A promising area to explore is how digital health technologies can improve care efficiency. The majority of rheumatologists have their schedules filled with follow-up visits. Finding data to prove this point is difficult, but our colleagues agree that approximately one-third of return visits may be discretionary for patients who have stable symptoms. While ensuring monitoring laboratories occur, answering patient questions and counseling patients about health maintenance are all parts of what we enjoy as rheumatologists, many of these activities can be done outside an appointment by primary care providers or by APPs.
The rheumatology workforce shortage mandates that we view face-to-face time between patient and clinician as a vanishing resource to be conserved for appropriate application to those patients who need it most. So how can we deliver responsive, high-quality care for the right patients—those with active disease in need of intervention—and see fewer patients whose inactive or stable disease may allow them to safely stay home and be seen less frequently?
Digital health technologies provide some answers. We can all agree that technology for technology’s sake is problematic, but technology that solves problems is worth considering. The problem we face is poor access to rheumatologic care, which stems from too few new patient appointment slots. Thus, if technology can help diminish stable follow-up visits while helping maintain a therapeutic doctor-patient relationship, this may be technology worth pursuing.
We have been interested in whether remote patient monitoring via digital technology, such as mobile health apps, could help serve this dual purpose: inform clinicians when visits are needed for active patients and when they can be avoided in stable patients, while allowing providers and patients to remain in contact about symptoms. In essence, the question becomes whether remote assessment of disease activity on a precision basis can allow rheumatic disease providers to effectively manage a larger population of patients than traditional management through face-to-face visits only—precision medicine on a population level.
Knowledge & Communication in an App
In 2018–19, Dr. Solomon collaborated with colleagues at Brigham and Women’s Hospital to test the feasibility of a mobile health app for rheumatoid arthritis (RA) that collects short-form patient-reported outcomes (PROs).7 This process started with user-centered design focus groups and tested different prototypes. The PRO app was tested with 100 patients over 12 months. Patients enjoyed using the app and were relatively compliant (~65%) over one year.8
In focus groups conducted after our study, patients provided further feedback about how often they wanted to answer PROs and which ones were most useful; they also wanted their clinicians to have easy access to their PRO data, as the original version did not integrate with the electronic health record (EHR).
