The Optimized Doctor

Doctors have been conjecturing about how the new Apple Watch, with its spectacular fitness and wellness tracking features, will transform health care. The real rock star at Apple’s March 9 “Spring Forward” event, however, was the opening band, ResearchKit.

What is it?

ResearchKit is Apple’s (beautiful) solution to one of the great problems of medical research: recruiting subjects. ResearchKit allows researchers to collect data in a way that before today was impossible: with just a click from their smartphones. The open-source software platform allows developers to design studies and to recruit subjects right from the app store. Researchers can leverage high-tech smartphone sensors and can push out surveys, collecting both objective and subjective data from thousands (heck, potentially millions) of participants.

Five apps were developed for the launch: mPower for Parkinson’s disease, from the University of Rochester, N.Y.; GlucoSuccess for diabetes, from Massachusetts General Hospital, Boston; MyHeart Counts for cardiovascular disease, from Stanford (Calif.) University and the University of Oxford, England; Asthma Health from Mount Sinai and Weill Medical College of Cornell University, New York, N.Y.; and Share the Journey for breast cancer, from the Dana-Farber Cancer Institute, Boston; the University of California, Los Angeles Fielding School of Public Health; and Penn Medicine, Philadelphia.

My take

I took a closer look at MyHeart Counts, which evaluates how patients’ activity levels influence their cardiovascular health. According to Stanford University, a mere 4 days after its release, the MyHeart Counts app had been downloaded 52,900 times in the United States and Canada and had more than 22,000 users who had consented to the study. Try getting that kind of response to your research study with a flyer with tear-off phone number posted in your hospital cafeteria.

I was impressed with its beautiful interface and ease of use. Designed to gather sensor and health data from your iPhone and personal devices, this app is designed to help researchers (and you) detect patterns or details about your heart health. To start, you download the app, give your consent, answer questions about your health and lifestyle, and begin recording your activity with your phone or wearable device. You do a walk test to determine your heart health and potential health risk.

What happens to the data you input? It is sent (with your permission) to a secure database, and your name is replaced with a random code. Your coded and encrypted data are then shared with scientists and physicians to use in medical research.

For this particular study, they ask you to participate 10-15 minutes per day for 1 week, then hope that you can contribute further for 1 week every 3 months answering surveys about your health, lifestyle, and physical activity. Apple reassures users that they can withdraw at any time.

Why? Who cares?

The value proposition for researchers is obvious: The platform provides access to many more subjects than even imaginable. The accelerometer, barometer, gyroscope, and GPS send interesting data to researchers friction free. The Parkinson’s app, for example, uses a cool algorithm and the phone’s microphone to detect symptoms by having patients say “ahhhh.” By pushing out questionnaires regularly, you can collect much more data with shorter intervals for longer periods of time.

The advantages for patients are equally compelling. In addition to sending their data to researchers, they also receive information back from the researchers, helping them monitor their cardiovascular health. In fact, just knowing they are participating in the study might be of benefit. As dermatologist Dr. Steve Feldman of Wake Forest Baptist Medical Center, Winston Salem, N.C., has shown, patients are more likely to adhere to therapies when they know they are being watched, a manifestation of the Hawthorne effect.

Shortcomings

Surely there is a catch? And there is. With potentially millions of participants sending self-reported data, there is the potential that ResearchKit studies glean big, beautiful, bad data. How, for example, could you verify that self-reported asthma patients actually have asthma? Maybe they just read about ResearchKit and wanted to be part of the fun.

For patients, privacy concerns are paramount. Apple promised that no one, not even Apple, will see your data without your permission. But with privacy breaches reported in the news weekly, what can Apple’s assurance mean? Didn’t Target and Aetna promise to keep your data safe as well?

The potential for interesting research is enormous. By the time you read this, I wouldn’t be surprised if a psoriasis study had already launched. In fact, a year from now, the problem might be a dozen or more interesting psoriasis studies all competing for the same patients. Ah, maybe we should be glad if we should be so lucky.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

Doctors have been conjecturing about how the new Apple Watch, with its spectacular fitness and wellness tracking features, will transform health care. The real rock star at Apple’s March 9 “Spring Forward” event, however, was the opening band, ResearchKit.

What is it?

ResearchKit is Apple’s (beautiful) solution to one of the great problems of medical research: recruiting subjects. ResearchKit allows researchers to collect data in a way that before today was impossible: with just a click from their smartphones. The open-source software platform allows developers to design studies and to recruit subjects right from the app store. Researchers can leverage high-tech smartphone sensors and can push out surveys, collecting both objective and subjective data from thousands (heck, potentially millions) of participants.

Five apps were developed for the launch: mPower for Parkinson’s disease, from the University of Rochester, N.Y.; GlucoSuccess for diabetes, from Massachusetts General Hospital, Boston; MyHeart Counts for cardiovascular disease, from Stanford (Calif.) University and the University of Oxford, England; Asthma Health from Mount Sinai and Weill Medical College of Cornell University, New York, N.Y.; and Share the Journey for breast cancer, from the Dana-Farber Cancer Institute, Boston; the University of California, Los Angeles Fielding School of Public Health; and Penn Medicine, Philadelphia.

My take

I took a closer look at MyHeart Counts, which evaluates how patients’ activity levels influence their cardiovascular health. According to Stanford University, a mere 4 days after its release, the MyHeart Counts app had been downloaded 52,900 times in the United States and Canada and had more than 22,000 users who had consented to the study. Try getting that kind of response to your research study with a flyer with tear-off phone number posted in your hospital cafeteria.

