By Sara Berg, American Medical Association | May 10, 2019
If a new digital health technology (DHT) tool were introduced that would make hypertension management easier, would you use it? While different digital health solutions have shown great promise in improving patient outcomes and disease management, adoption by patients and physicians remains low.
When designed and implemented properly, digital health tools support the quadruple aim of health care by enhancing health outcomes, improving the patient experience, cutting medical costs and increasing physician satisfaction.
The AMA has developed online tools and resources created using the latest evidence-based information to support physicians to help manage their patients’ high blood pressure (BP). These resources are available to all physicians and health systems as part of Target: BP™, a national initiative co-led by the AMA and American Heart Association.
The authors of a study published in JMIR Cardiology completed a scoping review of 36 peer-reviewed research studies to explore the primary factors for physicians and patients to adopt digital health solutions.
The study was co-written by Kate Kirley, MD—a family physician and the AMA’s director of chronic disease prevention—AMA experts Amanda Coleman, MPH, Stacy Lloyd, MPH and Chelsea Katz, MBA, along with other researchers affiliated with Harvard Medical School, Partners HealthCare Pivot Labs and Massachusetts General Hospital. They are: Ramya Sita Palacholla, MD, MPH, Nils Fischer, MPH, Stephen Agboola, MD, MPH, Jennifer Felsted, PhD, and Kamal Jethwani, MD, MPH.
The research team described how these eight factors play an important role in patients and physicians adopting digital health technology for blood pressure management.
Workflow interaction. The implementation of new technology into existing workflow strongly influences a physician’s decision to adopt the tool, as well as having a care team to support implementation.
Physicians successfully adopted digital solutions when the data provided were “actionable and could be readily utilized within preexisting clinical workflows to enable timeline intervention to improve patient outcomes.” Doctors also preferred tools with automatic alerts that identified a need for medication or dosage changes.
Impact on patients. If physicians believed the technology improved clinical outcomes or engaged patients in self-management, they reported that they would be more likely to adopt the technology. For example, if a DHT was validated in pilot and shown to improve outcomes, physicians perceived these as acceptable options.
Physicians also valued tools that got patients active and engaged in their own health. Solutions that enabled a timelier response to elevated BP levels also helped physicians prevent adverse health outcomes in their patients by addressing the changes in a timely manner.
Technology usability and support. Physicians value simplicity and ease of use. They also prefer technology that requires minimal training and they value adequate technical support when using the DHT tool as part of their clinical workflow.
This also played a role in patient adoption of technology. Older patients with less experience using technology also found the availability of support played a role in their adoption. Patients also valued solutions that were easy to integrate into their daily routines.
Leadership and organizational support. The organizational culture of innovation paired with the presence of physician champions positively influenced the adoption of technology in clinical settings. Without the support of their organization and leadership, especially in terms of budget and personnel, physicians found it difficult to adopt digital health technology.
Financial factors. Some studies noted that physicians were more likely to adopt technology when financial incentives were involved. Payment and financial savings for using DHTs in clinical practice were also important factors in physician adoption.
Patient-physician relationship. Patients reported they would be more likely to adopt DHTs that improved communication with their physician. Some patients reported that some solutions allowed them to directly contact their physician to share health data and receive feedback. This data sharing helped patients better understand their care plans while promoting shared decision making.
Self-management and patient experience. If technology raised a patient’s motivation to manage their own conditions, that played an important role in adoption. The ability to access and view health data from their own device encouraged patients to be more proactive about their health, especially for hypertension management. Using DHTs to monitor BP readings also helped alleviate health-related anxiety some patients felt.
Fewer in-office visits. When digital health technology potentially allowed patients to avoid having to travel to the physician’s office, it generated stronger adoption. Patients also reported that they would adopt technology if the solution allowed for easier monitoring of medications remotely rather than going into the office. This eliminates commuting barriers for patients with lack of access to a vehicle.