When digital health apps fail to talk to EHRs, do they really make a difference?
It’s good for doctors to be patients occasionally to experience the system from the other side. I have worked in digital health for over a decade and while I don’t love going through a new health issue, I welcome the chance to experience the industry from a patient perspective when the opportunity presents itself.
One day in December I noticed a twinge in my back while unloading the dishwasher. I consider myself an active person, typically clocking 10,000 steps per day, and was surprised when my body rebelled during a common motion. I didn’t think it was anything too serious and went along with my day. However, as the next week passed and I continued to exert myself outside of my usual routine – carrying Christmas trees, hauling gifts, and cleaning and cooking on overdrive, I noticed that my back pain was getting worse. After about 2 weeks of trying rest (unsuccessfully), a mix of pain medications, as well as heat packs and ice, I decided it was time to see a professional and made an appointment with a physical therapist.
I think the most common questions asked to a provider when you are worried about your health are ‘What’s wrong?’, ‘Is this in the range of normal?’, and ‘How am I going to get better?’ I walked into my visit with all of those in my head, as well as ‘How quickly can I improve because I am about to go on a ski trip.’
After a conversation about my symptoms and a physical exam, my PT determined that I had a quadratus lumborum (QL) strain. This meant a muscle strain in my middle back that is aggravated by what he called BLT – bending, lifting, and twisting. Check, check, check. The good news was that while it might take a few weeks to improve, I didn’t need surgery, nor had I herniated a disk. It was a fairly common overuse injury and could be improved by specific stretches and exercises.
Once my PT started going over the exercises, I asked if he had an information sheet that illustrated what I was supposed to do. When he told me that he would be sending me information to log into a mobile app with videos my face lit up like a Christmas tree. An opportunity to try out a new piece of health tech? Say less.
That evening, I downloaded the app, created a login (groan, another user name and password) and was ready to start improving my injured back muscle. Then I realized I couldn’t turn off my UX/patient experience brain. I really appreciated that I could see a list of named videos with the stretches, however there were some hiccups. The program was set up to jump immediately into doing the exercises and logging completion. I would have benefitted from an initial tutorial that I could watch sitting up, and then given a moment to pause and get into position to begin the work. It’s pretty hard to watch a video on your phone while in child’s pose – a position that requires your face to be flush with the mat and your feet tucked under you like a human ball. Other hiccups I noticed were 5 seconds of transition time between one exercise to the next (too quick), video lengths that were shorter than the expected hold time, and even though I was supposed to complete the exercises twice a day, if I ran through them once I was logged out for the rest of the day and unable to access the program again.
When I went to my next visit, I shared some of my observations with my PT (along with my line of work.) I also shared that I had been diligently logging my exercises in the app and clicking the option to send a report to my therapist. He said that he was thrilled that I was doing what I was supposed to do, and that it was helping, but that he usually didn’t log in to check patient compliance. When I asked why, (I felt like I already knew the answer but was curious about the data point) he shared that there simply wasn’t enough time in the day to check another piece of software outside of providing patient care and updating records in the EHR. DING DING DING – exactly what I expected. The incentive often isn’t there for providers to follow up on digital tools nor is the time provided to do so. I constantly hear about the benefits of insights into patient activity at home for digital health tools. We all know that recall is flawed and hard data can’t be ignored. However, in this situation the provider value + level of effort to access the information + decision-making on how to proceed with my care equation didn’t balance.
When I worked at a health system in digital strategy, mental health care and physical therapy were high priority areas for leveraging health technology for patient care. After my experience with PT, I can certainly see the appeal and benefit of being able to provide videos to patients and track their progress. I also learned that while I only experienced one digital platform and others may provide a better patient experience, that digital couldn’t stand alone for my particular injury. My care required some hands-on exams, physical manipulation, and provider observation of improvements and setbacks. The physical aspect of physical therapy really mattered, while the app was a supporting player in the path to improvement.
Katie D. McMillan, MPH is the CEO of Well Made Health, LLC, a business strategy consulting firm for health technology companies. She is also a curious researcher and writer focusing on digital health evidence, healthcare innovation, and women’s health. Katie can be reached at [email protected] or LinkedIn.