AMA Digital Health Research Physicians’ motivations and requirements for adopting digital health Adoption and attitudinal shifts from 2016 to 2019 February 2020 1 Background and Objectives • In July 2016 The American Medical Association conducted a comprehensive study of physician’s motivations and requirements for the adoption of digital clinical tools. • The AMA repeated the study to determine the degree to which adoption has occurred in the past 3 years and identify attitudinal shifts among physicians towards their use and adoption. • The goals for this research were to update the 2016 study to determine: 2 1. Any change in overall interest in digital health tools and the degree to which physicians believe they will help or hinder their patient care 2. Current familiarity with 7 specific digital health tools and physician enthusiasm, belief in the relevance to their practice, timeline for incorporating or current use 3. For each tool, the motivators and level of disruption caused or foreseen 4. The ideal level of involvement physicians would like to have in adoption decisions 5. An understanding of enthusiasm, current usage and requirements for emerging technologies © 2020 American Medical Association. All rights reserved. Methodology • This survey was designed to replicate the 2016 survey exactly, to have a statistically valid and reliable comparative sample. • The same physician panel was used as in 2016, provided by WebMD. • The 2019 survey was slightly longer at 18 rather than the original 15 minutes, but new questions were added at the back of the survey to not interfere with the flow of the original questionnaire. • The basic 2016 survey was followed exactly in wording and question order, with only a few variations, to remove some small questions that were no longer relevant. • The sample used careful quotas to ensure a similar sample composition as in 2016. 3 Total PCPs Specialists Solo Practice Group Practice Other 2016 1300 650 650 196 879 225 2019 1359 672 687 155 829 375 © 2020 American Medical Association. All rights reserved. Survey Instrument Digital healthcare: Digital health encompasses a broad scope of tools that engage patients for clinical purposes; collect, organize, interpret and use clinical data; and manage outcomes and other measures of care quality. This includes, but is not limited to, digital solutions involving telemedicine and telehealth, mobile health (mHealth), wearables (Fitbit), remote monitoring, apps and others. 7 Specific Tools Remote monitoring for efficiency Remote monitoring and management for improved care Clinical decision support Tele-visits/ virtual visits Point of care/ Workflow enhancement Consumer access to clinical data Questions Overall Involvement in Digital Health • • • Impact of ability to provide care Overall motivators/attractants Overall functional requirements Specific digital tools • • • • • • 4 Familiarity Current use Relevance for practice Enthusiasm Timeline for incorporating into practice Ideal level of involvement in Digital Health in general © 2020 American Medical Association. All rights reserved. Individual tool deep dives (Ask for up to two relevant solutions, not currently being used) • Overall motivators/attractants towards solution • Rank of top 3 motivators/attractants • Overall functional requirements of solution adoption • Rank of top 3 functional requirements • Level of disruption caused by solution • Ideal level of involvement with decision to incorporate solutions Patient engagement WebMD recruited a sample of 1,300 practicing US physicians Requirements for participation: • Age 28-65 • Practicing physicians including those focused on research, academia or public health • Full-owner, part-owner or employee of a practice (not an independent contractor) • Provide a minimum of 20 hours of direct patient care each week Key definitions in the study 5 • Digital health encompasses a broad scope of tools that engage patients for clinical purposes; collect, organize, interpret and use clinical data; and manage outcomes and other measures of care quality. This includes, but is not limited to, digital solutions involving telemedicine and telehealth, mobile health (mHealth), wearables (e.g., Fitbit), remote monitoring, apps, and others. • Seven specific tools: Remote monitoring for efficiency Smart versions of common clinical devices such as thermometers, blood pressure cuffs, and scales that automatically record readings in