Physicians leading a town hall discussion Thursday night drew different lines between where technology helps physicians and where it can interfere with the practice of medicine.
The town hall, held in the Bently Reserve in San Francisco, California, was sponsored by Medscape and was the third event in the Medicine 3.0 series that presents "conversations with physicians about ideas that can change medicine."
Most in the audience of almost 100 physicians agreed electronic health records (EHRs) haven't lived up to their promise. In an informal electronic poll at the beginning of the session, three quarters of the respondents said EHRs were driving patients and physicians farther apart.
The discussion was much more positive surrounding the potential for telemedicine and artificial intelligence (AI).
Abraham Verghese, MD, a noted author and a professor at Stanford University in California, said that if you believe that medicine is "a human being in distress seeking the counsel of someone that they are willing to confide in and, incredibly, are willing to disrobe and allow touch, then you have to accept that that is more than science. When there is an intimate relationship like that, technology can be intrusive if it's not carefully applied. And I think we're constantly fighting that balance."
Michael Blum, MD, a cardiologist and chief medical information officer at the University of California San Francisco, agreed that while it's true EHRs are pulling physicians away from their patients in the exam room, in some ways patients are much more connected to their doctors.
"Patients can send me a note whenever they want and within a day I'll get back to them. That didn't exist before there were patient portals and electronic records," he said.
Eric Topol, MD, Medscape's editor-in-chief and director of the Scripps Translational Science Institute, noted that patients are now often equipped with devices that not only track their steps and heart rate but can monitor their glucose levels and check their oxygen saturation to see if they have sleep apnea without undergoing a sleep study. He asked the panel members whether they thought this meant physicians are losing control.
Dr Verghese said he worries that while the devices generate a wealth of data, the scientific filters to properly evaluate the data just aren't there yet.
"A signal without interpretation is just noise," he said, "and there's a great danger that we're generating lots and lots of noise."
Jessica Mega, MD, MPH, chief medical officer at Verily, formerly Google Life Sciences, said she sees the personal devices as an important part of the partnership and an extension of the physician visit. They can empower people, she said, such as people with diabetes who are asked to do so much outside the office, to manage their disease.
Medicine 3.0 Panel: (l-r) Dr Eric Topol, Dr Abraham Verghese, Dr Jessica Mega, and Dr Michael Blum
Dr Blum added: "The more people who have the data and want to engage in the conversation, that's always better. The flip side is when people text me and say my heart rate went from 70 to 80 — what do I do? That's not so great."
Technology and Dissatisfaction
Talk turned to physician dissatisfaction and technology's role in that.
Dr Verghese said that EHRs were mostly responsible for physician dissatisfaction, but not solely. Physician distress is coming from being asked to document so much information for each patient, he said. "People in medicine by their very nature are driven — they don't like to leave any box unchecked."
He pointed to a study last year led by Christine Sinsky, MD, showing that for every hour you spend with a patient cumulatively, you spend 2 hours on the computer and 1 more hour of your personal time.
Dr Blum argued that physician burnout predated the big EHR push.
"I would trace it back to 10 to 15 years ago, when there was increased regulation and…all of a sudden the way you wrote a note was a billing document. It became the thing that you bill from and the thing that was going to keep you out of trouble when someone came to look at what you were doing. Then you threw the EHR on top of that and made a bad situation horribly worse."
Artificial Intelligence
Both the panel and the audience had high hopes for the potential of AI to improve medicine, mostly, to this point in time, in reading images.
Dr Mega's research team used AI in conjunction with ophthalmologists to find referable diabetic retinopathy with image recognition among fundus retinal photographs. While diabetic retinopathy is one of the leading causes of blindness, fewer than 50% of patients with diabetes are getting screened for it, she said, adding that the number of ophthalmologists and optometrists is limited.
"We could create algorithms that had relatively high sensitivity and specificity sometimes beyond what the ophthalmologist could see," she said.
Dr Blum said rather than the technology being imposed on physicians largely without their input, AI is an opportunity for physicians to be leading the development.
"The good news is that to develop algorithms, you need very large data sets that only medical entities have," he said. "They need to be very well curated, which means lots of physicians looking through them."
He added, "This is our opportunity. We're creating these partnerships that are clinical partnerships with industry to build these things, not waiting for industry to give them to us and tell us to go use them."
Telemedicine
Responding to a question from the audience, the panel addressed the potential of telemedicine.
Dr Topol pointed to the Lancet study this month that showed that telemedicine in inflammatory bowel disease reduced hospital admissions and outpatient visits. But he noted that some previous studies have not been as conclusive or positive.
Dr Blum said, "Telemedicine is absolutely going to be a significant part of the future of healthcare delivery."
He said surveys for people having follow-up visits have shown that satisfaction and quality are higher for video visits than in-person visits. The patients highly value not having to drive and park and sit in a waiting room with sick patients.
However, he said, "We need to decrease the documentation burden of the videos. A video that's recorded is self-documented. So I'm going to start typing what just happened? That's insanity."
A member of the audience argued that while developments that take monitoring out of the physician's office, such as continuous glucose monitoring, may be a good thing for diabetic patients, the danger is that "the financial incentives are going to extend this to each and every living person — athletes, children — this is the way financial systems work."
Dr Mega agreed but added that the questioner really addressed a bigger problem of how we value healthcare.
"If we don't move toward value-based incentives, you're going to continue to have perverse incentives," she said.
Medscape Medical News © 2017
Cite this: Experts Describe How Technology Can Help, Hurt Healthcare - Medscape - Jul 21, 2017.
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