What ‘digital transformation’ means for cardiology

The notion of a digital transformation in cardiology, and healthcare as a whole, is an appealing one. Data presented at MedAxiom’s CV Transforum in Dana Point, Calif., however, suggests we’re further away from a transformation than we might think.

For nearly a decade now, physicians have been grappling with the idea of a “digital transformation” in healthcare, John Rumsfeld, MD, PhD, chief innovation officer at the American College of Cardiology, said at the meeting. The concept is promising—especially for cardiologists, who are typically tech advocates—but the reality is that digital disruption is falling short of its potential.

“Cardiology is inherently a high-tech field,” Rumsfeld said. “The problem is not that we haven’t had the advances in science, medicine and technology—it’s that we haven’t allowed the system to also evolve in the same period.”

The U.S. health system is an outlier on the global stage, he said, in both medical costs and outcomes. It’s often described as the most expensive, least effective healthcare system in the developed world, criticized for losing ground at both the macro and micro levels. Unnecessary variation in quality of care, risk factor management and health outcomes has rendered the system inefficient, and digital transformation presents an attractive opportunity for growth.

In theory, digital transformation should improve a system’s efficiency, encourage patient engagement and boost both patient and clinician satisfaction through better tech. A Cisco survey found that in retail settings, digital transformation boosted customer satisfaction by 28%, employee engagement by 27%, revenue by 26% and customer experience by 25%—but while nearly every industry has been positively affected by digital transformation at this point, healthcare continues to lag behind.

Too much tech

“Silicon Valley has been telling us, since 2009 or 2010, that we’re right in the middle of this digital transformation,” Rumsfeld said. “And while there are pockets of this and you sort of hear about it, I don’t see it when I’m in clinic on Thursdays at the VA in Denver. I just don’t feel that transformation.”

That doesn’t mean Silicon Valley isn’t trying, though. Investors funneled around $7 billion into digital health startups in 2017 and over $8 billion in 2018, with even higher numbers expected this year. Rumsfeld said the jump to capitalize on the trend of digital health has resulted in “way too many technology solutions in search of a problem,” with hundreds of new companies moving forward without the expertise they need to craft a viable medical tool.

“It’s a kaleidoscope of technology,” he said. “It’s difficult to know where we should jump in. Which of these are the ones we should use? Which are solving a problem we want to solve?”

Rumsfeld said that, as someone who works regularly with both established and fresh tech companies, he rarely sees startups employ clinical partners to help create and design usable products. As cardiologist Paul Yock wrote in 2018, the “move fast and break things” approach that’s so often applied to tech just doesn’t work in healthcare.

Looking back

One way to move forward in this age of digital disruption is to recognize where physicians and researchers have failed in the past, Rumsfeld said. And if there’s one tech revelation clinicians have a universal bone to pick with, it’s the EHR.

“The EHR was not digital transformation—or at least not successful digital transformation,” Rumsfeld said. “Yes, it’s a digital technology, but unless your metric of success is a better billing platform, I’d argue pretty strongly that it’s not an example of digital transformation.”

If anything, he said, it’s holding medicine back from a bigger digital transformation. We’re $36 billion deep into a reporting system that once promised to improve efficiency and cut errors, but studies have shown that EHRs have actually perpetuated medical errors instead of reducing them. An Annals of Internal Medicine study that included cardiologists found that for every hour of face time with a patient, physicians spent an additional two hours of their workday and one to two hours of their off time on desk work and EHR input.

Because the data quality is relatively poor, EHRs represent a roadblock for digital transformation, Rumsfeld said. EHRs are also infamously resistant to APIs (application programming interfaces) that block even the best digital tools from integrating into clinical workflow—a problem that’s become so dire the federal government is stepping in to minimize the data blocking.

Rumsfeld said remote monitoring, virtual care and AI-driven solutions have all become integral to this elusive digital transformation, but it will take better partnerships with the tech world to get anywhere near where we want to be.

“Let’s face it,” he said. “It’s not yet been the same to say we’re going to go digital and take care of our patients in a digital platform the same way we do in the clinic or hospital.

“If digital health is the future—and many of us believe it—the future is not here yet.”

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