The previous article in this series described how digital IT companies differ from clinical settings, and focused on the importance of clinicians deciding what their particular IT needs are. This article, and the next, lay out criteria for choosing a solution.
Even once you know what you need in your clinical setting, demonstrating the value of a new technology is hard. Dr. Omar Manejwala, chief medical officer at DarioHealth, looks for real-world evidence of outcomes. A study by the vendor is nice to see, but is it peer reviewed by a neutral party? Dr. Tim Church, chief medical officer at Wondr Health, similarly recommends checking that the app follows modern, evidence-based treatment guidelines.
“During the COVID-19 quarantine, literally thousands of new apps sprung up, particularly related to weight loss, and a lot of them are already gone,” Church says. “Many sound legit on the surface, but they’re not. Buyer beware. Most importantly, make sure that the vendor’s clinical services are scientifically supported, so they’re safe and effective.”
Although a peer-reviewed study would be strong evidence that technology works, Dr. Romi Chopra of MIMIT Health says that you might not be able to wait for such a study, which can take years. He prefers to install a pilot of “proof of concept” and test it himself, something even small practices can do. He insists on a short contract, such as six months, before signing a multi-year contract. If running the product yourself isn’t feasible, go to another site where the vendor has a real-life installation to see it in action.
Dr. Colin Banas, chief medical officer at DrFirst, places a premium on transparency in the software, particularly where AI is used. What data sets is it trained on? How often is it updated? Who is training the model? What is the accuracy rate? DrFirst’s AI is trained on actual prescription data, has guardrails in place for safety to prevent hallucinations, and is overseen continuously by a clinical team that includes actively practicing pharmacists along with Banas himself.
If you find that the technology works according to Chopra, ask next whether it’s faster, cheaper, and better than what you’re doing now. Many solutions are very expensive.
Dr. Mark Stephan, chief medical officer of Equality Health, said that clinicians must make sure that the new technology reduces administrative burdens on clinicians.
The opposite can happen too easily, as the industry saw after the adoption of electronic health records in the 2010 decade. According to Cindy Gaines, chief clinical transformation officer at Lumeon, many organizations just adapted their paper process to their new EHR and didn’t realize the efficiencies they expected. Organizations need to think about workflow redesign when implementing technology. Technology without workflow redesign, she says, can actually increase the burden on the team.
It’s too easy for app vendors to promise all kinds of benefits to patient care or reimbursement—but at the expense of extra work for clinicians who are already sweating over the hours spent at documentation. Making this trade-off is unfair to clinicians and will be fiercely resented by them.
Dr. Patrick Hunt, chief medical officer at QGenda, writes in email, “I’ve seen several phenomenal technologies that were poorly designed and never instituted by clinicians simply because they didn’t have the time to learn a complex system.”
Dr. Khaliq Siddiq, chief medical officer at Clever Care Health Plan, reminds us, “Clinicians are already challenged to find ways to spend quality time with their patients, so the new technology must not make that worse.”
Scalability is another issue. Siddiq asks, “How will the technology handle additional clinicians, staff, clinical sites, and specialties? How well does the technology integrate into a surgical practice compared to a primary care setting?”
Gaines and Cindy Koppen, chief nursing officer at care.ai, ask on a very concrete level, “How many clicks does this solution require?” Lisbeth Votruba, MSN, RN, chief clinical officer at AvaSure, says that vendors must come into a clinical site asking questions, not just offering a solution.
Gaines advises management to get input from staff on the ground—don’t make assumptions about their day to day needs. Typical issues that may surface include the need for different data for different people on the team, which in turn may also require different interfaces, and the need to support different types of devices they might be using. Koppen lists clinical, IT, financial, and operations staff as stakeholders you have to bring into the decision.
To reduce administrative tasks, solutions must be seamlessly integrated with the organization’s current EHR, billing, scheduling, and other systems. Dr. Reza Hosseini Ghomi, MD, MSE, neuropsychiatrist and Chief Medical Officer at BrainCheck shares how integration can improve results for patients, clinicians, and facilities: “It not only saves clinicians time, but also makes adoption more seamless and thus ultimately makes cutting-edge solutions more accessible. BrainCheck’s latest platform, integrated into the athenahealth Marketplace and accessible on any Internet-connected device, lets PCPs and specialists efficiently deploy superior cognitive care anytime and anywhere, with instant access to accurate results accessed directly in their EHR.”
How narrow or broad should a digital solution be? Interviewees identified another trade-off here. Many insisted that the technology should solve several problems simultaneously—at least, they have to work for many clinical disciplines. A team that focuses on one narrow problem is more likely to have established and evolving expertise in addressing that problem, as suggested by Banas. He also said that it’s easy to become distracted by the market’s offerings.
But real clinicians and patients are trying to solve multiple problems at once. They need a single solution that handles all the participants and issues in a clinical endeavor. Aaron Neinstein, chief medical officer at Notable, pointed out quite reasonably that each vendor with whom you work requires evaluation, meetings, and coordination with a new set of people. IT teams and administrators can’t spend all their time on these tasks, so they prefer to choose one vendor with a broad range of solutions.
Manejwala points out that most patients suffer from multiple medical conditions at once, and don’t want to juggle multiple apps any more than a provider does.
Church looks for apps that can be tailored to each patient. “Your likelihood of success goes up exponentially when the clinical program is customized,” he says. “If somebody’s not an emotional eater, don’t give them material on emotional eating. You’re wasting their time and potentially distracting them from the real path to success.”
Dr. Omar Manejwala, chief medical officer at DarioHealth, says a technology must have been tested on different races and ethnicities, and for people with lower economic status who tend to have less access to, or knowledge of, technology.
Similarly, Siddiq points to “a tremendous variability in the end user’s skills, socioeconomic status, and desire to incorporate technology in their healthcare.” Telehealth, for instance, might seem to help seniors get care, but they might be used to in-person visits and prefer to continue them.
The next article looks at some more criteria, less often considered, for adopting a technology.
