Alignment of Key Stakeholders' Priorities for Patient-Facing Tools in Digital Health: Mixed Methods Study.

BACKGROUND: There is widespread agreement on the promise of patient-facing digital health tools to transform health care. Yet, few tools are in widespread use or have documented clinical effectiveness. OBJECTIVE: The aim of this study was to gain insight into the gap between the potential of patient-facing digital health tools and real-world uptake. METHODS: We interviewed and surveyed experts (in total, n=24) across key digital health stakeholder groups-venture capitalists, digital health companies, payers, and health care system providers or leaders-guided by the Consolidated Framework for Implementation Research. RESULTS: Our findings revealed that external policy, regulatory demands, internal organizational workflow, and integration needs often take priority over patient needs and patient preferences for digital health tools, which lowers patient acceptance rates. We discovered alignment, across all 4 stakeholder groups, in the desire to engage both patients and frontline health care providers in broader dissemination and evaluation of digital health tools. However, major areas of misalignment between stakeholder groups have stymied the progress of digital health tool uptake-venture capitalists and companies focused on external policy and regulatory demands, while payers and providers focused on internal organizational workflow and integration needs. CONCLUSIONS: Misalignment of the priorities of digital health companies and their funders with those of providers and payers requires direct attention to improve uptake of patient-facing digital health tools and platforms.

Why real-world health information technology performance transparency is challenging, even when everyone (claims to) want it.

Crowdsourced ratings have driven increased performance transparency between consumers and suppliers. While many industries have benefitted from such transparency, crowdsourced ratings have struggled to scale in the healthcare domain. In theory, interoperability services offer an ideal setting for crowdsourced ratings: costs are high, performance is variable, and information asymmetries between provider organizations (customers) and vendors offering interoperability solutions exist. Via a Cooperative Agreement between the Office of the National Coordinator for Health Information Technology and University of California, San Francisco, we developed InteropSelect, a public website that allows crowdsourced ratings of interoperability service purchases. While we garnered broad engagement during the development process, the site failed to attract sufficient reviewers, which is fundamental to the success of crowdsourcing. Additional challenges included the lack of service commoditization that resulted in a complex rating form and lack of market dynamics that facilitated vendor engagement. Our lessons cast doubt on whether crowdsourcing and similar performance transparency efforts under the 21st Century Cures Act will succeed.

Patient characteristics associated with objective measures of digital health tool use in the United States: A literature review.

OBJECTIVE: The study sought to determine which patient characteristics are associated with the use of patient-facing digital health tools in the United States. MATERIALS AND METHODS: We conducted a literature review of studies of patient-facing digital health tools that objectively evaluated use (eg, system/platform data representing frequency of use) by patient characteristics (eg, age, race or ethnicity, income, digital literacy). We included any type of patient-facing digital health tool except patient portals. We reran results using the subset of studies identified as having robust methodology to detect differences in patient characteristics. RESULTS: We included 29 studies; 13 had robust methodology. Most studies examined smartphone apps and text messaging programs for chronic disease management and evaluated only 1-3 patient characteristics, primarily age and gender. Overall, the majority of studies found no association between patient characteristics and use. Among the subset with robust methodology, white race and poor health status appeared to be associated with higher use. DISCUSSION: Given the substantial investment in digital health tools, it is surprising how little is known about the types of patients who use them. Strategies that engage diverse populations in digital health tool use appear to be needed. CONCLUSION: Few studies evaluate objective measures of digital health tool use by patient characteristics, and those that do include a narrow range of characteristics. Evidence suggests that resources and need drive use.

Deploying Patient-Facing Application Programming Interfaces: Thematic Analysis of Health System Experiences.

BACKGROUND: Health systems have recently started to activate patient-facing application programming interfaces (APIs) to facilitate patient access to health data and other interactions. OBJECTIVE: This study sought to ascertain health systems' understanding, strategies, governance, and organizational infrastructure around patient-facing APIs, as well as their business drivers and barriers, to facilitate national learning, policy, and progress toward adoption. METHODS: We performed a content analysis of semistructured interviews with a convenience sample of 10 health systems known to be leading adopters of health technology, having either implemented or planning to implement patient-facing APIs. RESULTS: Of the 10 health systems, eight had operational patient-facing APIs, with organizational strategy driven most by federal policy, the emergence of Health Records on iPhone, and feelings of ethical obligation. The two priority use cases identified were enablement of a patient's longitudinal health record and digital interactions with the health system. The themes most frequently cited as barriers to the increased use of patient-facing APIs were security concerns, an immature app ecosystem that does not currently offer superior functionality compared with widely adopted electronic health record (EHR)-tethered portals, a lack of business drivers, EHR vendor hesitation toward data sharing, and immature technology and standards. CONCLUSIONS: Our findings reveal heterogeneity in health system understanding and approaches to the implementation and use of patient-facing APIs. Ongoing study, targeted policy interventions, and sharing of best practices appear necessary to achieve successful national implementation.