How Technology Can Deliver Broad Improvements in Health Care

As director of the Institute for Population Health Improvement at the University of California, Davis, Kenneth W. Kizer brings plenty of experience in the use of technology to help manage large populations.

A physician by training who is board-certified in several specialties, Dr. Kizer was California’s top health official before serving as undersecretary for health in the Department of Veterans Affairs in the 1990s. At the VA, he is credited with modernizing the nation’s largest health system, including adopting one of the first major electronic health records systems. He later was founding president and chief executive of the National Quality Forum, which sets quality standards and performance measures for U.S. health-care providers. He recently answered questions from The Wall Street Journal’s Laura Landro. Edited excerpts follow.

WSJ: What does population health mean, and why is it important?

DR. KIZER: Population health refers to the health status or health outcomes of a group of people who share one or more common characteristics. Populations can be defined by age, gender, race or ethnicity, where they live, type of health insurance, clinical conditions such as diabetes or asthma, or any number of other characteristics.

The term population health was introduced about a decade ago to recognize the important role that factors other than health care have in determining health outcomes. Prominent among these factors are education, employment, housing, transportation, public safety, lifestyle and the environment. Many people are surprised to learn that these social determinants of health have more to do with reducing preventable deaths and improving population health than health care itself.

WSJ: How can technology help improve population health?

DR. KIZER: Many of the new information and communication technologies have begun to be used in health care in recent years. These include the internet and smartphones, electronic health records, health-information exchanges, telemedicine, and many types of wearable devices and mobile health applications.

Use of these technologies to improve population health is still in its infancy, but it is clear that they will fundamentally change the nature of health care in coming years by connecting patients and caregivers in ways previously unimaginable, making health care more convenient, helping people stay healthy and patients recover from illness more quickly, and coordinating care across caregivers and sites of care.

These new technologies necessitate that we fundamentally redefine what access to health care means, since access is no longer only about face-to-face visits. Information can now be exchanged between caregivers and patients in multiple ways, which means we can design innovative ways to tailor health care to someone’s individual needs and lifestyle. The stage is set for a virtual-care revolution.

Apps, for example, are being used for in-home monitoring of lung function in patients with chronic obstructive pulmonary disease, and to track the weight of patients with congestive heart failure so that fluid retention can be detected and treated before hospitalization is needed. Apps for managing asthma are being used to track an asthmatic’s medication use and to communicate a child’s asthma-action plan among caregivers and family members, reducing emergency room visits and hospitalizations.

Social media help tell patients when it’s time for a cancer screening or cholesterol check, and remind diabetics to take their medications. Tele-mental health care is increasingly used to help manage behavioral health conditions. Mental-health patients often prefer this kind of communication to face-to-face visits, which may result in better treatment compliance. These technologies also can help overcome transportation, language and other access barriers to health care for rural and inner-city populations.

WSJ: What are some barriers to using technology like this?

DR. KIZER: There are multiple barriers. Perhaps at the top of the list is health care’s conservative culture, which is notoriously slow to embrace new ways of doing things, followed by lack of health-insurance payment for most virtual-care methods. Lack of payment can undermine an effective method of virtual care by making it economically nonviable. The development of telemedicine was hampered for years by payment problems, although this has improved recently. As health-care payers increasingly move to value-based payment methods like patient-centered medical homes and accountable-care organizations, the business case for virtual care will become clear.

To read the rest of this article, published in the Wall Street Journal, please click here.