To scale digital health, providers need organizational structure changes

By Aditi Pai
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Lauren CheungTwo challenges to scaling digital health technologies within a provider group are lack of collaboration between departments and too much focus on the technology instead of how the technology can be applied within a care model, according to Dr. Lauren Cheung, medical director of strategic innovations at Stanford Health Care.

Cheung spoke at the Connected Health Symposium in Boston along with University of Pittsburgh Medical Center Vice President Andrew Watson and Penn Medicine Chief Innovation Officer Roy Rosin.

She explained that at Stanford, when administrators ran the digital health team and they'd find a new technology they wanted clinicians to use, there was often a large amount of push back, and it almost never happened.

"What we found the best model is, is to really focus on creating these collaborations across the health system," Cheung said. "The clinician is the champion, for the most part, and then collaborates with the ops team and with the IT team to drive an initiative forward. We also have found that you really do need that clinical input, because without it, you are not going to design something clinicians want to use, but if it’s the clinician alone trying to do it without the help of the health system, we've encountered the same thing, which is, we just can’t scale and an initiative just won’t move forward."

Rosin also saw this lack of coordination as a roadblock for implementing digital health technologies at Penn Medicine.

"One of our best connected health interventions that we’ve done so far had to do with congestive heart failure," he explained. "...It was a perfect perfect pilot in some ways...But the thing that’s fascinating is after this pilot we had zero preventable readmissions and everyone said this is fantastic, we should invest and scale this across the system. Nothing happened, months go by, nothing happened, a year goes by, nothing happened. And everyone thought we should do this, yet no organizational structure that actually made this core to the way we did our work."

Watson added that finding the technology is only about 20 percent of the challenge and that the real issue is aligning operations and finance departments as well.

"We are going through a very large process of reengineering our remote monitoring program and what you realize is it’s slowing down the hospitals and doctors," Watson said. "And if you want to walk in to the CFO of the hospital’s office and tell him that, then go for it. There’s an enormous cultural change but an operational hurdle to make sure that when telemedicine happens, you have the financial models built at scale and also the operations to support it. The technologies have faded to the back, but it is the most alluring part of it. And that’s one of the things we are seeing most persistently."

But beyond just the difficulty with coordinating with all of the departments, there are other reasons why the technology shouldn't be a provider's main focus.

"It’s really how do you design a care model that looks at how the patients and provider wants to use technology and then develop a solution that works for those populations," Cheung said.

In Stanford's clinic, Cheung and her team found that their patients' acceptance of digital health tools, like telemedicine, for their care, did not pan out the way they thought it would.

"What we are finding is there’s a split between new and return patients, but about 70 percent of our new patient visits are done in person even when the patient is given an opportunity to do the visit virtually because we know based on their complaint or what they want that we can get it done virtually," Cheung said. "Moving from there to return patient visits, we are seeing that 60 percent of our visits are now done virtually, and that’s 30 percent of all return visits are done through video visits and the other 30 percent are done through phone."

But when she compared these statistics to the wellness coaches who only operate virtually, she saw that that 70 percent of their visits are video visits and 30 percent are via phone calls.

"And then we look at connected devices and I always say whenever I prescribe a connected device, I get maybe 5 percent using them," she said. "Whereas the wellness coaches, who have that one-on-one relationship with the patients -- they are interacting with the patient much, much more frequently than I am and giving them active feedback on what’s going on and they are getting better uptake of connected devices than I am, the doctor who sees the patients only once in a while."