Challenges to overcome Despite such enthusiasm, Shrestha and other users acknowledge there are significant obstacles to widespread adoption of these technologies – particularly for medical practices that rely on a fee-for-service payment model. That’s because engagement technologies are designed to keep patients healthier and to connect patients with their doctors outside the exam room. And at this point, under traditional reimbursement models, doctors don’t get paid for that work. Richard Ricciardi, PhD, NP, director of the Agency for Healthcare Research and Quality (AHRQ) division of practice improvement, and AHRQ’s senior nursing advisor, says few providers are wholeheartedly embracing these technologies, “because they’re not integrated with electronic health records, payment models, [and] reimbursements.” But Kvedar points out that payment models are changing, and as more doctors get paid under models other than fee-for-service, they’ll see that using technologies to remotely monitor and analyze their patients’ health and encourage healthy habits will save time and money by producing better patient outcomes. “That way I’m using my brick-and-mortar resources to take care of the patients who need it the most,” he explains. Clinician concerns about adding to their already busy workload is another obstacle, say Kvedar and others. They’ll need to figure out how to incorporate these platforms into their workflows to create efficiencies rather than redundancies. Kvedar says he’s confident that will happen. He compares these technologies to email; many clinicians once viewed email as burdensome extra work, but now it has nearly replaced voicemail and added efficiencies to boot.
Making technology fit Doctors likely will find that connected care technologies fit best into practices where the workflow process includes physician extenders – coaches, patient advocates, nutritionists, and other support staff – who can take the lead in using the technologies to teach, motivate and interact with patients as well as track patient data, allowing doctors to focus their time on delivering the highly-skilled care they’ve been trained to provide. “If it’s just the doctor that’s trying to manage this continuous care delivery, then that’s a lot and it’s not leveraging their skills,” says Moore. “There’s a lot of evidence that the most cost-effective model of care would be a combination of these practice extenders so each one can [work] at the top of their practice.” David C. Rhew, MD, chief medical officer and head of healthcare and fitness for Samsung Electronics America, which offers technologies in this market, says doctors will have to adjust their mindset. “Physicians have been traditionally focused on what happened in their office,” he says, with doctors assuming that patients follow their instructions once they were sent home. But as any doctor knows, “that doesn’t always occur.”
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That could explain why studies show that physicians who follow up after office visits produce better patient outcomes than those who don’t, Rhew says. In the past, such follow-up was time-consuming and costly. But these connected care technologies are designed to make follow-ups easier and enable more collaborations and communication with patients in timely cost-effective ways. “The more contact you have, the more ability to course correct or reinforce one’s behavior to help them better understand risks, the more you allow patients to become empowered, the better results you’ll get,” he says. Ricciardi, though, cautions against expecting too much from these technologies. He says they may indeed help patients stay motivated and encourage them to adopt or keep healthy habits, but the patients still must be willing to do whatever work their doctors prescribe, whether it’s adherence to their medication schedule or a nutrition plan. “I see them as a lever for management, but not a panacea,” says Ricciardi, who in his practice at a Department of Defense facility uses activity trackers as a way to help patients stay motivated and record their physical exercise. “If you want to help facilitate someone to lose weight and get some physiological data on their activity levels, yes, you could use apps that could track that information and provide a feedback loop,” he says. “But in my opinion they’re primarily there to help the patient with self-management.” Ricciardi adds: “Is this the first thing they think of in terms of self-management? No. Is it part of the tool kit? Yes.” Copyrighted 2016. Advanstar. 124845:1216DS
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