American Medical Association CEO Dr. James Madara took some shots at digital health at the AMA annual meeting in Chicago last week. He said:
“Today we have really remarkable tools — robotic surgery, new forms of radiation treatment, targeted biologics; and we live in a time of rapid development in the digital world — telemedicine as an example. But appearing in disguise among these positive products are other digital so-called advancements that don’t have an appropriate evidence base, or just don’t work that well — or actually impede care, confuse patients and waste our time. From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality – it’s the digital snake oil of the early 21st century,”
We accomplished exactly what we set out to do.
The ineffective EHR comment is nothing new. Given the number of complaints we hear from providers on that front, it’s no wonder that the frustration can carry over to their opinion of other products. However, as John Halamka points out in his rebuttal, the AMA needs to take a step back and acknowledge that the regulatory efforts of the past several years have accomplished exactly what they set out to do. The EHRs and other tools that we have today are a direct reflection of that He says, and I agree, that the AMA and other stakeholders should redirect this energy to defining “a small number of desirable outcomes as our next goals.” In other words, don’t complain about where we are, but tell us where we need to go. I love how practical he is.
The tools are useless on their own
CareMore Health System CEO Sachin H. Jain offered his thoughts in this Forbes post. He starts by telling the story of where the term “snake oil” came from. It turns out that the original form of snake oil was very effective in treating arthritis and bursitis. Later, bad-actors diluted the product and made outlandish claims about its abilities. That lead to the analogy we all know today. The point of his story is that “the original product, water snake oil, administered the right way, in the right context, for the right medical conditions—actually worked.” Jain goes on to talk about some very specific use cases for digital health tools at CareMore and how they’ve improved care. However, he adds that without the broader system of care and the culture in which it’s delivered, these tools would be useless: “just as real water snake oil works when you apply it to the right patients under the right conditions, the same could be said of most of our digital healthcare innovations.”
This is the free market at work
In addition to the points made above, I see another factor at play. Healthcare has long been insulated from the “meddling” of entrepreneurs from outside of healthcare. This is largely due to the intermediated landscape of healthcare where the providers and payers do business and patients just get treated. This environment necessarily leads to a one-size-fits-all approach when determining what’s valuable and what’s not. That’s starting to change. Patients are paying more out of pocket and smart phone apps are easy to build and distribute. It’s only natural that more entrepreneurs are going to try and solve problems for patients. Some will do it well and others won’t. The beauty of it is that the patients will get to decide what’s best for them and that will determine which apps survive. And don’t tell me that it can’t work because it works in every other market. It’s bottom-up instead of top-down and the industry has to learn how to work in that model. Even if only a little bit.
On Wednesday, June 22, 2016 the Business of Healthcare tweet chat will dive into the snake oil debate:
12:00 PM EST — Tweet Chat
The tweetchat begins at 12:00 PM EST and will ask 3 questions in 30 minutes:
Q1: Are today’s digital health tools exactly what the regulatory efforts ordered, or have vendors just fallen short?
Q2: Which digital health tools are missing the mark and what needs to change?
Q3: What are the primary use cases that digital health tools should be trying to solve for? Who’s doing it right?
12:30 PM EST — Blab
Then at 12:30 PM EST, the #hcbiz Show welcomes Steve Sisko (@shimcode). We’ll dig into this snake oil business a little bit more but will largely focus on Steve’s takeaways from AHIP 2016.