Today there are just 33,368 cardiologists in the U.S. They can't possibly care for 30.3 million adults with heart disease in the U.S. right now.

On a related note: About 647,000 people die every year in the U.S. from heart-related issues.

And it's not just cardiologists who are in short supply. The U.S. is lacking most medical specialists today. That's where technology can step in – to help scale and magnify the impact of specialists to manage chronic disease.

We interviewed Dr. Ashul Govil, a practicing cardiologist at Sutter Health and chief medical officer at Story Health, a technology company that aims to expand the reach of specialists in the U.S., to discuss the specialist crisis and talk about how to fill the gaps in specialty care with patient-facing apps so that interventions come at the right time and patients adhere to their treatment for the best possible outcomes.

Q. Please describe the situation in healthcare today with regard to the number of specialists and the demand for specialty care.

A. The issue of specialty care and physician shortages is not new and continues to be a growing problem. For well over a decade, we've seen this challenge progressively worsen, partially because we have had a relatively fixed number of graduates from medical programs since 1997, when Medicare started limiting the funding for these programs.

In addition to the limited number of professionals, our population is aging and living longer. Roughly 16% of the U.S. population is over the age of 65, but they account for nearly one-third of healthcare spending, much of which is going into specialty care. These numbers leave the U.S. with proportionally fewer providers for a significantly increased and in-need patient population.

Now, consider the pandemic's impact on the specialty care crisis. Medicine is not immune to the Great Resignation, and the pandemic has impacted our profession more than others.

As a result, we're seeing overburdened providers retiring early or transitioning their careers, further exacerbating the specialty shortage set in motion decades earlier. At this current trajectory, by 2034, the shortage of specialty care physicians is projected to be somewhere between 21,000 and 77,000.

Finally, during the nation's time in lockdown, we all saw how our current healthcare structure failed some of our most vulnerable and marginalized communities. A myriad of challenges bar patients from critical care they need.

Social determinants of health issues in underserved populations that reduce access to care, such as underinsurance, literacy and transportation issues, historically have not been addressed. This was only magnified during the pandemic, where tools that were employed, such as video visits, further reduced access for these populations.

Factoring in these barriers, the care gaps are likely farther reaching than estimates suggest.

Q. How can technology help scale and magnify the impact of available specialists?

A. To effectively magnify the availability of specialists, technology needs to address both the shortage of physicians as well as their distribution to get specialty care into medical deserts. To date, the most the industry has done to address these two variables is to leverage telehealth and remote patient monitoring capabilities.

Telemedicine has allowed specialists to deliver care for some patients who might otherwise have difficulty in accessing care. As a subset of telemedicine, RPM picked up steam in the past two years as more patients and providers were looking for more impactful and convenient ways to receive and deliver care.

RPM provides that level of care delivery through a combination of devices for tracking and communicating health data directly from the home to the physician, bridging the space between the traditional healthcare setting and where the patient lives.

This makes patients' health data potentially more accessible and actionable, with the promise of saving both the patient's and provider's time by reducing office visits. In addition, it allows providers to extend their geographic reach with specialized telehealth technology.

What this RPM technology doesn't do is ease the burden of the limited number of specialists. Unfortunately, much of a physician's day-to-day work has little to do with the actual practice of medicine and intellectually invigorating problem solving to improve patients' health.

Instead, the specialist's time often is spent in administrative and lower-level tasks to keep practices and departments operational – tasks that should be offloaded from the physician to tech tools and administrative assistants. This is especially true when it comes to gathering the data into a logical single source to aid providers in clinical decision-making.

Valuable patient-provider time can be freed up by reducing the burden of clinician involvement for tasks, such as documentation, pre-authorization, or calling relatives to have them peek into cabinets in order to track down each prescription and form an accurate medication list.

RPM in its current form doesn't aid in these workflow issues, and it can actually exacerbate them by adding an additional thing for clinicians to have to deal with during their busy days. These tools can be made more effective by integrating into existing workflows in a way that allows scalability of a provider's time.

Technology also can support more sophisticated tasks, such as the synthesis of health data with AI software so physicians don't have to wade through extraneous details for the essential information. Instead, this type of software saves the specialist's time significantly by serving up the clinically relevant health data with AI-supported clinical decision-making.

The physician then is able to spend their time guiding the treatment plans, connecting with patients and troubleshooting more complex issues throughout the patients' care journeys on a more individual basis. This care model increases physician throughput so each physician can help more patients, while also engaging more deeply with them.

Asynchronous care models using technology also allow for specialists to scale their expertise by allowing primary care physicians, or even advanced practice providers, to deliver complex care through standardized protocols that can bring in the specialist only when they are needed.

Over time, with new datasets that are more locally sourced and incorporate novel links between variables, specialists can use this technology to produce novel care algorithms on a population health level using machine learning and AI. This can reduce the resources and time needed to test new protocols for therapies in patient care.

Q. You suggest filling the gaps in specialty care with patient-facing apps so that interventions come at the right time and patients adhere to their treatment for the best possible outcomes. Please elaborate.

A. From the physician side, they can more easily identify points in a patient's trajectory where they can provide essential care more quickly through these apps. Providers could get everything right for their patients, but if it is not done in a timely manner, it doesn't improve the resulting patient outcomes.

By utilizing two-way dialogue, patient-facing apps pick up where RPM fails as a one-directional communication channel, closing the loop on delivering clinical action based on data. As an example, patients can inform their provider about any challenges or adverse reactions they might experience, and providers can work to address those challenges in a timely fashion to prevent further complications.

In cardiology, these challenges might include connecting patients to community resources that help them access and pay for medication, facilitating transportation or home administered testing, or quickly addressing an adverse reaction that prevents unneeded visits to the emergency department or hospitalization.

These are all issues that providers want to address immediately in order to facilitate the best outcomes for their patients. Of course, providers already have overburdened workloads, so the patient-facing solutions need to be intelligent about how they triage information that gets back to providers and automate responses and actions where possible.

If this can be done in a way that integrates with existing clinical workflows, patient-facing solutions shorten the timeline and bring an immediacy to medicine that is valuable to the patient.

In addition to the right time, patient-facing apps can make the challenge of providing care to patients in the right place obsolete. Patients can communicate with their providers from virtually anywhere. This is key as health systems and providers address the increasing disparities and social determinant issues that prevent adequate patient care.

In a system where the provider can effectively deliver care outside the traditional healthcare setting, if a patient working an hourly job can't take time off to drive to the doctor's office, that doesn't matter because they can connect during their lunch break just as easily.

With this immediacy comes intimacy. Most patient-provider relationships occur during an annual wellness exam. For a patient with a chronic illness, they may see their provider four times a year due to physician availability. With patient-facing apps, patients can have more frequent and impactful, albeit shorter, interactions with their providers.

As a result, they feel more connected, watched over and engaged with during their care journeys. This patient-provider bond then can be leveraged as the fulcrum to create a sustained change in patient behavior over time that will improve patient outcomes.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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