apps are consumer (not patient) oriented, with little proof of efficacy via clinical studies.

That said, there remain fundamental reasons that mobile health app prescribing will occur:

• Patients are mobile. According to the Pew Research Center’s Internet and American Life Project, 91% of adults in the United States own a cell phone. Few older adults use smart phones (18% in 2013), but effective mobile health can take the form of text messages, as has been proven with prenatal care and smoking cessation, as well as more sophisticated disease management apps such as WellDoc. Even though older patients might not be smart phone users now, a baby boomer turns 65 every 8 seconds. Many in the sandwich generation today and all in the future will be mobile health tech ready.

• There is a perfect storm of necessity and opportunity. The number of patients participating in health care has increased because of the Affordable Care Act. There is a well-recognized physician shortage, especially in primary care. Americans today do not want to live out their last years in an institutional setting as 70% of them do today. Digital technology will be required for this aging at home. Sensor technology, whether environmental or wearable, will be fundamental. Mobile technology not only will facilitate new care models, but will create them.

• Useful information and data will be at patients’ fingertips. New technologies – such as IBM’s Watson and Apple’s HealthKit – will hopefully serve as frameworks for many disease-specific apps. EHRs are repositories of huge amounts of data. The key to better health care lies in applying analytics to harness the power of this data and make it useful for better care on both population and individualized patient levels. Analytics will improve patient safety, proscribe therapy based on individual and population data, and increase efficiency.

• It is how patient content will be delivered. Physicians and health policy experts recognize the need for better patient education with regard to their diagnoses and medications. A research2guidance report on the disappointing diabetes app market illustrates the pharmaceutical industry’s heretofore slow uptake of mobile health. In general, the pharmaceutical and medical device industries (with 250 of the approximately 100,000 health and fitness apps) have so far concentrated on disease-specific content. The challenge remains to design apps that center on the clinician-patient interaction, not just the disease state. Interoperability with EHRs via more robust patient portals will help close this loop.

• It will create the engaged patient. "Patient engagement" is as overused as "innovation" when discussing technology in health care today. However, the concept is paramount to improving health and promoting wellness. I like a definition of patient engagement from the Center for Advanced Health: "Actions individuals must take to obtain the greatest benefit from the health care services available to them."

I believe that the basis of patient engagement is the combination of an informed patient (and caregiver) and shared decision making. It is not surprising that a significant percentage of patients leave the hospital or physician’s office not knowing their diagnosis or why a medication was prescribed. Mobile health is the potential holy grail of patient engagement. Behavioral change by both patients and providers in the broad sense (which includes payers, clinicians, and institutions) is imperative to affect patient engagement.

Health care must, for the first time, be approached as a rightful partnership between the patient and physician. I believe that mobile technology can utilize trending patient-derived data, transforming it into a useful actionable tool, and create a multidirectional (patient, provider, caregiver) platform of communication leading to better shared decision making.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

Medical imaging was the first taste of digital health technology for physicians and most health care providers. The technology provides prompt high-quality information which improves efficiency and is mobile. Then came electronic health records (EHRs). EHRs were mandated as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The goals of EHRs are to improve patient safety, decrease costs, and allow for the seamless exchange of information among providers and providing entities. As a proponent of digital health technologies, I submit that they are patient advocacy tools. The debate over the "effectiveness"of EHRs continues. It is too early to evaluate the true impact of EHRs on patient care at this juncture. Stage 1 of Meaningful Use (MU) of EHRs pertains solely to data capture. It is with Stages 2 and 3 that patient engagement and clinical decision support tools are incorporated in processes around the EHR. These stages have not been fully implemented and won’t be for a few years to come. Therefore those attributes of MU potentially having the most impact on patients are not in use today. What we do know is that: A) Physicians are spending more time looking at computer screens than into the faces of the people they are treating. B) That much of the data entered is to satisfy regulations of the HITECH Act and not directly related to patient care. C) That EHRs were designed for billing and regulatory purposes and do not in any way reflect clinical work flow. D) EHRs do not integrate well with medical devices or disparate digital health technology systems. However some excellent progress has been made in developing true interoperability among systems.

The EHR does not represent the face of digital technology in health care. Mobile health technologies, wearable sensor technologies, aging at home technologies, and ingestible medication sensor technology populate today’s digital health landscape. These are developments which will contribute directly to more efficient and improved patient care. They will address gaps in care. Having a mother who is ill and requiring significant help at home has taken me on a journey riddled with frustration and pain that is also experienced by my patients and their caregivers daily. It has made me a better physician, who realizes that the most important aspect of care is empathy. Most people view technology as a something that creates a divide between provider and patient. Effective technology can actually bring them closer. It can deliver trending data (which must be accurate, filtered, and actionable in order to be useful), drastically altering care recommendations and preventing hospitalizations and medical emergencies. While there remains much to be proven with regards to digital technologies, I expect them to become a backbone of the health care landscape.

Another digital health technology sector making its way into advanced health care enterprises is analytics. These tools take health care "big data" and make it relevant to treating individual patients as well as populations. Use cases for health care analytics demonstrate that EHRs, while being innately clumsy can be transformed into powerful sources of useful information.

Patients as consumers are demanding mobile tools long utilized in the retail and finance sectors . Examples can be seen in patient-physician video conferencing, mobile appointment schedulers, and even a smartphone ECG rhythm monitor. Digital health also involves social media. Patients are now finding themselves in online patient support groups. There are significant advantages of online versus real life support groups. On the provider side, digital tools such as Doximity and Epocratesare widely used.

