John Halamka: Telehealth, Apps & AI Make Progress, But Will Everyone Benefit?

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reduce clerical work for caregivers.

“Today, physicians spend about 50 percent of their time typing,” Halamka says. “This has resulted in many clinicians wanting to retire and frustration with electronic health records.”

He suggests machine learning-enabled technologies will be able to listen to conversations between doctors and patients, automatically fill out the patient’s digital chart, and then the doctor would review it and make any necessary corrections. Indeed, companies such as Suki and Nuance Communications (NASDAQ: NUAN) are working on similar products.

3. Patient demand and reimbursement changes will drive the “consumerization” of healthcare.

Today, receiving healthcare isn’t as easy as pushing a few buttons on a smartphone to order food to your doorstep or a ride to the airport. But Halamka believes it will get there, and perhaps soon. He predicts within five years, a “significant percentage of income to healthcare systems will be digital health services that, if you will, are the Uber, Grubhub, and Amazon of digital health,” he says.

He gives a hypothetical future scenario. Say a person notices a spot on her right wrist. She takes a picture of it using her phone and securely shares it online with a healthcare provider, which analyzes the lesion using advanced software. It spits out an assessment: There’s a 90 percent chance the spot is harmless. Just in case, the care provider refers the patient to a telemedicine service for a second opinion, if she wants, for say $25. That care provider reviews the image and data and also says the lesion doesn’t appear to be cancerous, but recommends developing a care plan to watch the spot over the next year for any changes.

It would take relatively little time, energy, and money to provide this type of care, Halamka says. “But yet, [the patient] got good, quality care, and physicians will be reimbursed for providing good expertise,” he adds. (Halamka is an advocate for telemedicine services. A toxicology expert and farmer, Halamka says he sees 900 patients annually via virtual visits, advising them whether the mushrooms or plants they ingested are poisonous or not.)

Achieving this vision will require the healthcare industry to complete its ongoing shift from charging a fee for each service provided, to getting reimbursed based on the outcomes of care given. For some hospital systems, that transformation is nearly finished; Halamka says the majority of Beth Israel’s income is now tied to “value-based purchasing” contracts.

“The notion that doctors will be paid for quality and outcomes, rather than just more healthcare, aligns economic incentives to use these digital health devices, with the idea that we be kept well in the home instead of a hospital,” Halamka says.

Incentives tied directly to digital health products are also on the rise, including expanded access to telehealth benefits for Medicare Advantage patients.

Patient demand is the other key factor that Halamka predicts will drive the healthcare industry to embrace digital technologies that make care more convenient. “If you’ve got two healthcare providers in a city, and one is digitally enabled and one isn’t, they’re going to flock to the digitally enabled one—and the other one will wither,” he says.

4. Beware the digital divide.

As digital technologies proliferate in healthcare, medical providers and other stakeholders need to be careful that some patients don’t get left out, Halamka says. Some people might not be comfortable with digital technologies, while others might have a language barrier or lack the income required to buy connected devices, he says.

“How do we ensure every member of society can take advantage of digital health without creating more inequity?” Halamka wonders. “We need to be very careful that we don’t create a sense of, ‘Well, you need the latest iPhone and $500 worth of digital sensors, and then you’ll get all these great services.'”

Halamka says he’s working on this issue with The Dimock Center in Boston’s Roxbury neighborhood, which provides health and human services to underserved communities. The center and its partners are exploring the development of low-income housing that would incorporate digital health sensors and related services “into the housing project itself,” Halamka says. He acknowledges the idea raises privacy concerns, but he emphasizes that health technologies would only be installed in a home with the tenant’s consent. The proposal is still in the early stages, he adds.

“It will be a longitudinal project that involves academia, government, and industry,” Halamka says.

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