The American Medical Association (AMA) is working to address physicians’ adoption of digital health applications from concept to clinical integration to improve care delivery for patients. Toward this effort, the AMA convened the Digital Health Physician Adoption Summit earlier this year, bringing together 20 leading innovators, researchers, physicians, and decision makers from across the digital health ecosystem. The participants engaged in dialogue about how best to support physician adoption of safe and effective digital health innovations that will advance the quadruple aim: better health outcomes, improved patient experience, improved clinician experience, and lower cost of care.

At the summit, participants shared best practices, lessons learned, perceived gaps in knowledge, and opportunities to improve adoption of digital health innovations. Participants also shared their perspectives on the role that the AMA, the Summit participants, and other key stakeholders might play in bringing the ideas to fruition.

Current State Of Physician Adoption Of Digital Health

It’s commonly understood that diffusion of innovations into clinical practice can take 17 years to achieve widespread adoption. Diffusion research has identified a complex set of factors that contribute to this lag, including some purposefully designed to protect patient safety and uphold evidence-based medicine.

In narrowing the scope of the dialogue to adoption of digital health solutions, summit participants sought to evaluate the factors driving implementations to succeed or fail. Firsthand experience of those in the room coupled with examples from research literature and market data collectively identified the following implications of ineffective digital health implementation.

First, a high volume of capital is at risk. In 2017, digital health startups raised a record $11.5 billion, a 44 percent increase from 2016, according to a StartUp Health Insights Global Digital Health Funding 2017 Year End Report. Poorly designed and executed implementation reduces the impact of promising solutions and diverts funding that could have driven greater impact elsewhere.

Second, patients, clinicians, and provider organizations waste time and resources on adoption of solutions that are not sustainable, not scalable, or do not provide positive return on investment. Failed interventions contribute to fatigue, reducing motivation to engage in future implementations of promising solutions.

Finally, the need for impactful solutions cannot be understated. We are seeing unprecedented levels of physician burnout due to an inefficient health care system. Patients have become smarter health care consumers, further emphasizing the need to improve the patient experience. Chronic disease continues to affect more patients, worsening health outcomes and increasing cost of care. Poorly executed digital health interventions exacerbate these problems, instead of being part of a much needed solution.

Identifying Barriers And Facilitators To Scale

Participants were broken up into small groups and asked to assign factors that enable or inhibit adoption of digital health innovations to four categories: patient adoption, physician practices, health systems, and technology. Several familiar and common themes emerged, including interoperability, system and clinician resource limitations, and design and user experience considerations. Often, barriers and facilitators reflected two sides of the same coin, such as ease of use versus complexity as a driver of patient adoption, and organizational support versus risk-averse culture as a health system factor.

A clustering exercise of the output of the group discussion revealed the barriers and facilitators shown in Exhibit 1.

Exhibit 1: Factors That Inhibit Or Facilitate Adoption Of Digital Health Innovation

Source: Digital Health Physician Adoption Summit

The groups then spent time developing themes describing why these facilitators and barriers exist. Themes included:

• Incentives created by our current fee-for-service payment environment
• Outdated technology and data infrastructure
• Lack of sufficient evidence of return on investment
• Lack of available capital to invest in crossing the chasm from pilot to scale
• Culture of risk aversion and resistance to change within health systems and physician population
• Limited resources and capacity—especially for clinicians working outside of large systems
• Failure to effectively engage patients and clinicians in design and implementation of solutions

Innumerable opportunities for improvement were identified throughout this discussion, albeit with no easy solutions. Addressing these barriers and the underlying core issues will require changes across all levels and sectors of the health care delivery system. Leaders struggling to drive innovation are aware that there is likely a better and more efficient path to scaled adoption but report that knowledge, collaboration, and best practices are sparse. Summit participants agreed that the digital health industry should come together and share what is and is not working if we are to accelerate the pace of change.

Proposed Roadmap For Scaling Adoption

The final portion of the summit was spent identifying opportunities upon which the AMA, the summit participants, and the broader industry should take action. A large number of ideas were generated across teams, with a shorter list prioritized for voting by the full group. The ideas with the highest number of votes are listed below.

• Digital Health Implementation Playbook—a tool to help physicians and practices implement and scale digital health innovations in clinical practice
• Digital Health Solution Marketplace—a platform where physicians and practices go to review and select digital health innovations that are safe and effective for implementation
• End User Feedback Collaborative—a convening of providers, patients, and other users of digital health tools to design, build, and provide feedback on solutions, ensuring all voices are heard
• Payer Summit on Digital Health—an event that focuses on the role of payers to accelerate coverage, payment, and adoption of digital health innovations
• Physician Phenotype Model for Adoption—development and application of a physician phenotyping study to understand what motivates different demographic and behavioral segments of physicians to adopt new solutions

A post-summit review of these ideas identified the needs that summit participants believed were most important for the industry to address. As an immediate step, the AMA is exploring the potential of the Digital Health Implementation Playbook and the Digital Health Solution Marketplace to improve development, selection, and implementation of solutions.

These tools will seek to support health care provider organizations in answering the following questions:

1. What organizational and practice problems are we facing?
2. Are we ready to solve it?
3. Which digital solution should we choose?
4. How should we implement it, both initially and at scale?
5. How will we know if it is successful?

The AMA is grateful for the contributions of the participants in the Digital Health Physician Adoption Summit and looks forward to partnering with interested stakeholders to refine our questions and develop an optimal solution roadmap.

Digital Health Physician Adoption Summit Participants

Michael Adcock, FACHE (University of Mississippi Medical Center); Michael Anderes, MBA (Froedtert and the Medical College of Wisconsin Health Network); Jitendra Barmecha, MD (Node Health); Meg Barron, MBA (American Medical Association); Bruce Brandes, MBA (Lucro); Pavan Choksi (Rx.Health); Amanda Coleman, MPH (American Medical Association); Michael Hodgkins, MD, MPH (American Medical Association); Carolyn Jasik, MD (Omada Health); Maithili Jha, MPH (American Medical Association); Kamal Jethwani, MD, MPH (Partners Healthcare); Nina Kandilian ([email protected]); Matt Karls, MBA (Echo Health Ventures); Chelsea Katz, MBA (American Medical Association); Christopher Khoury, MBA (American Medical Association); Kate Kirley, MD (American Medical Association); Larry Kosinski, MD, MBA (Illinois Gastroenterology Group, SonarMD); Joseph Kvedar, MD (Partners Healthcare); Jason Lineen, MBA (AVIA); Stacy Lloyd, MPH (American Medical Association); Laurie McGraw (American Medical Association); Claire Meunier, MBA (Evidation Health); Joey Nakayama (American Medical Association); Shantanu Nundy, MD, MBA (Human Diagnosis Project); Neil Patel, MBA (Healthbox); Fred Rachman, MD (AllianceChicago); Jordan Shlain, MD (HealthLoop); Niko Skievaski (Redox); and Omid Toloui, MBA, MPH (CareMore)