For every new medical device or piece of equipment family physicians encounter, questions inevitably arise. Do I really need this? Does it work? Will it help me in my practice? Is it worth the investment? How am I going to pay for it?
For digital health tools such as telemedicine software or EHRs, those questions are often even more important because these tools can have a substantial effect on an FP's practice every day. Professional medical organizations have taken notice and are actively monitoring trends related to these tools and their impact.
Case in point: Study results from a 2019 survey(www.ama-assn.org) the AMA published earlier this month show that use of digital health tools has increased substantially since 2016. Specifically, the study found that more physicians -- especially primary care physicians -- are recognizing the value of tools that allow them to provide care remotely. Participants cited the tools' ability to improve efficiency, increase patient safety and provide greater convenience as top motivators for adoption.
Study Design and Findings
The research largely reiterated a 2016 survey of 1,300 physicians -- half of whom were PCPs -- that examined what factors motivated physicians to adopt digital clinical tools and what drove these clinicians to implement them in practice. The same physician panel was used for the 2019 survey to yield a statistically valid and reliable comparative sample.
- A survey of 1,300 physicians found that use of several categories of digital health tools increased considerably from 2016 to 2019.
- The largest increases were seen in tools that enable remote care.
- A greater percentage of primary care physicians cited a definite advantage to using digital health tools compared with specialists.
In both surveys, participants answered a series of virtually identical questions about their use of and enthusiasm for seven digital health tools:
- remote monitoring for efficiency,
- remote monitoring and management for improved care,
- clinical decision support,
- patient engagement,
- televisits/virtual visits,
- point of care/workflow enhancement, and
- consumer access to clinical data.
The 2019 survey added three new questions on the use of emerging technologies such as augmented intelligence and precision medicine. They appeared at the end of the survey to preserve the flow of the original series of questions.
Among the study's chief findings was that use of all seven digital health tools increased between 2016 and 2019. The largest increases were seen in two types of remote care tools: televisits/virtual visits, where physician usage doubled from 14% to 28%, and remote monitoring and management for improved care, where usage rose from 13% to 22%.
Sixty-eight percent of physicians cited the ability to provide remote care to their patients as being very important or somewhat important when considering whether to incorporate digital health tools into their practice. This was the only motivating factor in the survey to see an upward trend from 2016.
In addition, more physicians reported in the 2019 survey that digital health tools would help reduce stress and burnout and result in increased patient adherence.
Overall, 87% of physicians said that digital health tools give them an advantage in their ability to care for patients. More PCPs (40%) said there was a definite advantage to using digital health tools compared with specialists (33%).
Physicians also outlined their requirements for adopting digital health tools. Compared with 2016, more physicians said it was important that tools
- are covered under standard malpractice insurance,
- are well integrated with EHRs,
- are reimbursable for the time spent using them,
- have been proven to be as good as or superior to traditional care, and
- have demonstrated safety and efficacy.
Finally, the survey showed that current use or planned adoption of digital health tools continued to increase slightly, with the highest levels of planned adoption seen for televisits/virtual visits and remote monitoring.
Q&A With Medical Informatics Expert
Steven Waldren, M.D., M.S., is an AAFP vice president and the Academy's chief medical informatics officer. For more than a decade, he has advocated with government and vendors on behalf of family physicians, specifically articulating the need for more useful and usable health IT that supports, rather than hinders, patient care. A dual mission is his work to ensure that family physicians remain at the forefront of emerging health IT, and he has spearheaded a number of innovation projects in this area. Waldren shared his thoughts on the survey and the AAFP's ongoing efforts in the following Q&A.
Q: Compared with specialists, significantly more primary care physicians thought digital health tools better enabled them to care for patients. What features of these tools give PCPs that advantage?
A: I don't have any data on why the differential in attitudes. I would speculate that some factors contributing to that are: first, primary care physicians are more risk- and uncertainty-tolerant; second, they face the greater demands to manage patients longitudinally; third, prevention is a common area for digital health tool companies; and fourth, there has been potentially greater penetration of value-based care among PCPs.
Q: The biggest increases in usage occurred with tools that focused on remote care such as televisits and remote monitoring. Why do you think the gains were highest in these areas?
A: Virtual care is farther in the diffusion of technology cycle than other digital health tools, so more accelerated growth is expected.
Q: Televisits and remote monitoring also were the tools that physicians were most enthusiastic about. Where do you see those trends heading?
A: Growth in virtual care will continue due, in part, to better reimbursement by health plans and the industry's move toward value-based care.
Q: Many physicians also cited helping to reduce stress and burnout as a reason for using digital health tools. Can you tell us about the Academy's efforts in this area?
A: We are working with companies on products that use proven innovations in mobile, voice, machine learning and AI to validate solutions that reduce burdens in documentation, prior authorization and quality measurement reporting. Burdens experienced every day across these areas are simply unsustainable. We are also strong advocates for the adoption of application programming interfaces by the industry and EHRs, to enable integration of these digital health tools into the physician's EHR and workflow.
Q: Physicians listed several requirements for adopting digital health tools. What is the Academy doing to ensure these requirements are met?
A: We are advocating within the federal government to require exchange of health data in standardized APIs, integrated within EHRs and health IT, to minimize one-off approaches and solutions to data-sharing that would otherwise ultimately add to practice burdens. We are also working with innovators in the API space. We joined Logica Health(www.logicahealth.org) to help establish the semantic data standards needed to allow for not only the sharing of health data, but also of meaning and knowledge. This semantic standardization is needed to enable smart health IT that can filter, analyze, aggregate and compute on clinical data. These capabilities can decrease the unnecessary, extraordinary cognitive load and time-suck burdens on family physicians, supporting our ability to practice full-scope family medicine while improving the family medicine experience.
Q: The report also contained a section on augmented intelligence technologies. Could you explain that term and its importance in health care?
A: This is a term that AMA uses when talking about artificial intelligence. The term's purpose is to articulate the point that artificial intelligence systems should be focused on augmenting the physician and not trying to replace the physician.
Q: Many physicians appeared to be familiar with augmented intelligence technologies, but few are using them. Why do you think this is so, and how can the Academy help increase use of these technologies among FPs?
A: Solutions that leverage artificial intelligence have become commonplace (Siri, Alexa, Google Assistant, Google Search) and there is a lot of buzz in the media about AI and its potential. It is common with new innovations to see greater awareness and hype than adoption in the early stages of diffusion of technology. The AAFP is working to establish long-term relationships with leading AI companies (big and small) so that the family physician's voice is part of the conversation about the future of health AI. As solutions are better tailored to the needs and workflows of family physicians, we will see rapid adoption.
Q: How would use of these technologies benefit the typical FP?
A: It is very dependent on the tool. Tools can reduce administrative burdens, expand the capacity of a practice, and expand the capabilities of a practice.
Q: What Academy resources would you recommend for members on these topics?
A: There are several.
The Telemedicine for Family Physicians page under Physician Health First contains links to numerous resources.
The AAFP also has an on-demand webcast titled The Business of Telemedicine that focuses on fee-for-service Medicare telehealth services and reimbursement.
FPM published an article that touches on telehealth, telemedicine and other technology tools and trends.
And, of course, there's the Telehealth Member Interest Group, where you can talk with peers about what they are doing and finding to work well.
Related AAFP News Coverage
Artificial Intelligence, Machine Learning Poised to Help FPs