Clinicians, in particular physicians, have always played a significant role in healthcare. Some call it an outsized role with an outsized voice; but, the last 20 years have seen a significant decline in physician autonomy as payors have stepped in to more closely oversee and dictate, via reimbursements, how clinicians practice and provide care while more and more health system has employed physicians and taken them out of independent practices. These are just the trends. There are market forces creating and sustaining these trends.
In this fourth part of our 2018 Healthcare Trends series, I explore what we can expect to see as clinicians broaden their skillsets into digital health.
One huge recent trend is the implementation of EHRs. Today, clinicians spend more time in the EHR than any other activity; this study found ER doctors spent 44% of their time on data entry and only 28% on direct patient care. Doctors have been forced, again for various good and bad reasons, to document data in a certain way and a certain format. The EHR adoption of the last 15 years has been driven by non-clinical forces.
Today, we see new trends in technology beyond the EHR. New digital health technology is being developed and adopted for everything from clinical communications to telemedicine. With this increased technology fragmentation, as opposed to the monolithic EHR era, we are in a time of letting 1,000 flowers bloom. And clinicians are taking the opportunity to influence, build, and deliver these new digital health solutions.
Physicians as makers of digital health products
Doctors, individually and as a group, are an interesting group. Painting with a very broad brush, doctors as a group are hard-working self-starters who believe they can do a lot of things well. They are also intimately knowledgeable about healthcare delivery, having spent thousands of hours in clinical settings in training and practice. Considering that, it’s not surprising to see more and more physicians designing and sometimes building digital health technologies.
What’s fascinating is that this trend of clinicians as developers is in stark contrast in so many ways to the EHR proliferation era we are now exiting. While EHRs were developed to enable workflows, most clinicians conformed to the workflows of the EHR, not the other way around; EHRs can be customized to clinician workflows, but they rarely are in practice. Now, what we’re seeing is more and more clinicians developing technology to meet their own bespoke, or customized, workflows. That’s why it’s 1000s of blooming flowers of new clinician-designed and built digital health technologies.
Yes, some clinicians are attempting to build sizeable digital health business meant to scale, but that’s not who I’m talking about in this post. I’m talking about clinicians, typically academic or independent practice, developing solutions for their day to day. There are often plans to commercialize and scale these bespoke solutions, but this is challenging because of the customized nature of the solutions.
Risks and Challenges for Clinicians
Despite the potential upside of digital health bringing efficiencies to clinician practices by automating or improving workflows, there are risks and challenges inherent to this approach, especially for health systems and academic medical centers. At Datica, we see this time and time again as health systems grapple to inventory all of the tools being built and used. This is the struggle of shadow IT.
The reason this is happening is that clinicians have digital health technologies they want to build, or have already developed. They want to put these technologies to use in their practices. And, often, the traditional IT channels are too slow or don’t have the physician or human resources available. Today, more than ever before, there are no barriers to deploying and managing your own IT resources, so that is typically what clinicians do.
As this becomes more widespread, and it’s already pretty common, we’re going to see more and more health systems develop strategies to enable clinicians as developers. The solution is likely not through traditional IT, at least unless traditional IT embraces cloud and new paradigms of technology delivery. What’s more likely is that formal innovation or digital strategies will develop that balance the needs of clinician developers with the needs of health systems to know what technologies are being used in their organization and where their patient data is flowing.
I Invite you to also take a look at the first two trends we’ve already explored in this series: How cash-pay practices will grow in 2018 and my 6 predictions for a post-EHR world. And don’t forget to subscribe to the blog to the right to have the rest of the trends we’ll explore delivered right to your inbox.