I was impressed with its beautiful interface and ease of use. Designed to gather sensor and health data from your iPhone and personal devices, this app is designed to help researchers (and you) detect patterns or details about your heart health. To start, you download the app, give your consent, answer questions about your health and lifestyle, and begin recording your activity with your phone or wearable device. You do a walk test to determine your heart health and potential health risk.

What happens to the data you input? It is sent (with your permission) to a secure database, and your name is replaced with a random code. Your coded and encrypted data are then shared with scientists and physicians to use in medical research.

For this particular study, they ask you to participate 10-15 minutes per day for 1 week, then hope that you can contribute further for 1 week every 3 months answering surveys about your health, lifestyle, and physical activity. Apple reassures users that they can withdraw at any time.

Why? Who cares?

The value proposition for researchers is obvious: The platform provides access to many more subjects than even imaginable. The accelerometer, barometer, gyroscope, and GPS send interesting data to researchers friction free. The Parkinson’s app, for example, uses a cool algorithm and the phone’s microphone to detect symptoms by having patients say “ahhhh.” By pushing out questionnaires regularly, you can collect much more data with shorter intervals for longer periods of time.

The advantages for patients are equally compelling. In addition to sending their data to researchers, they also receive information back from the researchers, helping them monitor their cardiovascular health. In fact, just knowing they are participating in the study might be of benefit. As dermatologist Dr. Steve Feldman of Wake Forest Baptist Medical Center, Winston Salem, N.C., has shown, patients are more likely to adhere to therapies when they know they are being watched, a manifestation of the Hawthorne effect.

Shortcomings

Surely there is a catch? And there is. With potentially millions of participants sending self-reported data, there is the potential that ResearchKit studies glean big, beautiful, bad data. How, for example, could you verify that self-reported asthma patients actually have asthma? Maybe they just read about ResearchKit and wanted to be part of the fun.

For patients, privacy concerns are paramount. Apple promised that no one, not even Apple, will see your data without your permission. But with privacy breaches reported in the news weekly, what can Apple’s assurance mean? Didn’t Target and Aetna promise to keep your data safe as well?

The potential for interesting research is enormous. By the time you read this, I wouldn’t be surprised if a psoriasis study had already launched. In fact, a year from now, the problem might be a dozen or more interesting psoriasis studies all competing for the same patients. Ah, maybe we should be glad if we should be so lucky.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

Doctors have been conjecturing about how the new Apple Watch, with its spectacular fitness and wellness tracking features, will transform health care. The real rock star at Apple’s March 9 “Spring Forward” event, however, was the opening band, ResearchKit.

What is it?

ResearchKit is Apple’s (beautiful) solution to one of the great problems of medical research: recruiting subjects. ResearchKit allows researchers to collect data in a way that before today was impossible: with just a click from their smartphones. The open-source software platform allows developers to design studies and to recruit subjects right from the app store. Researchers can leverage high-tech smartphone sensors and can push out surveys, collecting both objective and subjective data from thousands (heck, potentially millions) of participants.

Five apps were developed for the launch: mPower for Parkinson’s disease, from the University of Rochester, N.Y.; GlucoSuccess for diabetes, from Massachusetts General Hospital, Boston; MyHeart Counts for cardiovascular disease, from Stanford (Calif.) University and the University of Oxford, England; Asthma Health from Mount Sinai and Weill Medical College of Cornell University, New York, N.Y.; and Share the Journey for breast cancer, from the Dana-Farber Cancer Institute, Boston; the University of California, Los Angeles Fielding School of Public Health; and Penn Medicine, Philadelphia.

My take

I took a closer look at MyHeart Counts, which evaluates how patients’ activity levels influence their cardiovascular health. According to Stanford University, a mere 4 days after its release, the MyHeart Counts app had been downloaded 52,900 times in the United States and Canada and had more than 22,000 users who had consented to the study. Try getting that kind of response to your research study with a flyer with tear-off phone number posted in your hospital cafeteria.

I was impressed with its beautiful interface and ease of use. Designed to gather sensor and health data from your iPhone and personal devices, this app is designed to help researchers (and you) detect patterns or details about your heart health. To start, you download the app, give your consent, answer questions about your health and lifestyle, and begin recording your activity with your phone or wearable device. You do a walk test to determine your heart health and potential health risk.

What happens to the data you input? It is sent (with your permission) to a secure database, and your name is replaced with a random code. Your coded and encrypted data are then shared with scientists and physicians to use in medical research.

For this particular study, they ask you to participate 10-15 minutes per day for 1 week, then hope that you can contribute further for 1 week every 3 months answering surveys about your health, lifestyle, and physical activity. Apple reassures users that they can withdraw at any time.

Why? Who cares?

The value proposition for researchers is obvious: The platform provides access to many more subjects than even imaginable. The accelerometer, barometer, gyroscope, and GPS send interesting data to researchers friction free. The Parkinson’s app, for example, uses a cool algorithm and the phone’s microphone to detect symptoms by having patients say “ahhhh.” By pushing out questionnaires regularly, you can collect much more data with shorter intervals for longer periods of time.

The advantages for patients are equally compelling. In addition to sending their data to researchers, they also receive information back from the researchers, helping them monitor their cardiovascular health. In fact, just knowing they are participating in the study might be of benefit. As dermatologist Dr. Steve Feldman of Wake Forest Baptist Medical Center, Winston Salem, N.C., has shown, patients are more likely to adhere to therapies when they know they are being watched, a manifestation of the Hawthorne effect.

Shortcomings

Surely there is a catch? And there is. With potentially millions of participants sending self-reported data, there is the potential that ResearchKit studies glean big, beautiful, bad data. How, for example, could you verify that self-reported asthma patients actually have asthma? Maybe they just read about ResearchKit and wanted to be part of the fun.