In summary, the digital health landscape is much broader and friendlier than the EHR of today. I look forward to EHRs becoming more user friendly and clinically rewarding.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

Medical imaging was the first taste of digital health technology for physicians and most health care providers. The technology provides prompt high-quality information which improves efficiency and is mobile. Then came electronic health records (EHRs). EHRs were mandated as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The goals of EHRs are to improve patient safety, decrease costs, and allow for the seamless exchange of information among providers and providing entities. As a proponent of digital health technologies, I submit that they are patient advocacy tools. The debate over the "effectiveness"of EHRs continues. It is too early to evaluate the true impact of EHRs on patient care at this juncture. Stage 1 of Meaningful Use (MU) of EHRs pertains solely to data capture. It is with Stages 2 and 3 that patient engagement and clinical decision support tools are incorporated in processes around the EHR. These stages have not been fully implemented and won’t be for a few years to come. Therefore those attributes of MU potentially having the most impact on patients are not in use today. What we do know is that: A) Physicians are spending more time looking at computer screens than into the faces of the people they are treating. B) That much of the data entered is to satisfy regulations of the HITECH Act and not directly related to patient care. C) That EHRs were designed for billing and regulatory purposes and do not in any way reflect clinical work flow. D) EHRs do not integrate well with medical devices or disparate digital health technology systems. However some excellent progress has been made in developing true interoperability among systems.

The EHR does not represent the face of digital technology in health care. Mobile health technologies, wearable sensor technologies, aging at home technologies, and ingestible medication sensor technology populate today’s digital health landscape. These are developments which will contribute directly to more efficient and improved patient care. They will address gaps in care. Having a mother who is ill and requiring significant help at home has taken me on a journey riddled with frustration and pain that is also experienced by my patients and their caregivers daily. It has made me a better physician, who realizes that the most important aspect of care is empathy. Most people view technology as a something that creates a divide between provider and patient. Effective technology can actually bring them closer. It can deliver trending data (which must be accurate, filtered, and actionable in order to be useful), drastically altering care recommendations and preventing hospitalizations and medical emergencies. While there remains much to be proven with regards to digital technologies, I expect them to become a backbone of the health care landscape.

Another digital health technology sector making its way into advanced health care enterprises is analytics. These tools take health care "big data" and make it relevant to treating individual patients as well as populations. Use cases for health care analytics demonstrate that EHRs, while being innately clumsy can be transformed into powerful sources of useful information.

Patients as consumers are demanding mobile tools long utilized in the retail and finance sectors . Examples can be seen in patient-physician video conferencing, mobile appointment schedulers, and even a smartphone ECG rhythm monitor. Digital health also involves social media. Patients are now finding themselves in online patient support groups. There are significant advantages of online versus real life support groups. On the provider side, digital tools such as Doximity and Epocratesare widely used.

In summary, the digital health landscape is much broader and friendlier than the EHR of today. I look forward to EHRs becoming more user friendly and clinically rewarding.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

Medical imaging was the first taste of digital health technology for physicians and most health care providers. The technology provides prompt high-quality information which improves efficiency and is mobile. Then came electronic health records (EHRs). EHRs were mandated as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The goals of EHRs are to improve patient safety, decrease costs, and allow for the seamless exchange of information among providers and providing entities. As a proponent of digital health technologies, I submit that they are patient advocacy tools. The debate over the "effectiveness"of EHRs continues. It is too early to evaluate the true impact of EHRs on patient care at this juncture. Stage 1 of Meaningful Use (MU) of EHRs pertains solely to data capture. It is with Stages 2 and 3 that patient engagement and clinical decision support tools are incorporated in processes around the EHR. These stages have not been fully implemented and won’t be for a few years to come. Therefore those attributes of MU potentially having the most impact on patients are not in use today. What we do know is that: A) Physicians are spending more time looking at computer screens than into the faces of the people they are treating. B) That much of the data entered is to satisfy regulations of the HITECH Act and not directly related to patient care. C) That EHRs were designed for billing and regulatory purposes and do not in any way reflect clinical work flow. D) EHRs do not integrate well with medical devices or disparate digital health technology systems. However some excellent progress has been made in developing true interoperability among systems.

The EHR does not represent the face of digital technology in health care. Mobile health technologies, wearable sensor technologies, aging at home technologies, and ingestible medication sensor technology populate today’s digital health landscape. These are developments which will contribute directly to more efficient and improved patient care. They will address gaps in care. Having a mother who is ill and requiring significant help at home has taken me on a journey riddled with frustration and pain that is also experienced by my patients and their caregivers daily. It has made me a better physician, who realizes that the most important aspect of care is empathy. Most people view technology as a something that creates a divide between provider and patient. Effective technology can actually bring them closer. It can deliver trending data (which must be accurate, filtered, and actionable in order to be useful), drastically altering care recommendations and preventing hospitalizations and medical emergencies. While there remains much to be proven with regards to digital technologies, I expect them to become a backbone of the health care landscape.

Another digital health technology sector making its way into advanced health care enterprises is analytics. These tools take health care "big data" and make it relevant to treating individual patients as well as populations. Use cases for health care analytics demonstrate that EHRs, while being innately clumsy can be transformed into powerful sources of useful information.

Patients as consumers are demanding mobile tools long utilized in the retail and finance sectors . Examples can be seen in patient-physician video conferencing, mobile appointment schedulers, and even a smartphone ECG rhythm monitor. Digital health also involves social media. Patients are now finding themselves in online patient support groups. There are significant advantages of online versus real life support groups. On the provider side, digital tools such as Doximity and Epocratesare widely used.

In summary, the digital health landscape is much broader and friendlier than the EHR of today. I look forward to EHRs becoming more user friendly and clinically rewarding.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.