By Dr. Paul Berggreen
Paul Berggreen, MD, has been in private practice since 1993. A graduate of LSU, he led the formation of the Arizona Endoscopy Center in 1999 and has served as its medical director since then. In 2007 he helped launch Arizona Digestive Health, now one of the largest gastroenterology groups in the U.S., and still serves as its president. In 2014 he founded Smart Clinic, a mobile communication platform designed to enhance patient engagement, compliance and satisfaction. He also served as director of the Good Samaritan gastroenterology fellowship program from 1998-2013.
Q. What’s the one promise of mHealth that will drive the most adoption over the coming year?
A. Improved compliance. Let’s face it: From a patient perspective medicine has become so complex it’s sometimes almost impossible to be compliant. Yet compliance, whether with a medication, a procedure preparation or a treatment regimen of any sort, is vital to a successful outcome. As doctors, we are using the same communication methods with our patients that we were using 30 years ago – pieces of paper and verbal instruction. If we want better compliance from our patients, we have to come up with better tools for them to use. mHealth is an important tool.
Q. What mHealth technology will become ubiquitous in the next 5 years? Why?
A. Patient-physician communication of some form, using smartphone technology, will become commonplace in the next five years. Changes in reimbursement for chronic disease management and expansion of telemedicine billing codes will push this adoption even further. 70 percent of U.S. adults now have a smartphone, a number that has been increasing exponentially and will likely hit 85 percent or 90 percent in the next five years. It’s the obvious channel of communication, and most people in this field realize that. Patients will demand it and physicians will respond, although doctors have historically been slow to adopt new technology.
Q. What’s the most cutting-edge application you’re seeing now? What other innovations might we see in the near future?
A. I recently viewed a demonstration of a product called Photon Med. It’s basically a consult accelerator on steroids, allowing referring physicians such as ER doctors to consult a specialist and simultaneously send their pertinent information and images to that specialist’s smartphone. The information is relevant and the interface is slick. It’s being rolled out nationwide just this month in selected hospitals, and I think it has great potential. Doctors are going to find that extremely useful. It’s just one example of a new type of tool that makes physicians’ lives more efficient and easier while tying networks of physicians together. The accountable care organization movement and hospital networks will find these types of tools irresistible. We’re going to see more of this type of tool in the near future.
Q. What mHealth tool or trend will likely die out or fail?
A. Patient portals, whether mobile or desktop, are doomed to failure if they do not evolve. The only thing driving physicians to encourage patient portal sign-up is the carrot-and-stick of meaningful use stage 2. Otherwise, portals are of very limited use in their current form. “Change or die” is particularly applicable here.
Q. What mHealth tool or trend has surprised you the most, either with its success or its failure?
A. Fitness trackers and their rapid adoption have been somewhat of a surprise. This is particularly true since most people who use these are very much interested in their health and are simply using these tools to validate their activity. This probably accounts for the fairly high rate of abandonment of these tools at the one-year mark, as noted in the media. For these tools to be truly useful, there needs to be application to patients with chronic diseases that can show improvement in measurable outcomes.
Q. What’s your biggest fear about mHealth? Why?
A. Compartmentalization. Currently, electronic health record companies are jealously guarding their data and are very reluctant to allow any significant interoperability. If mobile health innovators are co-opted or overrun by the large EHR companies, that compartmentalization and lack of interoperability will persist in the mHealth arena. That will likely inhibit true spread of this important technology for patient benefit. Unless true data interchange is facilitated, the healthcare cost curve will not improve.
Q. Who’s going to push mHealth “to the next level” – consumers, providers or some other party?
A. It’s going to be the electronic health records companies responding to the demands of the consumer. Very few of these companies now have a viable mobile product for patients, but physicians will adopt these tools widely when they are made integral to their existing electronic health records systems. It’s not that doctors don’t want to adopt these tools; it’s that they have so many demands on their time and their resources that they are hesitant to adopt another add-on software product. Once it’s made easy, adoption will occur very quickly. Physicians see the value; they just don’t want any more pain.
Q. What are you working on now?
A. Two years ago I made a smartphone app for my group, Arizona Digestive Health, to help with colonoscopy preparation. We performed two studies to validate its utility, and both were remarkably positive and received national presentations and press coverage. I’ve since taken that concept and built upon it, and the culmination is Smart Clinic. A patient-facing smartphone app connecting to a web interface in the medical back office, Smart Clinic integrates with the EMR and sends structured procedure preparations to the patient, enables prep and medication compliance tracking, includes instructional text, images and videos and even sends patient satisfaction surveys and clinical surveys to the patient, all returning to the office in an easy-to-use and structured format. Smart Clinic is now the official mobile app of the American College of Gastroenterology. With Smart Clinic, we finally have a new tool to communicate with our patients and promote compliance.