For patients, privacy concerns are paramount. Apple promised that no one, not even Apple, will see your data without your permission. But with privacy breaches reported in the news weekly, what can Apple’s assurance mean? Didn’t Target and Aetna promise to keep your data safe as well?

The potential for interesting research is enormous. By the time you read this, I wouldn’t be surprised if a psoriasis study had already launched. In fact, a year from now, the problem might be a dozen or more interesting psoriasis studies all competing for the same patients. Ah, maybe we should be glad if we should be so lucky.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

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.

We can learn a lot from a car rentals. Like medicine, they are a service industry. And all service industries have the same problem: Service is delivered in real time, and the quality of that service depends on variables that may or may not be in the company’s control.

Even so, one bad experience can result in termination of a life-long customer, or in our case, patient. Worse, the patient can now go online and write a scathing review, criticizing everything from your bedside manner to the artwork in your waiting room.

What can you do when a visit goes wrong? Employ service-recovery techniques. Service recovery is the act of trying to resuscitate an encounter once things have gone badly. It happens to physicians and to restaurants and to car rentals.

While on vacation with my wife in Salt Lake City, we rented a car from a company (let’s call them “Discount Cars”). We don’t usually book with them; however, we got double airline points for choosing them, so we bit.

At the airport rental terminal, we waited for 15 minutes before being helped. When we reached the counter, we were told that our reserved car was not ready yet. (I immediately thought of the Seinfeld episode when Jerry says: “So you can take a reservation, but you can’t keep a reservation?!”) We were advised that our car was being washed and would be ready in 15 minutes “tops.” Thirty minutes later, my miffed wife pushed through the line to the counter. “It’s still being washed,” she was told. So she asked for another car and was offered a full-size pickup truck. My wife, who drives a teeny Honda Fit at home, said no thanks. Another 30 minutes passed and my incensed wife returned to the counter. “It’s been over an hour! This is unacceptable!” A different representative replied it was our fault for declining the pickup truck. There would be more cars soon, so they promised.

We were too far to walk to any airport bars, and the situation was rapidly deteriorating. I decided to take action. I fired up Twitter and let her rip:

“Closing in on 1 hr for a car promised in 15 min. Which we reserved ahead. This isn’t the first time, @DiscountCars #operations #fail.”

Within minutes, they replied by Twitter:

Them: @Dermdoc We are so sorry for the wait! What location are you at?

My wife, along with five other equally incensed wives, continued to wait for a response (and a car) from the live representatives at the counter.

Nearly 1 hour and 20 minutes later, we got a car. It was much larger than we wanted, but we were done waiting. After signing the papers, we got inside – it reeked of smoke. Oh, this is no bueno, I thought. We requested a different car. Twenty more minutes passed before our smoke-free vehicle arrived. The gas tank was 7/8’s full. And the carpets were littered with twigs and leaves.

Now I’m thinking, this is so bad, I should write an article about it. From the front seat of our faulty but moving vehicle, I fired again: “Dear @DiscountCars we waited 1+ hrs. Not the car we wanted. Then tank not full. Yet, not a single apology from anyone. Really?”

Them: @Dermdoc, we are sorry.

Them: @Dermdoc Please e-mail us the details and your RA# to socialinfo@discountgroup.com so we can look into this for you!

Me: @Discount Thank you! Will do.

I sent a list of grievances to the e-mail as they requested. Within an hour they offered us a $50 credit on a future rental.

What’s remarkable about this story is that not a single live person was able to assuage us, but their digital team managed to apologize and save us as customers. There might have been legitimate reasons for their service failure, but it didn’t matter. What mattered was that they responded to me personally, apologized, and made amends. This is an important lesson for us physicians. Patients will expect that your digital channels are legitimate ways to express their level of satisfaction with your practice. The stakes are higher for us in health care in particular because of the risks of violating patients’ privacy. However, as you can see from the rental car example, it can effectively be done without revealing any information about the customer or the experience. The goal is to recover the service publicly and take all of the information offline and manage it in a secure, private fashion.

The formula is simple: Believe the customer. Listen. Apologize for not satisfying the customer. Even if you’ve done nothing wrong, you have in some way failed to satisfy the customer’s needs. Ask for more information in a secure, private manner, never on a public platform. Do what you can reasonably do to remedy the problem and remediate the situation.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

We can learn a lot from a car rentals. Like medicine, they are a service industry. And all service industries have the same problem: Service is delivered in real time, and the quality of that service depends on variables that may or may not be in the company’s control.

Even so, one bad experience can result in termination of a life-long customer, or in our case, patient. Worse, the patient can now go online and write a scathing review, criticizing everything from your bedside manner to the artwork in your waiting room.

What can you do when a visit goes wrong? Employ service-recovery techniques. Service recovery is the act of trying to resuscitate an encounter once things have gone badly. It happens to physicians and to restaurants and to car rentals.

While on vacation with my wife in Salt Lake City, we rented a car from a company (let’s call them “Discount Cars”). We don’t usually book with them; however, we got double airline points for choosing them, so we bit.

At the airport rental terminal, we waited for 15 minutes before being helped. When we reached the counter, we were told that our reserved car was not ready yet. (I immediately thought of the Seinfeld episode when Jerry says: “So you can take a reservation, but you can’t keep a reservation?!”) We were advised that our car was being washed and would be ready in 15 minutes “tops.” Thirty minutes later, my miffed wife pushed through the line to the counter. “It’s still being washed,” she was told. So she asked for another car and was offered a full-size pickup truck. My wife, who drives a teeny Honda Fit at home, said no thanks. Another 30 minutes passed and my incensed wife returned to the counter. “It’s been over an hour! This is unacceptable!” A different representative replied it was our fault for declining the pickup truck. There would be more cars soon, so they promised.

