AMA CEO: Digital Health Inches Forward But Needs Direction

American Medical Association CEO Dr. James Madara two years ago called ineffective EHRs and direct-to-consumer digital health products the “digital snake oil of the early 21st century.”

He is slightly more optimistic now.

“The origin of that [comment] is the recognition that digital health and mobile health apps are going to be really important and that was being contaminated in a way by products that weren’t so good,” Madara told Healthcare Dive on the sidelines of the HIMSS18 conference. “It was a little bit of the wild west.”

The field has moved forward, Madara said. EHR companies, for example, are incorporating cloud computing and platform capabilities to adapt as their customer needs evolve.

And some digital health companies are thriving; Madara pointed to the success of digital therapeutics Omada Health, which seeks to change patient behavior to tackle chronic conditions, as an example.

But more work needs to be done to help establish the field. AMA is working with organizations such as HIMSS and the American Heart Association to set up Xcertia, a nonprofit attempting to establish guidelines for mobile health app developers. The desire: apps based in evidence that are validated, actionable and connected.

“There was a competitive need to add some directionality to the field,” Madara said. “There are about 320,000 mobile apps currently. [The field is] moving in the right direction but these guidelines are going to be important to help establish the field.”

Healthcare Dive recently caught up with Madara to discuss the evolving health IT landscape. Here were the main takeaways from the conversation. Comments have been lightly edited for length and clarification.​

The digital health field will eventually need a certifying agent

“[E]ventually somebody — and it’s doubtful that’ll be the AMA — is going to have to be a certifying body. I think if it comes from the field and it’s led by some organization or groups of organizations that have the advantage of being viewed as having public trust, that would be an ideal situation.

The Googles and the Apples of the world — wonderful companies — probably don’t have the tattoo of being the public trust. The FDA has taken a tiered approach. I suspect there are some things that may punch through that tier because of the vast number of apps. We’re talking about a field where 200 apps per day are being introduced. There’s a capacity issue. I would imagine they would have some kind of role in the ultimate product but I would use the example of medical school certification as what could happen.

The Department of Education looked at how medical schools were being certified and they gave the authority to a new body underneath the AMA and the Association of American Medical Colleges, the Liaison Committee on Medical Education. That would be an interesting outcome.

It’ll be important to get on top of that quickly so you don’t have the sense this is not a wonderful, important field. When you introduce technology into a field that works — I would use robotic surgery as an example — people jump right on it. If the first introduction is a stumble followed by other stumbles, people back off and become somewhat skeptical.

What we’ve learned in technology and medicine is if you have a technology that works, physicians support it. If uptake is terrible or not great, it’s not being technophobic, it’s the canary in the coalmine reporting a problem with these tools. Those have to evolve to another level.

Former Google chairman Eric Schmidt recently said to run to the cloud as fast as possible. We would agree with that. We would say it’s a secure place to be without the hardware and the possessiveness of data that comes sometimes in the absence of that.”

Rightsizing EHR reporting is welcomed

“The HITECH Act forced, encouraged and helped support the infiltration of the medical system with some digital kind of approaches. The problem in retrospect is that the digital platforms that were available were not that mature. They’re not bad for claims and billing and risk mitigation; that’s not surprising because they came out of practice management systems.

For what people think they should be doing, they’re not really great and you hear conflicting language about this.

We’ve learned that drives physicians is time with patients. It turns out for every hour they have with patients, they have two hours of data entry.

Physicians are burned out because they enter the field to see patients and not to be data entry clerks. One of the problems we have are data. The AMA released the Integrated Health Model Initiative last October to help organize data in a clinically more meaningful way.

The other problem we have is the lack of data liquidity. If you look at multi-sided markets in other fields, they all tend to share a relatively inexpensive utility for piping whatever the major blood is. For international banking, that’s currency exchange. There’s no such equivalent for healthcare data. Akiri, a permissions-based blockchain secure data liquidity system spun out from AMA’s Health2047 arm, hopes to help.

That brings us back to control. We think its patient’s data and they should be in control of their data. The data should be able to be moved based on their permission easily from one provider area to another. CMS Administrator Seema Verma comments from HIMSS aligned with recent HHS Secretary Alex Azar comments that promise interoperability and patient control of that data is something that’s very attractive to us.

The other component of HHS’ message is to get administrative burden simplified and released. I think that everyone agrees you have to measure things but you don’t have to measure everything and you certainly shouldn’t be in the business of measuring things you’re not sure what the measurement means. We got tied into that kind of environment where we had tons and tons of measurements and it was taking physicians’ time where some specialists were having to report measurements that had nothing to do with their specialty. It was creating a skepticism of the entire system.

Making sure that the required measurements is a parsimonious group and meaningful is a great way of going.”

Financial incentives should be rethought in the industry

“We have to completely rethink incentives. Financial incentives work well at an institutional level. They don’t work so well at the individual physician level. If you want to incentive knowledge skill workers, you have to figure out what their intrinsic motivation is and pull that lever. We know what that intrinsic motivation is: Time with patients.

The problem is the incentive system was built when the power of behavioral economics was not recognized. It’s OK to create incentives that way but that’s not how people in the healthcare system work. That’s going to be a very tough to unscramble.

Our approach is sticking to our knitting and making tools and services that removes administrative burden.”