the patient record so you do not have to type it Remote monitoring and management for improved care Apps and devices for use by chronic disease patients for daily measurement of vital signs such as weight, blood pressure, blood glucose, etc. Readings are visible to patients and transmitted to the physician's office. Alerts are generated as appropriate for missing or out of range readings Clinical decision support Modules used in conjunction with the EHR or apps that integrate with the EHR that highlight potentially significant changes in patient data (e.g., gain or loss of weight, change in blood chemistry) Patient engagement Solutions to promote patient wellness and active participation in their care for chronic diseases (e.g., adherence to treatment regimens) Tele-visits/ virtual visits An audio/video connection used to see patients remotely (i.e., simple acute illness, adjusting therapy, etc.) Point of care/ workflow enhancement Communication and sharing of electronic clinical data to consult with specialists, make referrals and/or transitions of care Consumer access to clinical data Secure access allowing patients to view clinical information such as routine lab results, receive appointment reminders and treatment prompts, and to ask for prescription refills, appointments and to speak with their physician © 2020 American Medical Association. All rights reserved. Summary: Changes from 2016 1 • • Growth in those that see an advantage is among PCPs. Those that see no advantage are trending downwards and are concentrated in the age 50+ segment. 3 • • • 6 There has been an increase in the number of physicians that see a definite advantage in digital tools 2 • • • Adoption of remote care tools such as tele-visits and remote monitoring had the most movement Providing remote care to patients has increased significantly as a driver of adoption of digital tools. Use of these tools is still at roughly one quarter of physicians, but this is nearly doubled from 2016. Likelihood of adoption has increased significantly. © 2020 American Medical Association. All rights reserved. Use of all seven tools has increased. Increased efficiency and patient safety are key drivers. Tools need to be covered by standard malpractice insurance and data privacy concerns have increased. 4 • • Adoption of digital tools has grown significantly among all physicians regardless of gender, specialty or age. Awareness of most of the emerging technologies such as artificial or augmented intelligence is fairly high. Current adoption of these technologies is however very low. Intentions to adopt these emerging technologies is quite high and aggressive timelines are planned. Physicians’ motivations and requirements for adopting digital health Shifts from 2016 to 2019 7 © 2020 American Medical Association. All rights reserved. Advantage of digital health solutions to your ability to care for your patients There has been a small but significant increase in the advantage that physicians feel digital health solutions bring to their ability to care for their patients • • 31 The most notable increases are among PCPs with specialists moving slightly. Those that see no advantage are trending downwards and are concentrated in the age 50+ segment. 31 36 40 31 33 52 53 55 53 11 3 9 2 8 1 35 38 35 25 29 55 53 16 4 14 4 40 Definite Advantage 54 Some Advantage 51 13 11 3 2 Total Physicians 2016 2019 No Advantage or Disadvantage Some/Definite Disadvantage 56 11 3 46 11 3 PCPs 2016 2019 15 3 Specialists 2016 2019 Specialty Q16. Considering the overall impact, how much of an advantage do digital health solutions give to your ability to care for your patients?. Base: Total Physicians (n=1300), PCPs (n=650), Specialists (n=650), Age <40 (n=289), Age 41-50 (n=449), Age 51+ (n=562), Solo Practice (n=196), Group Practice (n=879), Other Practice (n=225), AMA Member (n=359), Non-Member (n=941) *Statistically significantly difference at 95% confidence interval 8 © 2020 American Medical Association. All rights reserved. <40 2016 2019 52 46 11 2 11 3 41-50 2016 2019 Physician Age 51+ 2016 2019 Use of Digital Health Tools in Practice Use of digital health tools has risen significantly Tele-visits have seen the greatest growth, doubling in use since 2016. % Currently Using 53 42 37 28 28 22 14 Tele-visits / virtual visits 12 16 Remote Remote monit. & Clinical decision monitoring for mgt for improved support efficiency care © 2020 American Medical Association. All rights reserved. 