We were too far to walk to any airport bars, and the situation was rapidly deteriorating. I decided to take action. I fired up Twitter and let her rip:

“Closing in on 1 hr for a car promised in 15 min. Which we reserved ahead. This isn’t the first time, @DiscountCars #operations #fail.”

Within minutes, they replied by Twitter:

Them: @Dermdoc We are so sorry for the wait! What location are you at?

My wife, along with five other equally incensed wives, continued to wait for a response (and a car) from the live representatives at the counter.

Nearly 1 hour and 20 minutes later, we got a car. It was much larger than we wanted, but we were done waiting. After signing the papers, we got inside – it reeked of smoke. Oh, this is no bueno, I thought. We requested a different car. Twenty more minutes passed before our smoke-free vehicle arrived. The gas tank was 7/8’s full. And the carpets were littered with twigs and leaves.

Now I’m thinking, this is so bad, I should write an article about it. From the front seat of our faulty but moving vehicle, I fired again: “Dear @DiscountCars we waited 1+ hrs. Not the car we wanted. Then tank not full. Yet, not a single apology from anyone. Really?”

Them: @Dermdoc, we are sorry.

Them: @Dermdoc Please e-mail us the details and your RA# to socialinfo@discountgroup.com so we can look into this for you!

Me: @Discount Thank you! Will do.

I sent a list of grievances to the e-mail as they requested. Within an hour they offered us a $50 credit on a future rental.

What’s remarkable about this story is that not a single live person was able to assuage us, but their digital team managed to apologize and save us as customers. There might have been legitimate reasons for their service failure, but it didn’t matter. What mattered was that they responded to me personally, apologized, and made amends. This is an important lesson for us physicians. Patients will expect that your digital channels are legitimate ways to express their level of satisfaction with your practice. The stakes are higher for us in health care in particular because of the risks of violating patients’ privacy. However, as you can see from the rental car example, it can effectively be done without revealing any information about the customer or the experience. The goal is to recover the service publicly and take all of the information offline and manage it in a secure, private fashion.

The formula is simple: Believe the customer. Listen. Apologize for not satisfying the customer. Even if you’ve done nothing wrong, you have in some way failed to satisfy the customer’s needs. Ask for more information in a secure, private manner, never on a public platform. Do what you can reasonably do to remedy the problem and remediate the situation.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

We can learn a lot from a car rentals. Like medicine, they are a service industry. And all service industries have the same problem: Service is delivered in real time, and the quality of that service depends on variables that may or may not be in the company’s control.

Even so, one bad experience can result in termination of a life-long customer, or in our case, patient. Worse, the patient can now go online and write a scathing review, criticizing everything from your bedside manner to the artwork in your waiting room.

What can you do when a visit goes wrong? Employ service-recovery techniques. Service recovery is the act of trying to resuscitate an encounter once things have gone badly. It happens to physicians and to restaurants and to car rentals.

While on vacation with my wife in Salt Lake City, we rented a car from a company (let’s call them “Discount Cars”). We don’t usually book with them; however, we got double airline points for choosing them, so we bit.

At the airport rental terminal, we waited for 15 minutes before being helped. When we reached the counter, we were told that our reserved car was not ready yet. (I immediately thought of the Seinfeld episode when Jerry says: “So you can take a reservation, but you can’t keep a reservation?!”) We were advised that our car was being washed and would be ready in 15 minutes “tops.” Thirty minutes later, my miffed wife pushed through the line to the counter. “It’s still being washed,” she was told. So she asked for another car and was offered a full-size pickup truck. My wife, who drives a teeny Honda Fit at home, said no thanks. Another 30 minutes passed and my incensed wife returned to the counter. “It’s been over an hour! This is unacceptable!” A different representative replied it was our fault for declining the pickup truck. There would be more cars soon, so they promised.

We were too far to walk to any airport bars, and the situation was rapidly deteriorating. I decided to take action. I fired up Twitter and let her rip:

“Closing in on 1 hr for a car promised in 15 min. Which we reserved ahead. This isn’t the first time, @DiscountCars #operations #fail.”

Within minutes, they replied by Twitter:

Them: @Dermdoc We are so sorry for the wait! What location are you at?

My wife, along with five other equally incensed wives, continued to wait for a response (and a car) from the live representatives at the counter.

Nearly 1 hour and 20 minutes later, we got a car. It was much larger than we wanted, but we were done waiting. After signing the papers, we got inside – it reeked of smoke. Oh, this is no bueno, I thought. We requested a different car. Twenty more minutes passed before our smoke-free vehicle arrived. The gas tank was 7/8’s full. And the carpets were littered with twigs and leaves.

Now I’m thinking, this is so bad, I should write an article about it. From the front seat of our faulty but moving vehicle, I fired again: “Dear @DiscountCars we waited 1+ hrs. Not the car we wanted. Then tank not full. Yet, not a single apology from anyone. Really?”

Them: @Dermdoc, we are sorry.

Them: @Dermdoc Please e-mail us the details and your RA# to socialinfo@discountgroup.com so we can look into this for you!

Me: @Discount Thank you! Will do.

I sent a list of grievances to the e-mail as they requested. Within an hour they offered us a $50 credit on a future rental.

What’s remarkable about this story is that not a single live person was able to assuage us, but their digital team managed to apologize and save us as customers. There might have been legitimate reasons for their service failure, but it didn’t matter. What mattered was that they responded to me personally, apologized, and made amends. This is an important lesson for us physicians. Patients will expect that your digital channels are legitimate ways to express their level of satisfaction with your practice. The stakes are higher for us in health care in particular because of the risks of violating patients’ privacy. However, as you can see from the rental car example, it can effectively be done without revealing any information about the customer or the experience. The goal is to recover the service publicly and take all of the information offline and manage it in a secure, private fashion.

