Population Health Insights

How to Overcome Physician Resistance to Digital Health

It’s safe to say that, here in 2017, digital health is here to stay. Encompassing as it does all forms of electronic healthcare — including telehealth, telemedicine and remote patient management as well as mobile health (mHealth), EMR/EHR, and even IT-oriented concepts like patient data security — digital health is now securely a part of the foundation upon which much of modern healthcare delivery rests.

Yet — and this may come as little surprise to administrators — digital health still hasn’t been accepted by all physicians. Some reports indicate that patients are more open to telehealth than their physicians; a 2016 Modern Healthcare report, for instance, notes that 64% of Americans “would be willing to have a video visit with their doctor.”

That report runs down the specific benefits telehealth offers patients, including “reducing wasted time — taking off from work, traveling to and from a medical office, and waiting to be seen.”

VIDEO: How RPM Benefits Patients

Doctors Often Resistant to Digital Health

Contrast that with a 2014 survey of family physicians that, according to mHealthIntelligence, found that, “while a vast majority see the benefits of telehealth, only 15 percent are actually using it,”

Citing this 2016 report from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, the mHealthIntelligence report adds that “the results fall in line with the plethora of surveys and studies that say healthcare providers would benefit from adopting telehealth — but they’re not compelled to use it.”

Writing at GIHealth.com, the website of his own My Total Health clinic in Los Angeles, Dr. Brennan Spiegel, MD, MSHS, addresses this resistance to digital health. In doing so, he recalls the first comment he heard after delivering a lecture about digital health to a group of physicians:

“Digital health? Is that like a rectal examination?”

“The doctor who made this comment snickered when he said it, prompting others in the audience to light up with exuberance,” Dr. Spiegel recalls, even as he points out that the lecture was given at “an esteemed academic medical center” and that the comment was “not a unique reaction among rank-and-file doctors.”

Dr. Spiegel — an accomplished physician who’s also a professor of medicine, co-editor-in-chief of the American Journal of Gastroenterology, and involved in digital health efforts for UCLA and Cedars-Sinai Health System — admits to seeing the humor in the comment, particularly “to a gastroenterologist like myself.”

Yet he also sees the danger in a population of physicians who are resistant to accepting some of the most important innovations in healthcare — innovations that have the capacity to not only improve patient care and reduce expenses, but relieve stress on over-worked clinicians and help fight the effects of the rural physician shortage.

VIDEO: How RPM Benefits Clinicians

Overcoming Physician Resistance to Digital Health

Whether the continuing resistance to digital health is a product of lack of familiarity with the term, resistance to the concept, or simply a fear of the unknown — or a combination of all three — it’s not unique to the United States. Even in other technologically advanced countries, physician groups have defied the transition.

In the UK, The Guardian has suggested that the benefits of telehealth “will only be realised if doctors stop looking for opportunities to reject it.” In South Korea, telemedicine is currently prohibited, “and a recent government attempt to legalize it was met with a wall of opposition from medical professionals and activists,” writes Max S. Kim for Quartz, which also describes how “tensions over the bill resulted in a doctors walkout in 2014.”

Dr. Spiegel understands the importance of overcoming this resistance. To that end, his article offers the top 10 digital health fears that he’s encountered on the lecture circuit, as well as his advice on overcoming them. Highlights include:

1. Time. “You’re kidding, right? How in the world do I have time to check all the data?” Dr. Spiegel’s first point is also among the most understandable: After all, how do busier-than-ever physicians have time to integrate new processes into their practices when they’re struggling to keep up with day-to-day activities and responsibilities? Dr. Spiegel’s solution: Training a new type of specialist called a “Digitalist” — a provider that Dr. Spiegel admits “does not yet exist,” but then, neither did the hospitalist specialty before 1996.

2. Liability. “What if a patient dies when there was clear evidence something bad was going to happen? Am I going to get sued?” Dr. Spiegel notes the importance of this point, too, and admits it must be addressed “before we get too much farther with remote digital monitoring in everyday clinical practice.” Again, “that will be the Digtalist’s responsibility.”

3. Proof. “This all sounds great, but until you can prove it to me, it’s just a bunch of toys and gadgets from entrepreneurs trying to make a buck. I need real evidence.” Though evidence is mounting that digital health innovations actually do work — and work very well, as per our list above — more is needed. “We need rigorous, hard-fought, meticulous, sufficiently powered, controlled trials to figure out if digital interventions work,” Dr. Spiegel writes. “This is no different than for any other biomedical advance, whether for cancer chemotherapy, biologics, invasive procedures, or anything else in medicine.”

4. Access. Digital health “may work for wealthy patients with access to care and resources, but what about the rest of our patients?” This point is founded on a fundamental misunderstanding of just what digital health is capable. “Just having access to a smartphone” — as the vast majority of Americans now do — "allows us to deploy apps and even virtual reality, among other technologies.” Witness the success of the Mississippi Diabetes Telehealth Network, which has projected a cost savings of $339,184 in just one yearamong 100 diabetic patients.

5. Age. “Maybe young people like using this stuff, but what about our older patients?” The misperception also persists that seniors aren’t going to engage with digital health out of fear of technology. Again, an understandable reaction — this has been, traditionally, a true enough complaint. Yet it ignores the fact that today’s seniors are actually embracing digital technology at astonishing levels. As the Pew Research Center pointed out in May, 2017, today’s seniors are “more digitally connected than ever.

“In fact, some groups of seniors — such as those who are younger, more affluent and more highly educated — report owning and using various technologies at rates similar to adults under the age of 65,” the report added.

Dr. Spiegel also observes that “we’ve noticed that many young patients are unwilling to use digital technologies, and many older patients are enthusiastic about them; there are no hard and fast rules.

“This only means we need to be aware of the digital divide and find ways to overcome it, where possible,” he adds. “There is a tremendous opportunity for research and patient engagement.”

“If this is successful, then digital health will expand care beyond the traditional clinic visit, use visits more effectively, reduce avoidable admissions, and improve outcomes of care while protecting you from additional work,” he concludes.

“Time will tell if this future becomes reality, but for many health systems the future has already arrived. Now is the time for doctors to shape the future of digital health for our field before others shape it for us.”

Interested in learning more about digital health and how it can help healthcare organizations meet their operational goals while improving care? We invite you to contact Care Innovations® for a complementary consultation.