Avoiding Digital Health Snake Oil

Blog post by Colin Hung.

At the recent #TopOfMind2018 conference, Amy Edgar, APRN, CRNP posed a tough question to one of the presenters “How do we prevent digital health from becoming the next snake oil”. It stunned the room into silence and for the rest of the day, Amy’s question was frequently referenced. I thought it would be interesting to explore this question in more detail on this week’s #hcldr chat.

Last week I had the privilege of attending the #TopOfMind2018 conference hosted by the Center for Connected Medicine (CCM). Regular HCLDR participants will recall that the CCM was one of the guest moderators for the #hcldr chat on 28 November 2017 that featured our friend Rasu Shrestha MD, MBA.

#TopOfMind2018 was a fantastic event and one of my personal highlights for 2017 as far as conferences go. The CCM team really paid attention to detail and spoiled attendees with copious amount of tasty food as well as healthy snacks. What made the event especially memorable was the people – and I don’t mean just the presenters (who were excellent), the audience at this event was equally impressive. There were no less than 10 members of the HCLDR and #pinksocks communities attending (Matt Keener, Larry Gioia, Amy Edgar, Erin Moore, Michael Joseph, Stephen Konya, Andrew Richards, Mike Biselli, myself and Rasu Shrestha – the MC for the event).

When you have that many passionate people in the audience, fun things are bound to happen.

On the morning of the first day, Amy Edgar posed a tough and thought-provoking question to tone of the presenters. “We don’t need more technology to engage patients. Patients are already engaged in their health. We just need to give them better and more useful tools to get engaged. How do we prevent digital health from becoming snake oil?”

You could hear a pin drop after Amy posed the question.

Google defines snake oil as a product of little real worth or value that is promoted as the solution to a problem. You don’t have to search too far before you find digital health snake oil. My go-to example is version 1 of patient portals. These were billed as the solution to every patient’s medical record access problem. Using these magic portals, patients could log in and see all their health data in one place. Dancing in the streets would ensue.

The early portals rolled out by hospitals were close to useless. The problems started right from the beginning with horribly complex login requirements for patients. In some cases patients had wait for their IDs and passwords to be mailed to them before they could access to the portal (billed as a security measure). For those that managed to get in, there was no online help or tutorials to guide them through the system. Instead patients were left to stumble through non-intuitive, jargon-filled menu options looking for their data. The irony was that many portals only provided access to limited medical data, like lab results. Many parts of the EHR were hidden from patients. It was not surprising when many patient portals fell into disuse. The problem became so acute that the ONC reduced the patient portal requirements in Meaningful Use 2 – a recognition of the lack of adoption/acceptance by patients.

David Blumenthal, President of The Commonwealth Fund, former National Coordinator for Health Information Technology put it best:

Every technological advance brings both benefits and risks, many of which are unanticipated. This is especially true of digitizing health information—a process that is inevitable and accelerating. Since the dawn of the information revolution, the very idea that health care would remain walled off from this profound development has been untenable. The question was not if but when, and with what effects.

In the case of patient portals the effect was much less than expected.

There are, unfortunately, many other examples of digital health snake oil. Many physicians would consider EHRs as snake oil. Billed as the solution to all of healthcare’s problems, they have since become a source of frustration and according to a Mayo Clinic report, a key reason for physician burnout. On the other hand, without EHRs would we be riding the wave of Artificial Intelligence tools and Machine Learning today? Without the gigabytes of health information stored in EHRs would we have datasets big enough to train these new systems? Maybe EHRs are not snake oil after all.

A key part of Amy Edgar’s statement came in her follow up tweet:

Amy asks a very important question – what can be done to prevent digital health from becoming snake oil? What can vendors do to design their products to be useful rather than a source of frustration? What can healthcare organizations do to deploy digital health in a way that is not overly disruptive to staff? What can clinicians do to help integrate digital health into the delivery of care? What can patients do to accept (and perhaps demand) digital health tools in their care?

Please join me on Tuesday December 12th at 8:30pm ET (for your local time click here) for the weekly #hcldr tweetchat where we will be discussing digital health and snake oil:

  • T1 What does digital health snake oil mean to you? How do you recognize it?
  • T2 Do you believe that EHRs are the digital health equivalent of snake oil? Why or why not?
  • T3 Are there digital health applications you consider snake oil (other than EHRs)? What about the opposite?
  • T4 What can vendors do to ensure their products are useful/valuable vs being considered snake oil?

References

“Is It Fair To Call Digital Health Apps Today’s Snake Oil?”, Christina Farr, Fast Company, 21 June 2016, https://www.fastcompany.com/3061125/is-it-fair-to-call-digital-health-apps-todays-snake-oil, accessed 12 December 2017.

“AMA’s Digital Health Snake Oil Claim Creates Needless Conflict”, Anne Zieger, EMRandHIPAA, 22 June 2016, http://www.emrandhipaa.com/katherine/2016/06/22/amas-digital-health-snake-oil-claim-creates-needless-conflict/, accessed 12 December 2017

“Commentary: The Truth About EHR and Digital Health Snake Oil”, Carla Smith and Patricia Mechael, Healthcare IT News, 20 July 2016, http://www.healthcareitnews.com/blog/commentary-truth-about-ehr-and-digital-health-snake-oil, accessed 12 December 2017

“AMA CEO Outlines Digital Challenges, Opportunities Facing Medicine”, American Medical Association, 11 June 2016, https://www.ama-assn.org/ama-ceo-outlines-digital-challenges-opportunities-facing-medicine, accessed 12 December 2017

“Top of Mind for Top US Health Systems 2018”, Center for Connected Health, December 2017, https://www.connectedmed.com/TopofMind2018, accessed 12 December 2017

“Why 98% of Digital Health Startups are Zombies And What They Can Do About It”, Dave Chase, Forbes, 18 May 2016, https://www.forbes.com/sites/davechase/2016/05/18/why-98-of-digital-health-startups-are-zombies-and-what-they-can-do-about-it/#376f38f7359a, accessed 12 December 2017

“Is The Digital Health Industry Failing or Flourishing? New Report Provides Answers”, Fard Johnmar, HIT Consultant, 5 October 2017, http://hitconsultant.net/2017/10/05/report-digital-health-failing-flourishing/, accessed 12 December 2017

“Data Withholding in the Age of Digital Health”, David Blumenthal, The Milbank Quarterly, March 2017, https://www.milbank.org/quarterly/articles/data-withholding-age-digital-health/, accessed 12 December 2017

“Mayo Study Links EHRs With Physician Burnout”, Becker’s Health IT & CIO Review, 28 June 2016, https://www.beckershospitalreview.com/healthcare-information-technology/mayo-study-links-ehrs-with-physician-burnout.html, accessed 12 December 2017

“How does the EHR drive burnout? Let’s count the ways”, Paul Dechant MD, KevinMD.com, 13 August 2017, https://www.kevinmd.com/blog/2017/08/ehr-drive-burnout-lets-count-ways.html, accessed 12 December 2017

Media Credit

Snake Oil – Robert Patton https://flic.kr/p/9E56tv

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