The formula is simple: Believe the customer. Listen. Apologize for not satisfying the customer. Even if you’ve done nothing wrong, you have in some way failed to satisfy the customer’s needs. Ask for more information in a secure, private manner, never on a public platform. Do what you can reasonably do to remedy the problem and remediate the situation.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

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.

I’ve never lived in a world without e-mail. No, I’m not one of those millennial kids; e-mail has been around for a long time. Sending messages between computers dates to the 1960s, but most people consider 1971 to be the birth of e-mail. That’s when Ray Tomlinson added the @ symbol to separate users’ names from their e-mail addresses.

Today, e-mail is ubiquitous. You can e-mail your mother, your colleagues, or your cable company. You can even e-mail the president of the United States. Other than the pope and most physicians, there aren’t many people you cannot e-mail. (Although, interestingly, you can reach His Holiness on Twitter @Pontifex.)

We physicians have historically had a few good reasons to avoid e-mailing patients, but many of those objections are unwarranted. As part the meaningful use EHR incentive program from the Centers for Medicare & Medicaid Services, secure messaging will now be required to be eligible for rewards. Although many physicians cite security as a concern, most electronic medical record systems now have patient portals that allow for secure, safe messaging. Encroachment into private time, however, is still a concern for many physicians.

At Kaiser Permanente (KP), we’ve been using secure e-mails with our patients for more than 5 years. When we started, I had some of the same concerns as most doctors: When am I going to have time to do this? What types of questions will patients send? As it turns out, the system has been wildly popular for patients. In 2013 alone, we replied to more than 14 million patient messages. We encourage our patients to use e-mail to stay connected with us, because it leads to improved patient experiences and improved outcomes.

Managing e-mail in-boxes is difficult work, and we KP physicians constantly try to find ways to be more efficient. E-mail does sometimes encroach on my personal time, but I’ve discovered that’s okay. As it turns out, e-mail encroaches on my entrepreneurial brother’s personal time, my financial planner’s personal time, and my plumber’s personal time. Being always connected is a modern luxury and a curse. It’s also part of being a professional.

Here are some steps I’ve taken to manage my patient e-mails. First, I always remember that this electronic message is connected to a real person with real worry. Second, I remember how appreciative patients are to get a message from their doctor. E-mail a patient after 8 p.m., and they will never forget you. Third, clearly delineate time to take care of business. It never feels burdensome in part because I am in control. I choose to e-mail patients not because I have to but because I’m that doctor and it makes me feel good.

This weekend, for example, I did patient messages in a Jackson Hole, Wyo., coffee shop while on vacation. Just as I opened my computer, I noticed a young guy in a fleece jacket next to me checking his e-mail while his wife and two kids enjoyed muffins and hot cocoa. While I was waiting for my wife, Susan, to order our lattes, I overheard him make a call to his office: “Yes, I’m out, but why don’t you e-mail me that and I’ll get right back to you.”

I’m right with you, buddy, I think. I use my token and the wifi there in Wyoming to access my patient e-mails. There are only five. The messages are like most I receive: “I have a new spot,” or “The cream you gave me isn’t working,” or “My acne is better, so should I reduce the spironolactone?” I hammer replies out in 10 minutes.

My wife returns with lattes and opens the local paper while I review 14 biopsy results from 2 days ago. For most of them, I use a template and the secure e-mail to send patients their results. I then send a few notes to some patients, advising them to follow up with me for excisional surgeries.

The work I was doing was not additive; the questions my patients sent would have had to be addressed at some time. In fact, if they had called, then they would have left a message with a nurse who would have sent a message to me, which I would have had to reply to, and then send the message back to the nurse who would have to reply to the patient.

Despite our love/hate relationship with it, e-mail has been one of the great innovations of the 20th century, and it is the primary form of communication in the business world. According to one study, more than 100 billion business e-mails were sent and received every day in 2013. Yet, fewer than one-third of physicians use e-mail to communicate with their patients.Personally, I have found patients to be generally understanding, courteous, and appreciative of e-mail. Of course, there are a few who don’t follow good etiquette. (One of my primary care colleagues relates a story of a patient who e-mailed her every time she had a bowel movement. Gastroenteritis can significantly add to e-mail burden, apparently.)

There’s no doubt that e-mail will soon become the primary way to communicate with patients. Based on our experience at KP, this will ultimately be to the benefit of both doctors and patients. A June 2014 survey by Catalyst Healthcare Research showed that 93% of patients preferred to see a physician who offers e-mail communication with his or her patients. More than one-quarter of those respondents said they’d be willing to pay a $25 charge for such communication. It’s not surprising; as with all businesses, not just medicine, that patients want more channels of communication, not fewer. Fortunately for them, many of today’s medical residents are being trained to use electronic communication with patients. For instance, a 2013 study published in the Postgraduate Medical Journal found that 57% of residents used e-mail to communicate with patients.

My wife finished reading the Jackson Hole Daily newspaper and outlined our hike to Taggart Lake. And I finished answering my messages. The guy sitting next to me is still tapping away at his keyboard. I make eye contact and say, “Almost done?” “Yup,” he replies, “Better for me to just knock it out now, because I’ll just have to deal with it on Monday.” I agree.

Susan and I pack up and head for the trail, which is thankfully connection free. Let’s just hope we don’t run into any bears.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

I’ve never lived in a world without e-mail. No, I’m not one of those millennial kids; e-mail has been around for a long time. Sending messages between computers dates to the 1960s, but most people consider 1971 to be the birth of e-mail. That’s when Ray Tomlinson added the @ symbol to separate users’ names from their e-mail addresses.