47 33 26 2016 2019 13 Q20. Which, if any, of these do you currently incorporate into your practice? Base: Total Physicians (n=1300) 9 58 Patient engagement Point of care/workflow enhancement Consumer access to clinical data Use of Digital Health Tools in Practice The average number of digital tools used has increased Older physicians and those less enthusiastic about technology (there is a lot of overlap) are catching up in their use. Average number of digital tools currently used 3 2.5 2.4 2.2 2.6 2.3 2.1 1.9 2 2.4 2.3 1.7 1.9 2.6 2.5 2.0 1.9 2.7 2.4 2.3 2.3 2.2 2.0 1.6 1.5 1.8 1.8 1.2 1 0.5 0 Total 28-40 41-50 51-65 Male Physician Age Q20. Which, if any, of these do you currently incorporate into your practice? Base: Total Physicians (n=1300) 10 © 2020 American Medical Association. All rights reserved. Female Gender 2016 <10 11 to 20 21+ Years in practice 2019 Skeptical Neutral Eager Tech enthusiasm Use of Digital Health Tools in Practice Use by solo practice physicians and partial owners has also increased These had been lagging behind other physicians in 2016 and are now closer to the average. Average Number of Tools Physicians Use 3.0 2.5 2.0 2.4 2.0 2.3 1.8 2.4 2.6 2.3 2.4 1.9 1.7 2.3 1.9 2.2 2.6 2.6 2.3 2.2 2.1 2.1 2.2 1.7 1.4 1.5 2.2 2.6 2.2 2.2 1.8 1.5 1.0 0.5 0.0 Empl. Full Part Ownership 11 © 2020 American Medical Association. All rights reserved. 28+ 9-27 4-8 Practice size 1-3 Med school/ Fac. Multi spec. Hosp. Single spec. Practice setting Solo PCP Specialist Practice type While all digital health tools have seen increases in adoption since 2016, remote care tools have seen the biggest moves forward Tele-visits/virtual visits and remote monitoring for improved patient care have seen a significant increase in use. 53 % Currently Using 42 37 28 28 22 14 Tele-visits / virtual visits 12 16 Remote Remote monit. & Clinical decision monitoring for mgt for improved support efficiency care © 2020 American Medical Association. All rights reserved. 47 33 26 2016 2019 13 Q20. Which, if any, of these do you currently incorporate into your practice? Base: Total Physicians (n=1300) 12 58 Patient engagement Point of care/workflow enhancement Consumer access to clinical data Remote care tools are also those with the highest likelihood of adoption within the next three years % Physicians Use or Plan to Use Total Use/ Adoption Plans 39 50 11 11 14 14 11 15 20 28 2016 2019 Tele-visits / virtual visits Will Adopt Beyond a Year Will Adopt Within a Year Already Using 13 47 12 48 48 14 15 32 18 16 53 9 14 17 31 17 20 13 22 2016 2019 2016 2019 Remote monitoring for efficiency Remote monitoring for improved care © 2020 American Medical Association. All rights reserved. 54 28 57 9 11 37 2016 2019 Clinical decision support 56 52 63 7 10 8 20 12 26 32 63 6 14 10 42 47 2016 2019 2016 2019 Patient Engagement Point of care / workflow enhancement 65 66 4 3 53 58 8 5 2016 2019 Consumer access to clinical data Providing remote care is also a driving force for adoption, and the only motivator that has seen upward movement in the past three years 5 = Very Important 26 31 28 27 27 26 22 23 25 22 21 21 Allows me to provide care to my patients remotely 2016 2019 Improves resource allocation for staff 2016 2019 Allows me to see more patients 2016 2019 Demonstrates awareness of the latest technologies 2016 2019 Provides a new stream of revenue 2016 2019 Differentiates my practice from others 2016 2019 Patients demand it 2016 2019 13 14 Q17. When thinking about incorporating digital health solutions into your practice, how important would each factor be? 14 © 2020 American Medical Association. All rights reserved. 4 = Somewhat Important 34 37 40 42 32 32 38 40 29 32 31 32 30 31 Base: Total Physicians (n=1300) 1-3 = Not Important 40 32 32 31 41 42 40 37 46 46 48 47 57 55 When asked what digital health tools they are most enthusiastic about, remote tools are the two that gained traction since 2016 % Physicians Top 2 Box Enthusiasm 42 45 46 50 45 45 45 53 49 50 44 42 41 36 2016 2019 Tele-visits Remote Remote monitor for monitor & mgt efficiency for improved care Clinical decision support Q22. Which, if any, of the solutions below are you enthusiastic about ? Base: Total Physicians (n=1300) 15 © 2020 American Medical Association. All rights reserved. Patient Point of care/ engagement workflow enhancement Consumer access to clinical data Multi-Specialty Groups are currently the heaviest users of remote