In part two of our three-part series on trends in healthcare consumerism, we examine the growth of technology in terms of telemedicine, monitoring chronic conditions and wearables and trackers.
With an increased focus on patient-centered healthcare, primary care providers are at the forefront of meeting patient needs. During the pandemic, primary care has accomplished a significant technology advancement — ushering in telehealth acceptance for healthcare consumers and fellow providers.
In 2020, the American College of Physicians (ACP) surveyed primary care doctors and found that 33% of all internists that already invested in a telehealth platform used virtual visits by the end of the year, while another 27% were considering it.1
The use of healthcare wearables and trackers (self-monitoring apps) is also on a slow but steady rise, with the ACP survey showing that although only 5% of internists are regularly integrating wearables data into patient care, that number is up from 1.2% in 2019.1
Although hospitalists and larger practices with 100 or more physicians use wearables data more often, internists use it for routine care and chronic care management.
Tara Scott, M.D., chief medical officer and founder of Revitalize Medical Group in Ohio, believes in the benefits of emerging technology in healthcare:
- Reaching a wider range of patients
- Convenient appointment times
- Higher grade monitoring devices (i.e., blood pressure cuffs, at-home EKGs and pulse oximeters)
And with 50% of her patients continuing with telehealth post-pandemic, "It's probably something that's here to stay," Scott says.
The rise of telemedicine visits
Though the pandemic saw a massive spike in telehealth visits at 80 times higher than in 2019, by 2021, telehealth utilization was up to 38 times higher than pre-pandemic levels, according to a McKinsey report.2
Reasons for this shift in telemedicine preference vary and include:
- Reduced exposure to other patients
- Not having to deal with inconvenient travel
- The ability to discuss private health concerns from home
Overall, patients still prefer in-person visits to telemedicine. But for those using telemedicine since before the pandemic, 40% continue to prefer virtual visits.2
Meanwhile, 58% of physicians have continued to view telehealth positively since the pandemic.2
Healthcare wearables & other monitoring devices
Wearable technology in healthcare extends to private consumer purchases and those physicians prescribe. Wearables and include remote patient monitoring (RPM) and self-monitoring devices and apps:
- Biometric sensors. Record and transmit biological information from the patient to the care provider, including heart rate, sleep patterns and even bladder fullness and function3
- Disease management apps. Allow patients with chronic illness to monitor biometrics and input data available to the provider
- Fitness trackers. Measure activity, calories burned and steps, which users can then share this information with physicians4
- Sleep apps. Help create ideal sleep conditions with meditations and ambient noise, some with heart rate and breathing pattern monitoring5
Sixty-three percent of physicians surveyed plan to invest in new RPM technologies, while 83% say they are more comfortable with these technologies now than before the pandemic. RPMs are improving patient care.
Of physicians currently utilizing RPMs:6
- 49% say patient outcomes have improved
- 44% say that compliance rates have improved
- 42% report that patients are more invested in their health
"I see wearables like any other medical test," says Samuel Werner, D.O., a family practice doctor and adjunct professor at Rowan University School of Osteopathic Medicine in New Jersey. "If there's a single place where wearables will shine, it's primary care," he says.
Another area where wearables and trackers are advancing is helping primary care physicians monitor chronic conditions.
For example, continuous glucose monitors are a great way to monitor prediabetic patients, says Scott.
"That's the patient who can prevent or reverse it."
If a patient has high sugars or high insulin, she'll order a continuous glucose monitor for them. Mobile device apps can also display how a patient responds to food, show cardiac outputs or, in the case of the Oura Ring, track heart rate, activity and sleep.
A fan of the Oura Ring, Scott attaches Oura screenshots to her patients' electronic medical records (EMR)s.
One concern regarding wearable technologies is the cost. Though RPM insurance coverage was already on an upward trend, the public health emergency expedited this. Currently, Medicare covers RPMs, and as of Spring 2021, Medicaid reimbursed costs of RPMs in 29 states.7
The ACP survey also covered other barriers to using remote monitoring devices:1
- 44% of respondents said remote device reimbursement levels were unclear or inconsistent between payers
- 40% said patients couldn't afford the technology and 26% said the potential reimbursement is not sufficient
- 37% of physicians also had issues organizing a support staff to set up and run a remote program, while 34% said it was too challenging to integrate it into their practice
Asynchronous virtual care: Utilizing portals & software
Portal messaging is a good way to communicate quick questions or medication refills with patients but not to deal with new complaints, as some patients attempt to do.
Ronald Dixon, M.D., an internal medicine physician in Boston and the founder/CEO of CareHive, a health technology company, believes not every patient needs to see a primary doctor for every need.
"With the right data and a way to exchange information with the patient at scale, primary care doctors can become more efficient, saving patients time as well as improving their outcomes and lives," he says.
- Help medical staff triage patients based on responses to validated questions
- Help with tracking and can build predictive algorithms using quantitative questioning techniques
Dixon calls this "asynchronous virtual care" because whether the patient and the doctor are available at the same time doesn't matter.
Physician burnout & remote patient care
Remote patient care is often helpful, but it can also promote physician burnout, already a problem in primary care.
"With primary care, there are so many things to do in the office. Providers don't want to go to multiple software systems to pull information. We're already too overwhelmed," Dixon says.
"We need a way to make it a lot easier before we start incorporating sensor data" and portal questions."
Telehealth appointments, self-monitoring and physician-monitored technology will create more substantial participation with patients in their care. Issues of transparency and trust addressed by leaning into these modalities improve by removing barriers to healthcare access.
For a comprehensive look at the latest trends in healthcare consumerism, read part one on the growing need for patient engagement and part three about the growing focus on wellness.
3: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916- 020-01773-w
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