Today, e-mail is ubiquitous. You can e-mail your mother, your colleagues, or your cable company. You can even e-mail the president of the United States. Other than the pope and most physicians, there aren’t many people you cannot e-mail. (Although, interestingly, you can reach His Holiness on Twitter @Pontifex.)

We physicians have historically had a few good reasons to avoid e-mailing patients, but many of those objections are unwarranted. As part the meaningful use EHR incentive program from the Centers for Medicare & Medicaid Services, secure messaging will now be required to be eligible for rewards. Although many physicians cite security as a concern, most electronic medical record systems now have patient portals that allow for secure, safe messaging. Encroachment into private time, however, is still a concern for many physicians.

At Kaiser Permanente (KP), we’ve been using secure e-mails with our patients for more than 5 years. When we started, I had some of the same concerns as most doctors: When am I going to have time to do this? What types of questions will patients send? As it turns out, the system has been wildly popular for patients. In 2013 alone, we replied to more than 14 million patient messages. We encourage our patients to use e-mail to stay connected with us, because it leads to improved patient experiences and improved outcomes.

Managing e-mail in-boxes is difficult work, and we KP physicians constantly try to find ways to be more efficient. E-mail does sometimes encroach on my personal time, but I’ve discovered that’s okay. As it turns out, e-mail encroaches on my entrepreneurial brother’s personal time, my financial planner’s personal time, and my plumber’s personal time. Being always connected is a modern luxury and a curse. It’s also part of being a professional.

Here are some steps I’ve taken to manage my patient e-mails. First, I always remember that this electronic message is connected to a real person with real worry. Second, I remember how appreciative patients are to get a message from their doctor. E-mail a patient after 8 p.m., and they will never forget you. Third, clearly delineate time to take care of business. It never feels burdensome in part because I am in control. I choose to e-mail patients not because I have to but because I’m that doctor and it makes me feel good.

This weekend, for example, I did patient messages in a Jackson Hole, Wyo., coffee shop while on vacation. Just as I opened my computer, I noticed a young guy in a fleece jacket next to me checking his e-mail while his wife and two kids enjoyed muffins and hot cocoa. While I was waiting for my wife, Susan, to order our lattes, I overheard him make a call to his office: “Yes, I’m out, but why don’t you e-mail me that and I’ll get right back to you.”

I’m right with you, buddy, I think. I use my token and the wifi there in Wyoming to access my patient e-mails. There are only five. The messages are like most I receive: “I have a new spot,” or “The cream you gave me isn’t working,” or “My acne is better, so should I reduce the spironolactone?” I hammer replies out in 10 minutes.

My wife returns with lattes and opens the local paper while I review 14 biopsy results from 2 days ago. For most of them, I use a template and the secure e-mail to send patients their results. I then send a few notes to some patients, advising them to follow up with me for excisional surgeries.

The work I was doing was not additive; the questions my patients sent would have had to be addressed at some time. In fact, if they had called, then they would have left a message with a nurse who would have sent a message to me, which I would have had to reply to, and then send the message back to the nurse who would have to reply to the patient.

Despite our love/hate relationship with it, e-mail has been one of the great innovations of the 20th century, and it is the primary form of communication in the business world. According to one study, more than 100 billion business e-mails were sent and received every day in 2013. Yet, fewer than one-third of physicians use e-mail to communicate with their patients.Personally, I have found patients to be generally understanding, courteous, and appreciative of e-mail. Of course, there are a few who don’t follow good etiquette. (One of my primary care colleagues relates a story of a patient who e-mailed her every time she had a bowel movement. Gastroenteritis can significantly add to e-mail burden, apparently.)

There’s no doubt that e-mail will soon become the primary way to communicate with patients. Based on our experience at KP, this will ultimately be to the benefit of both doctors and patients. A June 2014 survey by Catalyst Healthcare Research showed that 93% of patients preferred to see a physician who offers e-mail communication with his or her patients. More than one-quarter of those respondents said they’d be willing to pay a $25 charge for such communication. It’s not surprising; as with all businesses, not just medicine, that patients want more channels of communication, not fewer. Fortunately for them, many of today’s medical residents are being trained to use electronic communication with patients. For instance, a 2013 study published in the Postgraduate Medical Journal found that 57% of residents used e-mail to communicate with patients.

My wife finished reading the Jackson Hole Daily newspaper and outlined our hike to Taggart Lake. And I finished answering my messages. The guy sitting next to me is still tapping away at his keyboard. I make eye contact and say, “Almost done?” “Yup,” he replies, “Better for me to just knock it out now, because I’ll just have to deal with it on Monday.” I agree.

Susan and I pack up and head for the trail, which is thankfully connection free. Let’s just hope we don’t run into any bears.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

I’ve never lived in a world without e-mail. No, I’m not one of those millennial kids; e-mail has been around for a long time. Sending messages between computers dates to the 1960s, but most people consider 1971 to be the birth of e-mail. That’s when Ray Tomlinson added the @ symbol to separate users’ names from their e-mail addresses.

Today, e-mail is ubiquitous. You can e-mail your mother, your colleagues, or your cable company. You can even e-mail the president of the United States. Other than the pope and most physicians, there aren’t many people you cannot e-mail. (Although, interestingly, you can reach His Holiness on Twitter @Pontifex.)

We physicians have historically had a few good reasons to avoid e-mailing patients, but many of those objections are unwarranted. As part the meaningful use EHR incentive program from the Centers for Medicare & Medicaid Services, secure messaging will now be required to be eligible for rewards. Although many physicians cite security as a concern, most electronic medical record systems now have patient portals that allow for secure, safe messaging. Encroachment into private time, however, is still a concern for many physicians.

