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Friday Oct 16, 2020

We Must Ensure New Tech Works for FPs

U.S. patients make roughly 193 million trips to see family physicians each year. That’s 67 million more than the nation’s next-largest specialty and accounts for roughly 20% of all office visits.

[Physician working on tablet]

Unfortunately, we also know that for every hour we spend in direct face-to-face time with patients during those visits, we’re likely to spend two more with our EHR systems. (www.acpjournals.org)

Now imagine if we had technology and tools that worked for us instead of often feeling like that relationship was reversed.

A Harris Poll survey of primary care physicians found that roughly two-thirds of respondents thought EHRs have led to improved care, and a similar percentage were are at least somewhat satisfied with their EHRs. However, 40% of primary care physicians surveyed said the technology to date has presented more challenges than benefits, and more than 70% cited EHRs as a significant driver of burnout.

In that 2018 poll, nearly 40% of respondents cited voice-enabled scribing as one of the top short-term improvements they would like to see, and more than one-fourth cited AI support with patient care and practice administration as needed long-term goals.

In that same year, the AAFP Board of Directors approved a 48-month special project to address issues related to EHRs and find solutions. The project is intended to drive innovations utilizing the latest health IT, addressed from a family medicine perspective to improve and optimize our experience and truly enhance the delivery of patient care.

So where are we now, two years later?

As we enter a new era of medical technology, the AAFP is working to reduce administrative burden, which is one of members’ biggest concerns. In the long term, we want to make sure family medicine is in a leadership position in the development of artificial intelligence and machine learning. We must ensure that the technology meets the needs of family medicine and can be integrated into primary care.

The AAFP’s Innovation Lab is seeking a limited number of Academy members to evaluate Navina, an AI-driven platform for primary care that integrates with a practice’s EHR to mine patients’ data in real time to optimize diagnosis and coding processes. It is designed to enhance quality of care while also facilitating appropriate coding for services.

Members interested in participating in the project should contact the Academy’s Alliance for eHealth Innovation. 

That project is in stage one (proof of concept), while the Academy’s collaboration with Suki has advanced to stage two (validation). There is still time, however, for independent family physicians who are using Athena, Cerner or Epic EHRs to join the evaluation of Suki,(aafp.secure-platform.com) which is a digital assistant that combines artificial intelligence and voice-enabled technology.

Our pilot with Suki has demonstrated that this technology can dramatically reduce a practice’s administrative burden. In the future, such tools will function like a medical assistant who has worked with you for years, knows your practice habits and can predict what you need or what you might do.

Meanwhile, family physician Brent Sugimoto, M.D., M.P.H., helped found a startup that has an exclusive license on artificial intelligence technology developed at SRI International, and is applying it to primary care. The platform can handle tasks such as telephone triage, documentation and patient followup. It also can listen to patient speech for signs that may help a physician recognize conditions such as depression. By being involved in the development stages of new tools, family medicine can ensure that cutting-edge technologies work the way we need them to.

Some physicians are concerned that AI will encroach on family medicine’s scope, but we already are seeing evidence that new tools actually could augment it. For example, the FDA has approved a tool that utilizes artificial intelligence and machine learning to allow screening for diabetic retinopathy in the primary care setting. AI will allow things traditionally done by subspecialists to be done efficiently and effectively in primary care. Such advances have the potential to expand the capabilities of primary care and enhance the comprehensiveness of care.

The AAFP’s Innovation Lab initially was focused on issues related to administrative burden and value-based care delivery. Although those areas are still priorities, the Academy has expanded the scope of its efforts to include telehealth and other innovations focused on practice viability.

COVID-19 exposed the inadequacy of fee-for-service payment to support family medicine practices. However, the pandemic has also allowed our practices to innovate. From March to May, the number of AAFP members regularly providing video or telephone visits increased by more than 80 percent in response to pandemic. Nearly 80% of members surveyed by the AAFP said they were satisfied with virtual visits, and roughly 70% expressed an interest in continuing to provide virtual care beyond the pandemic.

Family physicians’ rapid adoption of telemedicine has allowed us to maintain continuity of care with patients and even engage new patients. Many practices are finding that telemedicine is a powerful tool to promote continuity of care and offer convenient, routine care, and the AAFP is working on multiple fronts to help members sustain and grow it.

  • Advocacy: The Academy is focused on preserving access to telemedicine beyond the pandemic, ensuring adequate reimbursement and protecting and promoting the medical home. The AAFP also is advocating for value-based payment that would provide practices with the needed flexibility in service delivery to leverage telehealth appropriately. 
  • Member Resources: The AAFP has developed a new Telehealth Toolkit(1 MB PDF) and other related resources. 
  • Innovation: The AAFP Innovation Lab is looking for new and emerging solutions to help family physicians integrate telemedicine into their practices.

Implementation of telemedicine in family medicine is a prime example of innovation that, pre-pandemic, had been slow. We should embrace innovation and participate in the development of new technologies that have the potential to support and augment our capabilities so the end result is tools that work for us.

Ada Stewart, M.D., is president of the AAFP.

Posted at 07:00AM Oct 16, 2020 by Ada Stewart, M.D.

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