Partnering for Better Digital Health Strategy

The American Medical Association is working to improve digital health for physicians, including updating the limitation of modern technologies and creating guidelines for helpful and accurate mobile health tools.

“The delivery of health care, especially focusing on how to maintain and improve both the quality of care as well as manage the cost of care as we move into more of a value-based economy, is directly dependent on having the right information technology assets,” said Dr. Michael Hodgkins, chief medical information officer at AMA.

Hodgkins has been with AMA for more than six years, where his primary focus is advancing public health and health information technology through strategies, policies, partnerships and collaborative discussions about new services.

He defines digital health in terms of both the use and integration of electronic health records and mobile health apps and solutions hosted on smartphones and various devices.

“With respect to the EHR, we’re very focused on matters of usability,” he said. “We still think that the EHR has a long way to go to really satisfy the needs of the health care system.” AMA is also focused on interoperability with EHRs and new mobile tools.

To address its mission, AMA’s digital health strategy involves three core elements:

  1. Research: Finding the best ways to integrate health IT into the practice of medicine while facilitating the care delivery process, improving quality, reducing costs and maintaining the patient-physician relationship.
  2. Guidance: AMA set up a standalone nonprofit called Xcertia to develop a set of best practices or “mHealth App Guidelines” targeted at the health app community. The Xcertia board and membership will be composed of stakeholders from the technology industry, consumers, physicians and health systems. The board will help discuss and develop the guideline content, which will include evidence, usability, privacy, security, operability and efficacy. It’ll also be publically available and focused on improving the quality, accuracy and benefits of mobile health apps. Physicians can use these guidelines to make better decisions about which apps are appropriate, especially to assist in the management of chronic disease.
  3. Collaboration: In an effort to include physicians in the digital health conversation, AMA is creating a virtual platform to connect physicians with health tech entrepreneurs (a system similar to a The physician community has shown interest in having a voice in the design of these tools and how they are executed. With this platform, physicians can interact with techies from the earliest concept of development to a tool’s eventual prototyping and readiness.

To build on its three-pronged strategy, AMA is leveraging its partnerships with third parties through Xcertia and working directly with EHR vendors to improve health IT development. For example, Xcertia and the physician-entrepreneur platform are intended to create dialogue and context between developers and physicians, so vendors can create tools and EHR systems that meet the needs of the health care team.

AMA is also working with the government. According to Hodgkins, AMA’s advocacy group in Washington D.C., interacts with government agencies most involved with health IT on a regular basis. The group is focused entirely on federal and state health IT policies and was involved in discussions that led to the 21st Century Cures Act enacted in December 2016.

Additional policy discussions surround issues of usability, payment practices for use of digital health tools and physician engagement in telehealth across state lines. AMA also interacts with the Office of the National Coordinator and divisions within the Health and Human Services Department.

“We’re very much involved throughout the federal government in matters related to health information technology,” Hodgkins said.

AMA also plans to invite government representatives as liaisons on the Xcertia board.

“We think it’s important to include them in those discussions,” Hodgkins said. He’s also looking to involve the Federal Trade Commission, as it has intervened in removing mobile health apps from app stores when they have provided misleading information.

“They are more actively involved in what's happening in the mobile health app space,” he added.

The government is also implementing EHR systems, including the Defense Department Military Health System’s GENESIS to electronically manage health information and the Veteran Affairs Department's nationwide Veterans Information Systems and Technology Architecture, or VistA. While AMA doesn’t play a role in how these agencies use that technology, “our efforts are focused on how that technology needs to be improved across the board,” Hodgkins noted.

For instance, Hodgkins did question the use of open-source software for VistA at the ACT-IAC Mobile Health Forum in Washington D.C., on April 20. Specifically, he’s concerned with the reliance on a voluntary community to continue making improvements and if that is going to be a reliable system for VA going forward. With vendor-based EHRs like GENESIS, Hodgkins also discussed the long development cycles that could prolong improvements. Rather than waiting for vendors to fix them, he said he would focus on open application program interfaces.

In the end, AMA is hoping its internal initiatives and external partnerships with industry and government result in delivering high-quality, low-cost health care with the support and applicable use of new health IT solutions.