At Kaiser Permanente (KP), we’ve been using secure e-mails with our patients for more than 5 years. When we started, I had some of the same concerns as most doctors: When am I going to have time to do this? What types of questions will patients send? As it turns out, the system has been wildly popular for patients. In 2013 alone, we replied to more than 14 million patient messages. We encourage our patients to use e-mail to stay connected with us, because it leads to improved patient experiences and improved outcomes.

Managing e-mail in-boxes is difficult work, and we KP physicians constantly try to find ways to be more efficient. E-mail does sometimes encroach on my personal time, but I’ve discovered that’s okay. As it turns out, e-mail encroaches on my entrepreneurial brother’s personal time, my financial planner’s personal time, and my plumber’s personal time. Being always connected is a modern luxury and a curse. It’s also part of being a professional.

Here are some steps I’ve taken to manage my patient e-mails. First, I always remember that this electronic message is connected to a real person with real worry. Second, I remember how appreciative patients are to get a message from their doctor. E-mail a patient after 8 p.m., and they will never forget you. Third, clearly delineate time to take care of business. It never feels burdensome in part because I am in control. I choose to e-mail patients not because I have to but because I’m that doctor and it makes me feel good.

This weekend, for example, I did patient messages in a Jackson Hole, Wyo., coffee shop while on vacation. Just as I opened my computer, I noticed a young guy in a fleece jacket next to me checking his e-mail while his wife and two kids enjoyed muffins and hot cocoa. While I was waiting for my wife, Susan, to order our lattes, I overheard him make a call to his office: “Yes, I’m out, but why don’t you e-mail me that and I’ll get right back to you.”

I’m right with you, buddy, I think. I use my token and the wifi there in Wyoming to access my patient e-mails. There are only five. The messages are like most I receive: “I have a new spot,” or “The cream you gave me isn’t working,” or “My acne is better, so should I reduce the spironolactone?” I hammer replies out in 10 minutes.

My wife returns with lattes and opens the local paper while I review 14 biopsy results from 2 days ago. For most of them, I use a template and the secure e-mail to send patients their results. I then send a few notes to some patients, advising them to follow up with me for excisional surgeries.

The work I was doing was not additive; the questions my patients sent would have had to be addressed at some time. In fact, if they had called, then they would have left a message with a nurse who would have sent a message to me, which I would have had to reply to, and then send the message back to the nurse who would have to reply to the patient.

Despite our love/hate relationship with it, e-mail has been one of the great innovations of the 20th century, and it is the primary form of communication in the business world. According to one study, more than 100 billion business e-mails were sent and received every day in 2013. Yet, fewer than one-third of physicians use e-mail to communicate with their patients.Personally, I have found patients to be generally understanding, courteous, and appreciative of e-mail. Of course, there are a few who don’t follow good etiquette. (One of my primary care colleagues relates a story of a patient who e-mailed her every time she had a bowel movement. Gastroenteritis can significantly add to e-mail burden, apparently.)

There’s no doubt that e-mail will soon become the primary way to communicate with patients. Based on our experience at KP, this will ultimately be to the benefit of both doctors and patients. A June 2014 survey by Catalyst Healthcare Research showed that 93% of patients preferred to see a physician who offers e-mail communication with his or her patients. More than one-quarter of those respondents said they’d be willing to pay a $25 charge for such communication. It’s not surprising; as with all businesses, not just medicine, that patients want more channels of communication, not fewer. Fortunately for them, many of today’s medical residents are being trained to use electronic communication with patients. For instance, a 2013 study published in the Postgraduate Medical Journal found that 57% of residents used e-mail to communicate with patients.

My wife finished reading the Jackson Hole Daily newspaper and outlined our hike to Taggart Lake. And I finished answering my messages. The guy sitting next to me is still tapping away at his keyboard. I make eye contact and say, “Almost done?” “Yup,” he replies, “Better for me to just knock it out now, because I’ll just have to deal with it on Monday.” I agree.

Susan and I pack up and head for the trail, which is thankfully connection free. Let’s just hope we don’t run into any bears.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

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.

In my last column, I addressed the question of whether or not to outsource your practice’s social media efforts. While some medical practices do their own social media, others simply don’t have the time, resources, or desire to do it themselves. That’s where social media consultants come in. Hiring the right consultant offers numerous benefits such as devising a strategic plan that aligns with your practice’s unique goals, as well helping you develop and market your personal brand.

Last time, I offered guidelines to help you choose the right consultant for your practice. This time, I’ll offer some pitfalls to avoid when choosing a social media consultant or agency. If a consultant promises any of the following, be skeptical:

• Thousands of followers in just a few weeks! Authentic social media takes time because it’s about building relationships. There are digital programs that let you buy followers, but I don’t recommend them. It’s much better to have a smaller, genuine, truly engaged target audience than a huge, inauthentic one. Building a genuine target audience takes longer to cultivate, but it is far more effective in the long run.

• Your videos will go viral! We’ve all seen videos that have gone viral (many involve grumpy cats, which I don’t recommend using for your brand). Chances are if you’re making a 2-minute video on how to treat rosacea or ringworm, it won’t go viral. (Unless it involves a grumpy cat.) Instead, focus on realistic expectations. Your consultant should offer creative ways to market your brand, whether it’s video or text. But getting hung up on going viral is like waiting to win the lottery. It’s better to regularly create and share high-quality content that over time will garner an audience.

• You’ll double your patients in weeks! The number one way physicians acquire new patients is through word of mouth. Social media is word of mouth enhanced by technology, so it has the potential to grow your patient base. But it takes time. If acquiring new patients is one of your goals, then be certain that your consultant creates a realistic plan to achieve that goal.

