Precision Medicine on a Population Level

Another comprehensive approach to facilitate digital health data capture of both PROs and clinically reported outcomes (ClinROs) has been pursued by Specialty Networks Rheumatology. Automated data capture from rheumatology clinic EHR systems generates a database from different sources (i.e., a data lake) which can be queried to provide clinical phenotyping and real-world clinical response insights.^20,21 Pairing PRO and ClinRO data allows distinction of between subjective and objective reflections of disease activity and can improve assessments in various rheumatic diseases.^22-24 By combining subjective (PRO) and more objective (ClinRO) perspectives, the application of enterprise software generates the opportunity for remote monitoring driven visit schedules coupled with precision treatment of inflammatory vs. noninflammatory symptoms according to dual treat-to-target and triangulated, shared decision making paradigms.^25,26 These data are required by rheumatologists to succeed in risk-bearing, value-based care programs with health plan payers.

Finally, a robust dataset can optimize identifying patients at risk for inadequate response or complications and, thereby, the need for more urgent follow-up visits to evaluate for treatment changes, as opposed to those at lower risk who can safely benefit from the convenience of delayed return appointments.

In Sum

In this commentary, we have focused on the promising role of digital health technologies and novel approaches to care that hold promise to improve access to rheumatologic care. Digital health technologies include many other potentially useful devices to enhance remote care: devices to measure joint warmth and appearance, better video visit procedures to enhance examination and history taking, and greater access to electronic consultations.²⁷

Digital health technology also offers new revenue opportunities through reimbursable remote monitoring models (RTM, CCM) to alternative payment models. These may help address the private practice profitability concerns that have been generated by simultaneous and sustained reductions in all three of the traditional sources of practice income: patient encounters, infusions and other ancillary service reimbursement.

Although periodic visits are critical to maintain the therapeutic relationship and confirm PROs, rheumatologists need solutions beyond working more hours; greater embrace of digital health technologies offers possible solutions.

Daniel H. Solomon, MD, MPH, is a professor of medicine at Harvard Medical School, Boston, and a member of the Division of Rheumatology and Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, Boston, where he holds the Matthew H. Liang Distinguished Chair in Arthritis and Population Health. He has several ongoing projects regarding digital health technologies in rheumatology, attempting to improve the use of patient-reported outcomes in routine practice. He is the editor in chief of Arthritis & Rheumatology.