This year provider organizations continued their dive into digital. Big names in the provider space including the Department of Veterans Affairs, Ascension and Brigham and Women’s Hospital made major deals with well-known tech companies. We’ve also seen new technologies catching on in the provider space, notably voice.
Another major trend is the use of telemedicine. While the technology is hardly a new kid on the block, it is picking up steam when it comes to legislation and as hybrid care models and other new types of telemedical care emerge. But at the end of the day providers are continuing to push patient-centered care, and to work out how technology can help, not hinder, the patient experience.
Here is a look at some of the biggest provider trends in 2019.
Looking to tech for partnerships
In the fall news broke that Google has been working with Ascension since 2018 on a collaboration involving patient data, called Project Nightingale.
While that news sparked concern among many patients (and some Ascension employees) about patient privacy, the fact that such a partnership appeared to be HIPAA compliant kicked off another major conversation about the distribution and use of sensitive data in healthcare.
Google isn’t the only Silicon Valley big-wig getting in on the partnership game. In September Apple announced that it will be launching three new Apple Watch health studies in partnership with major healthcare and academic organizations, including the World Health Organization, Brigham and Women’s Hospital, and others.
These studies will capture data regarding participants’ sound exposure, menstrual cycles, heart rate and physical activity. Each will be open to US Apple Watch owners, who will be able to enroll themselves through a new Apple Research App the company has since released.
Apple, Eli Lilly and Company and Evidation Health also teamed up on a new feasibility study that found sensors from consumer-grade devices like iPhones, Apple Watches, iPads and Beddit sleep monitors capture enough data to spot mild cognitive impairment or Alzheimer’s disease dementia.
Also in Apple partnership news, 10 months after announcing plans, and just shy of a year after those plans originally leaked, Apple and the VA completed the rollout of Apple Health Records for any iOS users among the more than 9 million veterans in the US and surrounding territories.
Siri, where is my medication?
Increasingly provider organizations are turning to voice technology as a way to deliver support and information to patients, as well as ease physician burnout. While still in the early days, voice is being used for everything from EHR entry to medication adherence.
“Now as opposed to having to learn how to tell the computer what you want it to do, you can literally tell the computer what you want it to do,” Dr. Yaa Kumah, assistant professor of biomedical informatics at Vanderbilt University Medical Center, said during The Voice of Healthcare Summit at Harvard Medical School in August. “That is just amazing and can allow so many more people who don’t have all the tools and resources to interact with a physical keyboard to still get the same benefits.”
Big tech giants, namely Amazon, continue to roll out provider-focused voice technologies.
For instance, earlier this month Amazon Web Services announced that it is tapping into its voice technology once again with the launch of the Amazon Transcribe Medical, an automated speech recognition service that lets developers add medical diction and documentation to their apps.
The streaming API tool is designed to cater to medical and pharmacological terms, thereby allowing doctors, clinicians and researchers to dictate into it. It also has a natural speech feature, which can transcribe a doctor-patient visit.
While more patient facing, Amazon also announced new feature that lets users link up their pharmacy prescription information and, in turn, get reminders about when to take their pills and order refills.
The latest feature was born out of a collaboration between the online retail giant and Omnicell, a tech-enabled medication management company. Initially the feature is being rolled out to Giant Eagle Pharmacy customers, but Amazon hinted that it plans to launch at more pharmacies next year depending on how the rollout goes.
However, the technology is not without its challenges. HIPAA is a top priority for health systems, but voice poses challenges that bring up privacy questions beyond just HIPAA.
“When it comes to healthcare and voice design, we have several challenges we face every day,” Freddie Feldman, voice design director at Wolters Kluwer Health, said at The Voice of Healthcare Summit. “HIPAA is a big topic on everyone’s mind nowadays, and it is one we take seriously. The first thing most people think about when they hear HIPAA is securing servers platforms, but there is more to it. We have to consider things like the unintended audience for a call.”