• We’re your one-stop shop! Although I advocate using social media to market your practice, I believe it should be only one spoke in your marketing wheel. Traditional forms of marketing, such as newspaper and magazine advertisements, newsletters, and local radio and television appearances, still offer real benefits for many practices. If someone is trying to convince you to abandon all your other marketing efforts, be cautious.

• We’ve had 100% success with all of our clients! Would you believe your fellow doctor if he said he hadn’t had a patient complaint in 3 years? I didn’t think so. Don’t believe a consultant who tells you he’s never made mistakes or had an unhappy client. Ask what a consultant has learned from negative and positive experiences. What insight have they gleaned from that unsuccessful experience? How can these insights help when devising your strategy?

With these guidelines in place, you’re putting your practice and your reputation in safer hands.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

In my last column, I addressed the question of whether or not to outsource your practice’s social media efforts. While some medical practices do their own social media, others simply don’t have the time, resources, or desire to do it themselves. That’s where social media consultants come in. Hiring the right consultant offers numerous benefits such as devising a strategic plan that aligns with your practice’s unique goals, as well helping you develop and market your personal brand.

Last time, I offered guidelines to help you choose the right consultant for your practice. This time, I’ll offer some pitfalls to avoid when choosing a social media consultant or agency. If a consultant promises any of the following, be skeptical:

• Thousands of followers in just a few weeks! Authentic social media takes time because it’s about building relationships. There are digital programs that let you buy followers, but I don’t recommend them. It’s much better to have a smaller, genuine, truly engaged target audience than a huge, inauthentic one. Building a genuine target audience takes longer to cultivate, but it is far more effective in the long run.

• Your videos will go viral! We’ve all seen videos that have gone viral (many involve grumpy cats, which I don’t recommend using for your brand). Chances are if you’re making a 2-minute video on how to treat rosacea or ringworm, it won’t go viral. (Unless it involves a grumpy cat.) Instead, focus on realistic expectations. Your consultant should offer creative ways to market your brand, whether it’s video or text. But getting hung up on going viral is like waiting to win the lottery. It’s better to regularly create and share high-quality content that over time will garner an audience.

• You’ll double your patients in weeks! The number one way physicians acquire new patients is through word of mouth. Social media is word of mouth enhanced by technology, so it has the potential to grow your patient base. But it takes time. If acquiring new patients is one of your goals, then be certain that your consultant creates a realistic plan to achieve that goal.

• We’re your one-stop shop! Although I advocate using social media to market your practice, I believe it should be only one spoke in your marketing wheel. Traditional forms of marketing, such as newspaper and magazine advertisements, newsletters, and local radio and television appearances, still offer real benefits for many practices. If someone is trying to convince you to abandon all your other marketing efforts, be cautious.

• We’ve had 100% success with all of our clients! Would you believe your fellow doctor if he said he hadn’t had a patient complaint in 3 years? I didn’t think so. Don’t believe a consultant who tells you he’s never made mistakes or had an unhappy client. Ask what a consultant has learned from negative and positive experiences. What insight have they gleaned from that unsuccessful experience? How can these insights help when devising your strategy?

With these guidelines in place, you’re putting your practice and your reputation in safer hands.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

In my last column, I addressed the question of whether or not to outsource your practice’s social media efforts. While some medical practices do their own social media, others simply don’t have the time, resources, or desire to do it themselves. That’s where social media consultants come in. Hiring the right consultant offers numerous benefits such as devising a strategic plan that aligns with your practice’s unique goals, as well helping you develop and market your personal brand.

Last time, I offered guidelines to help you choose the right consultant for your practice. This time, I’ll offer some pitfalls to avoid when choosing a social media consultant or agency. If a consultant promises any of the following, be skeptical:

• Thousands of followers in just a few weeks! Authentic social media takes time because it’s about building relationships. There are digital programs that let you buy followers, but I don’t recommend them. It’s much better to have a smaller, genuine, truly engaged target audience than a huge, inauthentic one. Building a genuine target audience takes longer to cultivate, but it is far more effective in the long run.

• Your videos will go viral! We’ve all seen videos that have gone viral (many involve grumpy cats, which I don’t recommend using for your brand). Chances are if you’re making a 2-minute video on how to treat rosacea or ringworm, it won’t go viral. (Unless it involves a grumpy cat.) Instead, focus on realistic expectations. Your consultant should offer creative ways to market your brand, whether it’s video or text. But getting hung up on going viral is like waiting to win the lottery. It’s better to regularly create and share high-quality content that over time will garner an audience.

• You’ll double your patients in weeks! The number one way physicians acquire new patients is through word of mouth. Social media is word of mouth enhanced by technology, so it has the potential to grow your patient base. But it takes time. If acquiring new patients is one of your goals, then be certain that your consultant creates a realistic plan to achieve that goal.

• We’re your one-stop shop! Although I advocate using social media to market your practice, I believe it should be only one spoke in your marketing wheel. Traditional forms of marketing, such as newspaper and magazine advertisements, newsletters, and local radio and television appearances, still offer real benefits for many practices. If someone is trying to convince you to abandon all your other marketing efforts, be cautious.

• We’ve had 100% success with all of our clients! Would you believe your fellow doctor if he said he hadn’t had a patient complaint in 3 years? I didn’t think so. Don’t believe a consultant who tells you he’s never made mistakes or had an unhappy client. Ask what a consultant has learned from negative and positive experiences. What insight have they gleaned from that unsuccessful experience? How can these insights help when devising your strategy?

With these guidelines in place, you’re putting your practice and your reputation in safer hands.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.