The Slow March of the Digital Health Revolution

A recent commentary (SD Dorn. Gastroenterol 2015; 149: 516-20) provides insight on the digital health revolution.

Key points:

  • “Amara’s law –that ‘we tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run’–seems to apply to digital health. Expect short-term gains to be incremental.”
  • The promise of ‘big data’ has not translated into big changes yet.  “Many systems are not interoperable owing to cost, competition, privacy concerns, and technical barriers.”
  • Mobile health, mHeath, “is skewed toward those who need the least help: the young, the fit, and the educated.” And, there is “no evidence supporting the effectiveness of the vast majority of mHealth tools.”

What’s wrong with electronic health records?

  • “The overall evidence that EHRs improve safety and quality is spotty. Cost savings remain elusive.”  Some reasons include that more time is needed and/or flaws in EHR design.
  • EHRs are not very usable –excessive clicks and scrolling.
  • EHRs “reduce productivity and can add hours to the busy clinician’s day”
  • Physicians “now spend up to two-thirds of a typical outpatient visit documenting.”
  • Clinical records may be more legible, but they are often less useful.  “Template-generated notes frequently lack coherent narratives, are bloated with extraneous and repetitive information, and sometimes contain obvious errors that are copied forward from one note to another.”
  • “Physicians suffering from ‘alert fatigue’ may ignore potentially valuable clinical alerts.”
  • EHRs require frequent sign-ins and computers often have to be unlocked.
  • EHRs are expensive.
  • In total, EHRs significantly worsen physician satisfaction.

From a patient vantage, EHRs offer the possibility of patient portals to send physician messages, obtain test results, request medication refills, and schedule appointments.  Telehealth offers the potential for expert advice from great distances.

Some integrated health systems, including the Veteran’s Health Administration and Kaiser Permanente, have shown that EHRs can be successful.

My take: The transition to digital technologies has great promise but could lead to a less personal approach. So far, the transition to digital health has been a bumpy slow road.

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3 thoughts on “The Slow March of the Digital Health Revolution

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