digital health tools Other groups that showed relatively heavier usage of remote digital health tools are hospitals, physicians under 50, and PCP’s. Tele-Visits/Virtual Visits 24 29 20 25 24 31 28 30 40 & under Total 22 19 29 30 33 31 28 24 25 23 41-50 51+ Solo Prac Single Spec Grp Age Will Adopt Beyond a Year Will Adopt Within a Year Already Using 16 © 2020 American Medical Association. All rights reserved. Remote Monitoring for Improved Care 20 25 26 22 32 Multi- Spec Grp Practice Setting 33 Hospital 29 27 34 34 22 25 Total PCP Specialty 32 31 31 23 29 33 34 33 35 18 20 19 Specialist Solo Prac Single Spec Grp 33 30 Multi- Spec Grp Practice Setting 20 Hospital What attracts physicians to digital health Improved efficiency and increased patient safety remain the top motivators for physicians to use digital health tools Patient adherence, convenience, and helping address physician burnout have increased in importance as reasons for attraction. 5 = Very Important Improves efficiency 2016 2019 Increases safety 2016 2019 Improves diagnostic ability 2016 2019 Burnout 2016 2019 Patient Adherence 2016 2019 Convenience 2016 2019 Relationship 2016 2019 48 51 47 46 41 41 39 40 36 39 32 36 38 35 Q17. When thinking about incorporating digital health solutions into your practice, how important would each factor be? 17 © 2020 American Medical Association. All rights reserved. 4 = Somewhat Important 34 31 33 34 38 38 27 29 39 39 45 43 35 38 Base: Total Physicians (n=1300) 1-3 = Not Important 18 18 20 20 21 21 34 31 25 22 23 21 27 27 What attracts physicians to digital health (cont.) There has been a significant shift in the importance of remote care More say it is very important as a reason to be attracted to digital health and fewer think it is not important. 5 = Very Important 2019 Improves resource allocation for staff 2016 2019 Allows me to see more patients 2016 2019 Demonstrates awareness of the latest technologies 2016 2019 Provides a new stream of revenue 2016 2019 Differentiates my practice from others 2016 2019 Patients demand it 2016 2019 13 14 Q17. When thinking about incorporating digital health solutions into your practice, how important would each factor be? 18 © 2020 American Medical Association. All rights reserved. 4 = Somewhat Important 34 26 31 28 27 27 26 22 23 25 22 21 21 Allows me to provide care to my patients remotely 2016 37 40 42 32 32 38 40 29 32 31 32 30 31 Base: Total Physicians (n=1300) 1-3 = Not Important 40 32 32 31 41 42 40 37 46 46 48 47 57 55 What attracts physicians to digital health Two elements that attract physicians to digital health tools have shifted in importance “Allows me to provide care remotely” and “Helps reduce stress/burn-out” have moved into the quadrants for drivers, now closely hovering along the line between key motivators and secondary drivers. The movements are small but meaningful. Key Motivator Niche Need Increases patient safety Increases patient adherence Ranked 1st/2nd/3rd Allows me to provide care remotely Provides new stream of revenue Helps reduce stress, burn-out Allows me to see more patients 2019 2016 Patients demand it Low Priority Differentiates my practice © 2020 American Medical Association. All rights reserved. Increases patient convenience Improves patientphysician relationship Improves resource allocation for staff Demonstrates awareness of technologies Importance (T2B) 19 Improves work efficiency Improves diagnostic ability Secondary Driver Requirements for Adoption Requirements for adopting digital health tools have remained unchanged Integration with EHR and being as good as traditional care are the two key requirements. Key Requirement Niche Need Ranked 1st/2nd/3rd Well integrated with EHR As good as traditional care Can be reimbursed for time spent using Covered by standard malpractice ins. Requires no special training Safety/efficacy demonstrated in peer reviewed pub. It is the standard of care / Data security assured by Safety/efficacy validated by FDA * EHR vendor / Data Supported by privacy assured by own EHR vendor practice * Leaders recommend it Other physicians are using 2019 Secondary Driver Low Priority Importance (T2B) 20 © 2020 American Medical Association. All rights reserved. * Those marked with an asterisk indicate that those 2 requirements are hovering on the same exact coordinates Requirements for Adoption The importance of digital health tools being covered by standard malpractice insurance has increased