While provider and tech organizations may be looking to voice as the future, it's worth noting that adoption remains low among patients. In October a survey conducted by Voicebot and Orbita reported that consumer adoption of voice assistants for healthcare was still relatively low (7.5%), although there is consumer interest in the technology.
Telemedicine has been around for nearly two decades now, and provider organizations are continuing to find new ways to implement the services.
The digital health industry is continuing to see the growth and emergence of hybrid telehealth and brick-and-mortar clinics. Rumors have been flying that One Medical, a primary care focused practice that lets patients access around the clock video visits with a doctor and in-person care, is moving towards an IPO.
In addition to primary care-focused hybrid systems, there are also a number of specialty providers in the startup space. In mid-December Emilio Health, a pediatric behavioral health startup, announced a $5 million raise. Its services will include brick-and-mortar clinics with specialty services including occupational therapy and behavioral specialists. The startup is also incorporating a digital platform, which can be used to help track progress, schedule appointments and access teletherapy. Kindbody, a women’s health startup, is another startup that combines in-person visits with digital care.
Increasingly, legislation has been supporting telemedicine reimbursement and coverage. As of October, 42 US states and the District of Columbia have statutes in place regarding commercial insurance coverage for telehealth, according to a survey report published recently by law firm Foley & Lardner.
Various government iniatives are pushing telemedicine. The US Department of Agriculture announced new grant investments in late November for infrastructure aimed at expanding education and healthcare access among rural US residents. The full bundle consists of 133 grants totaling $42.5 million, and are spread across 37 states and two US territories.
Additionally, in July the FCC’s Connected Care Pilot Program — a three-year, $100 million telehealth initiative that was first proposed last summer — took another step toward fruition with the commission’s unanimous vote to advance and seek public comment on the project.
Big tech is even dipping into telemedicine. In September the news broke that Amazon is launching Amazon Care, a virtual primary care offering for its Seattle-based employees. Amazon Care will include telemedicine, online chat with a nurse, medication delivery and app-enabled house calls to the employee's office or home. Amazon is not employing any doctors; instead, the company is contracting with a local clinic called Oasis Medical Group.
Keeping patients at the heart of care
Hospitals and health systems are talking about the patient experience more and more. A driving trend in healthcare is the consumerization of the industry. However, many are stressing that patients have different needs than other consumers.
“Healthcare can learn a lot from other industries. The vulnerability that our patients have will never make them a typical consumer,” Adrienne Boissy, chief experience officer at the Cleveland Clinic, said during a keynote at the event, which was conducted in partnership with HIMSS.
As it stands now, the health system has a lot of gaps.
“There is still a lot of work to do. People are still telling us access isn’t right, convenience isn’t right, it is still too difficult to navigate the system. So that is the future work,” Adrienne Boissy, chief patient experience officer at Cleveland Clinic, said at the Patient Experience Summit in May. “I think the challenge for organizations is get clear on standard work and what you should be doing that is non-negotiable for patient experience.”
Digital tech has pitfalls that can lead to misunderstandings and wrong impressions.
“There are many ways in which we communicate digitally,” Dr. Richard Frankel, of the Indiana University School of Medicine, said this morning during a panel at the Cleveland Clinic's Patient Experience: Empathy and Innovation Summit. “I think with email and secure messaging it’s much more difficult to express empathy and there is a much greater potential for misunderstanding and miscommunication.”
Education is key according to industry players.
“I also think learning how the technology works [is important],” Amy Windover, director of the Cleveland Clinic Center for Excellence in Healthcare Communication,said. “Teaching people to look at the camera instead at the screen and the person's face, and being able to look at both, makes a big difference so it doesn’t come across as if you are just looking down at them the whole time. They might be wondering why aren’t you making direct eye contact — direct eye contact is critical for empathy. Ask them 'Have you had any previous experience with virtual visits or technology?' so patients are able to share their experience and you can align around that and be helpful for teaching empathy.”