More devices don't equal better outcomes: Why hospitals should focus on social determinants of health

There’s an app for just about anything these days, like ordering food, meditating and checking your health records.

Griffin Myers, MD, is no stranger to technology. As the CMO of Chicago-based Oak Street Health, a company of primary care centers for adult Medicare patients, he is constantly evaluating patient care data to produce better outcomes.

While the assumption may be to acquire more technology to deliver better results, Dr. Myers has a different approach. Instead, he believes technology needs to be leveraged to treat patients prior to entering a hospital. This includes expanding technology to rural communities and underserved areas.

Here, Dr. Myers gives tips for how technology companies can better influence patient outcomes and the importance of social determinants of health.

Editor's note: Responses have been lightly edited for clarity and length.

Question: What steps can big tech companies take to help patients and clinicians use health-related devices?

Dr. Griffin Myers: There are three steps device companies can follow to help patients and clinicians.

1. Get accurate data: This is not a shot at tech companies for the data they get. Rather, it is hard at times to get accurate and clinically relevant data.

2. Get data that is needed: Sometimes device companies gather data to sell or market their products instead of focusing on the data that would benefit patients and providers.Device companies can create more value by taking the long approach to gathering data.

3. Share the data: This is the value captured portion. If you have accurate data and data that is needed, it is hugely valuable. But then to really capture the data, it is important to share the data with people who support patients.

There, however, is also a problem with health systems not providing device companies with patient data to create new devices. Hospitals that I trained at across Boston strategically do not share patient data as a defense to stay competitive with rival hospitals. This makes it so patients continue to revisit the same hospital with their data.

Sharing data is a hard problem. It's in a health system's incentive in a fee for service network to not share patient data, and we as a whole healthcare industry need to move past that.

Q: When Apple released its latest Watch with a feature to detect AFib, some cardiologists spoke out about the technology. Is it common for devices to be released without clinician support?

GM: I found that the particular reaction with cardiologists coming out against the device to be emotional. And it was a reaction that didn't come as a major surprise. With the Apple Watch, cardiologists expressed concerns that a patient may get an inaccurate atrial fibrillation alert from the watch.

Theoretically, it is important to understand that false positives harm patients. If someone believes they have a heart rhythm issue that isn't actually there, the patient is going to incur expense and tests that risk harm.

The focus needs to be on accuracy, getting the data that is clinically relevant for patients and providers. There will be other devices similar to Apple's AFib monitor that may prompt users with false positives. However, the way we can solve this is through collaboration with tech companies and hospitals.

Q: If you could create any device (money isn't an object) to support patients' health, what would it be?

GM: I would advise everyone in the healthcare space to challenge the assumption of what we need to have a healthier community, country or planet. Is another medical device going to be able to measure things we aren't measuring today?

I say this because there are so many therapies available today for so many things that hurt us as patients. There was a lecture at Boston-based Massachusetts General Hospital in 2007 that has changed the way I think about the world. A gentleman focused on social determinants of health found that only 20 percent of outcomes are related to the quality of care patients receive, leaving 80 percent attributed to social and environmental factors.

If money were no option, I would create some solution that would be able to measure the gap of where a patient is today and a patient's ability to participate in the evidence-based care plan that we have for them. It's about understanding the changing social dynamics of a patient's life. We need to better understand why patients can't take certain medicines or adhere to a diet: things we know drive better health outcomes.

Rather than making it one device, we in the healthcare industry will begin to collect so much data beyond just clinical information. Then, by leveraging machine learning, we will be able to make real change.

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