significantly as a requirement 5 = Very Important Covered by my malpractice ins. 2016 52 2019 19 29 57 28 15 Data privacy/security assured by EHR vendor 2016 50 32 18 2019 50 31 19 48 Well integrated with EHR 2016 34 49 2019 2019 33 47 Data privacy assured by my practice/hosp. 2016 Reimbursed for time spent using 2016 33 50 2019 43 32 32 45 32 19 17 19 19 25 23 Supported by EHR vendor 2016 40 36 24 2019 41 35 24 Q18. How important are each of the attributes below in facilitating the adoption of digital health solutions into your practice? Base: Total Physicians (n=1300) 21 4 = Somewhat Important 1-3 = Not Important © 2020 American Medical Association. All rights reserved. Requirements for Adoption (cont.) Demonstration of safety and efficacy in peer reviewed publications has also increased in importance 5 = Very Important Is proven to be as good/superior to traditional care 2016 40 38 32 36 36 35 33 34 33 34 2019 Safety and efficacy demonstrated in peer reviewed pubs 2016 2019 Intuitive; requires no special training 2016 2019 It is the standard of care 2016 2019 Its safety and efficacy is validated by the FDA 2016 2019 The leaders within my practice/area of specialty recommend it 2016 2019 Other physicians I know are using it 2016 2019 18 18 14 13 37 42 39 41 38 39 39 38 36 38 37 39 30 33 Q18. How important are each of the attributes below in facilitating the adoption of digital health solutions into your practice? Base: Total Physicians (n=1300) 22 © 2020 American Medical Association. All rights reserved. 4 = Somewhat Important 1-3 = Not Important 23 20 29 23 26 26 28 28 31 28 45 43 56 54 Desire for Personal Involvement in Adoption of Digital Health Solutions in Practice The degree of responsibility that physicians desire to have in the adoption of digital health solutions in their practice has not changed Physicians want to be part of the decision-making process; owners expect to be responsible. 44 46 42 43 43 42 49 73 45 7 4 2016 47 6 4 2019 Total Physicians Responsible Consulted Informed Don’t Know 45 47 6 4 6 3 44 8 6 7 7 Specialists Specialty 32 57 54 10 5 8 6 48 72 46 2016 2019 2016 2019 PCPs 28 21 21 3 3 2 5 43 44 5 3 4 4 2016 2019 2016 2019 2016 2019 Sole Part Ownership Q40-1. Ideally, how involved would you want to be in the adoption of digital health solutions into your practice? Base: Total Physicians (n=1300), PCPs (n=650), Specialists (n=650), Solo owner (n=329), Part owner (n=319), Employee (n=652) 23 © 2020 American Medical Association. All rights reserved. Employee Combined Use and Plans to Use Digital Health Tools in Practice Current or planned future use of digital health tools is also slightly up; most growth is in tele-visits/virtual visits and remote monitoring for improved care % Physicians Use or Plan to Use Total Use/ Adoption Plans 39 47 50 48 48 53 54 57 56 52 63 7 11 11 15 11 20 14 28 14 2016 12 2019 Tele-visits / virtual visits 2016 Will Adopt Beyond a Year Will Adopt Within a Year Already Using 24 © 2020 American Medical Association. All rights reserved. 14 18 16 2019 Remote monitoring for efficiency 15 14 17 9 17 20 13 2016 22 2019 Remote monitoring for improved care 28 2016 9 11 37 2019 Clinical decision support 10 20 26 2016 8 14 63 6 10 65 66 4 8 3 5 53 58 12 32 2019 Patient Engagement 42 2016 47 2019 Point of care / workflow enhancement 2016 2019 Consumer access to clinical data Emerging Technologies 25 © 2020 American Medical Association. All rights reserved. Emerging Technologies Awareness of augmented intelligence technologies is high, though adoption remains in single digits for almost all tools % Physicians Familiar with and Using Advanced Technology 78 76 76 72 72 60 46 Familiar Using 11 6 4 1 0 Augmented Intelligence for health administration Augmented Intelligence for clinical applications Precision & Personalized Medicine Augmented Intelligence for business operations Augmented Intelligence for population health Augmented Intelligence for research and development Blockchain, and other similar data solutions Familiar 78 76 76 72 72 60 46 Using 11 6 4 7 4 1 0 Q39. When would you expect to start incorporating this into your own practice? 