Am J Manag Care. 2023; 29(1): 17-18. https://doi.org/10.37765/ajmc.2023.89299
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Over the past 12 years that The American Journal of Handled Care ® has published the annual Health Information Technologies special issue, the landscape of digital health has changed dramatically. Although the march of technological progress had come slowly to health care organizations, 2 events spurred seismic changes. First, the rapid adoption associated with electronic health records (EHRs) in response to federal policy offers digitized care delivery, bringing with it a host of intended and unintended consequences for patients, clinicians, plus healthcare businesses. Second, the particular onset associated with the COVID-19 pandemic forced an immediate and sudden shift in order to the organization and delivery of wellness care—a shift that was only possible because of the electronic infrastructure built by broad EHR adoption. In this special issue, 11 papers advance our understanding of health information technology across 3 domains, each of which reflects those 2 events: telemedicine, EHR work and clinician burden, and the building of the better digital health system.
Evaluating the Telemedicine Revolution
The popularity associated with telemedicine exploded at the onset of the pandemic, and virtual care is likely here to stay in some form. Johnson et al use qualitative data from expert panels to highlight the challenges and barriers to continued use of telemedicine in rheumatology, identifying important issues around regulation plus reimbursement as potential pitfalls for sustainable telemedicine policy. Rodriguez et al study differences in practice adoption and utilization of telemedicine for diabetes and hypertension, finding that smaller practices were less likely to continue delivering care virtually by late 2020—highlighting the importance of providing technical support for small practices. Using claims data from California, Gidwani ainsi que al find significant variations in use of telehealth by payer, with Medicaid enrollees more likely to use telehealth plus managed treatment enrollees in both commercial and Medicaid plans having a higher rate of telehealth use compared with their fee-for-service peers, suggesting that payers play an important role in the modality associated with care individuals select. Finally, Huang ou al dive into the differences between video and audio-only telemedicine visits, finding more intense prescribing plus lower rates of 7-day follow-ups for video calls. Together, these studies help build the particular evidence base necessary in order to craft a successful long-term telemedicine strategy.
Electronic Health Records: Workflow and Burden
Although EHRs have delivered a wide range of benefits—including serving as a key piece of electronic infrastructure that enabled the rapid pivot to telemedicine in the starting point from the COVID-19 pandemic—broad ownership has come along with unintended effects. Perhaps most salient will be the volume of EHR function, ranging through alert fatigue to documentation burden, with regard to frontline clinicians. O’Connor et al make use of data from the Veterans Health Administration to assess whether changes in daily inbox notifications were associated with primary care physician burnout, without finding a strong relationship—suggesting EHR-related burnout is multifaceted and difficult to attribute to one specific issue. Richwine and Patel use information from the American Hospital Association annual survey to track hospital usage of an increasingly essential data source, EHR audit log metadata, that quantifies clinician time spent within the EHR. They found that the majority of hospitals had access to these types of data, especially those with market-leading vendors, and are increasingly using those data to identify areas associated with improvement regarding clinical workflow and targeting EHR training and support. Finally, Kim et ing use that will increasingly popular EHR audit log for an innovative research purpose: predicting plus classifying clinical work settings, a foundational task to using EHR metadata intended for applied research. The EHR plays the central role in treatment delivery—and the particular ongoing clinician burnout crisis—and impactful studies on how to reduce EHR burden are critical to chart a path forward in a digital health program.
Building a Better Digital Health System
Although broad EHR adoption has built the infrastructure for digital transformation, there are myriad ongoing issues that need robust evidence in order to inform plan makers and practitioners. McCullough and Stecher tackle the complex interplay between value-based payment reform and information about health exchange (HIE) for office-based physicians, discovering that payment change participants had been more likely to participate in HIE, but significant obstacles remained to full connectivity. Johnson plus Barker evaluate the proliferation of EHR-integrated health apps following the onset of the COVID-19 pandemic, obtaining a significant increase, especially in apps focused on telehealth. This highlights the potential of EHRs because information technology infrastructure that will allows third-party innovators to build software leveraging EHR-based medical data. Making use of qualitative interviews, Hare ainsi que al investigate patient perspectives on using technology in order to capture data on social needs, finding that patients were generally accepting of technology-enabled screening, especially if they felt they experienced a trusted relationship with their clinician. Another unintended consequence associated with digital transformation is that technologies can exacerbate bias. Yoo et ‘s assess the performance of commonly used calculators that function as clinical decision aids, discovering that many measures of calculator performance do not convey variability across demographic subgroups, and the authors recommend that health care organizations routinely perform stratified analyses of the overall performance of their digital tools to ensure that technology does not deepen disparities.
Conclusions
Although the US health system has broadly digitized treatment delivery, developing new ways to use those information to improve care delivery is an ongoing process. The particular research findings highlighted in this special problem help us move forward in overcoming obstacles—from pandemics to clinician burnout—and take steps toward realizing the particular promise of information technology within health care.
