The American Medical Association has always had an interesting relationship with digital health, vacillating between gadfly and cheerleader as it seeks to fulfill its role as the voice of physicians in industry conversations.
At the Cleveland Clinic Patient Experience: Empathy and Innovation Summit, an event held in Cleveland this week and organized in conjunction with HIMSS, AMA Board Chair Dr. Jack Resneck Jr. laid out the AMA’s perspective on the tremendous potential of digital health technology — as well as the many ways that potential is not being fulfilled.
“When I come to meetings like this, I get tremendously excited as everybody does seeing all of the disruptive innovation and things that are taking place that are going to help us take better care of some of our patients, and I also channel the frustrations of some of my peers about tools that are out there that don’t work, or don’t think of whether they affect a physician’s workflow or a patient’s health in a positive way,” Resneck said.
Resneck said that the AMA’s attitude toward technology has been shaped by what he sees as one of the great technological failures in medicine: the EHR. EHR interoperability is moving forward, Resneck said, but still has a long way to go.
An issue right now is that, as EHRs begin to talk to each other at last, they still aren’t speaking the same language in terms of having their data formatted in uniform or easy to use ways.
“When I do see [data from other EHRs], when I dig into them and get them, it’s like getting a DOS file from 1985,” Resneck said. “Interoperability isn’t worth that much when it’s a six-hour homework assignment for one patient.”
The AMA is supporting efforts that standardize the important data that physicians most need to see and make sure they are always easy to find.
Another area where tech is failing to live up to its significant potential is telemedicine, Resneck said.
“When I see the things that are actually being scaled rapidly in telehealth, unfortunately, rather than providing access for patients who don’t have enough access for chronic disease — diabetes, hypertension — we’re actually making it much more easy for people who have the sniffles or a viral respiratory infection to get antibiotics quickly and easily without having to leave their homes to go to the doctor’s office,” he said. “I don’t think that’s the best use of this technology.”
Additionally, scientific studies of consumer telehealth have demonstrated that the visits patients are having can be problematic.
“This is a study we did where we had medical students posing as patients sending structured cases to direct-to-consumer telehealth companies,” Resneck said. “Across the board, we saw a lack of transparency, patients weren’t being told who was taking care of them, there was no discussion of risks and benefits of prescriptions. It was very disappointing.”
And when it comes to digital health apps, an area where the AMA has long advocated for quality standards, it is still far too easy for a person searching in the app store to end up with an app that doesn’t really work, including many apps that claim to use the phone’s camera to take blood pressure readings.
“If you are looking for a random number generator, this is your tool. If you want to check your blood pressure, this is not,” Resneck said.
Finally, the AMA is sounding the call for ethics to catch up with technology in the area of artificial intelligence. As more and more innovators build tools that use machine learning to train on large datasets, it’s important to create intentional standards to make sure those models aren’t biased in various ways.
“AI has the potential to learn exactly what we’re doing wrong now and reinforce those disparities,” he said.