Opinion

More Doctors Adopt Digital Health Tools

By the AMERICAN MEDICAL ASSOC.

Adoption of digital health tools has grown significantly among all physicians since 2016, when the American Medical Assoc. (AMA) first benchmarked the integration of emerging health technology into clinical practice. New AMA research shows more physicians than ever recognize digital health tools as an advantage for driving improved efficiency and safety in health care.

The AMA has investigated shifts in physician adoption of digital health tools during the last three years, along with current attitudes and expectations among physicians. The research examines seven categories of digital health tools that engage patients for clinical purposes, interpret and use clinical data, and manage outcomes and other measures of care quality. According to the AMA survey, adoption trends in the following seven categories are helping to propel the digital transformation of healthcare.

• Tele-visits/virtual visits. Physician adoption doubled from 14% in 2016 to 28% in 2019, the largest growth in the digital health tool categories. This category includes audio/video connections used to see patients remotely.

• Remote monitoring and management for improved care. Physician adoption jumped from 13% in 2016 to 22% in 2019. This category includes mobile applications and devices for use by chronic-disease patients for daily measurement of vital signs, such as weight, blood pressure, blood glucose, etc. Readings are visible to patients and transmitted to the physician’s office. Alerts are generated as appropriate for missing or out-of-range readings.

• Remote monitoring for efficiency. Physician adoption grew modestly from 12% in 2016 to 16% in 2019. This category includes ‘smart’ versions of common clinical devices such as thermometers, blood-pressure cuffs, and scales that automatically enter readings in the patient medical record.

• Clinical decision support. Physician adoption climbed from 28% in 2016 to 37% in 2019. This category includes modules used in conjunction with the electronic health record (EHR), or mobile applications integrated with an EHR, that highlight potentially significant changes in patient data, such as weight gain or loss, change in blood chemistry, etc.

• Patient engagement. Physician adoption rose from 26% in 2016 to 32% in 2019. This category includes solutions to promote patient wellness and active participation in their care for chronic diseases, such as adherence to treatment regimens.

• Point of care/workflow enhancement. Physician adoption modestly increased from 42% in 2016 to 47% in 2019. This category includes communication and sharing of electronic clinical data to consult with specialists, make referrals, and/or facilitate transitions of care.

• Consumer access to clinical data. Physician adoption rose from 53% in 2016 to 58% in 2019, the highest adoption rate among the digital health tool categories. This category includes secure access allowing patients to view clinical information such as routine lab results, receive appointment reminders and treatment prompts, and ask for prescription refills, appointments, and to speak with their physician.

While all digital health tools have seen increases in physician adoption since 2016, the biggest growth in adoption was among digital tools in the categories of tele-visits/virtual visits and remote monitoring for improved patient care.

Improved efficiency and increased patient safety remain the most important factors driving physician interest in digital health tools, although addressing patient adherence, convenience, and physician burnout are growing drivers as well.

The AMA is dedicated to shaping a future when digital health tools are evidence-based, validated, interoperable, and actionable. Through its ongoing work, the AMA is committed to ensuring physicians play a greater role in leading trustworthy and equitable tech-enabled innovation that enhances patient care and shapes a better healthcare system. –


Workers’ Comp and Medical Marijuana

By ASSOCIATED INDUSTRIES OF MASSACHUSETTS

Should workers compensation insurance be required to cover medical marijuana used by an injured worker? The Massachusetts Supreme Judicial Court will decide that question later this year. 

The intersection of workers’ compensation and medical marijuana was perhaps inevitable. The Massachusetts medical-marijuana law provides that individuals may use it to treat certain enumerated medical conditions, and “other debilitating conditions as determined in writing by a qualifying patient’s healthcare provider.”

The summary of the case is as follows. A worker was injured. The worker believed he could compel a worker’s compensation insurer to pay for his medical marijuana, which he believes is necessary to treat his injury. After the employee’s claim was denied in the workers’ compensation dispute-resolution system, the injured worker appealed to the courts, and the state Supreme Judicial Court agreed to hear the case.

The parties have submitted written arguments stating why the court should rule in their favor. 

The employee argues that denying him access to medical marijuana would create a second class of injured workers who would be forced to use less effective methods to address the pain from their injuries. 

The workers’ compensation insurer claims that the injured worker may not compel the carrier to pay for this medical treatment because the federal Controlled Substances Act (CSA) of 1970 takes priority over Massachusetts’ medical-marijuana law. The carrier also argues that no aspect of the state’s medical-marijuana law requires insurers to reimburse workers for using marijuana.

The original ruling in the dispute was handed down by the Department of Industrial Accidents Review Board, denying that the insurance company be compelled to pay for medical marijuana because it would violate the CSA.

The Review Board acknowledged that, while state laws around the country are supportive of the use of medical marijuana (33 states have some law permitting the use of medical marijuana), the CSA continues to make it illegal because it is a controlled substance. 

The Review Board cited a June 2018 decision from Maine’s Supreme Judicial Court, which found any order requiring an employer to compensate a worker for medical marijuana would force a violation of the CSA.

But a victory for the insurer is by no means guaranteed in a case like this.

While the Maine Supreme Court ruled in favor of the insurer, New Jersey ruled last month that workers’ compensation carriers must reimburse the injured employee for the purchase of medical marijuana. The New Jersey ruling noted that it considered the CSA argument as well and rejected it. 

The trend toward rejecting the CSA argument has some recent history to it. Courts in Connecticut (2019), New Hampshire (2019), Minnesota (2018), and New Mexico (2014, 2015) have also considered the same issue and ruled in an employee’s favor. Other states, including Pennsylvania, are considering similar medical-marijuana questions regarding workers’ compensation injuries.

On the other hand, Florida, Michigan, and North Dakota have passed state statutes prohibiting reimbursement for medical-marijuana base claims.

Given the disagreement among different jurisdictions around the country, it is anybody’s guess which way the Massachusetts courts will go. Employers and workers’ compensation carriers will need to watch this case closely as the year goes on. –

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