26 7 4 © 2020 American Medical Association. All rights reserved. Emerging Technologies Intentions to adopt augmented intelligence tools within the next three years are very high even if current use is low One-third of physicians plan to adopt most of these technologies within the next year. 74 % Physicians Adoption Timeline for Advanced Technology 74 70 69 68 27 31 w/in 2-3 Years w/in Year Using 31 43 30 30 36 37 11 6 36 7 21 33 4 35 25 22 4 Augmented Intelligence for health administration Augmented Intelligence for clinical applications Augmented Intelligence for business operations Precision & Personalized Medicine w/in 2-3 Years 27 31 27 31 30 30 21 w/in Year 36 37 36 33 35 25 22 Using 11 6 7 4 4 1 0 Q39. When would you expect to start incorporating this into your own practice? 27 27 56 © 2020 American Medical Association. All rights reserved. Augmented Augmented Blockchain, and Intelligence for Intelligence for other similar data research and population health solutions development Emerging Technologies Physicians are most interested in these emerging technologies to help them serve chronic care patients Markets % Physicians Want New Technology to Serve 44 47 45 43 40 37 34 37 31 28 19 13 10 7 Total 13 8 Male Female PCPs Millennial population Patients in low resource environments Aging population (85+) © 2020 American Medical Association. All rights reserved. 8 6 Chronic care patients Q40. What audience would you most desire new technology or solutions to better serve? 28 6 13 Specialists Appendix 29 Key Definitions in the Study 30 • Digital health encompasses a broad scope of tools that engage patients for clinical purposes; collect, organize, interpret and use clinical data; and manage outcomes and other measures of care quality. This includes, but is not limited to, digital solutions involving telemedicine and telehealth, mobile health (mHealth), wearables (e.g., Fitbit), remote monitoring, apps, and others. • Seven specific tools: Remote monitoring for efficiency Smart versions of common clinical devices such as thermometers, blood pressure cuffs, and scales that automatically record readings in the patient record so you do not have to type it Remote monitoring and management for improved care Apps and devices for use by chronic disease patients for daily measurement of vital signs such as weight, blood pressure, blood glucose, etc. Readings are visible to patients and transmitted to the physician's office. Alerts are generated as appropriate for missing or out of range readings Clinical decision support Modules used in conjunction with the EHR or apps that integrate with the EHR that highlight potentially significant changes in patient data (e.g., gain or loss of weight, change in blood chemistry) Patient engagement Solutions to promote patient wellness and active participation in their care for chronic diseases (e.g., adherence to treatment regimens) Tele-visits/ virtual visits An audio/video connection used to see patients remotely (i.e., simple acute illness, adjusting therapy, etc.) Point of care/ workflow enhancement Communication and sharing of electronic clinical data to consult with specialists, make referrals and/or transitions of care Consumer access to clinical data Secure access allowing patients to view clinical information such as routine lab results, receive appointment reminders and treatment prompts, and to ask for prescription refills, appointments and to speak with their physician © 2020 American Medical Association. All rights reserved. Remote Monitoring for Efficiency Smart versions of common clinical devices such as thermometers, blood pressure cuffs, and scales that automatically record readings in the patient record so you do not have to type it. Evaluation among Total Physicians Drivers among Physicians where Tool is Relevant, but Not Yet Used Current State Current Incorporation Most Attractive Elements Above average importance & ranking 16 12 46 45 Enthusiasm 65 61 67 59 Relevance (T2B) Familiarity (T2B) Base: Total Physicians (n=1359) 1. Improves work efficiency 2. Improves diagnostic ability 3. Increases patient safety 4. Increases patient adherence 5. Improves resource allocation for staff * New in 2019 Enthusiasm 52 52 39 41 48 44 Specialty PCP Specialist <40 50 46 42 Key Functional Requirements Above average importance & ranking 44 % Physicians Top 2 Box Enthusiasm Physician Age 41-50 51+ J E E Timeline of Adoption Among Enthusiastic 2019 2016 Already using 30 21 7 8 Immediately 15 13 Next 6 months © 2020 American Medical Association. All rights reserved. 17 29 24 Next year 31 Next 2-3 years 3 1. Well integrated with EHR 2. As good as traditional care 3. Covered by standard malpractice * New in 2019 4. Requires no special training 5. Can be reimbursed for time * New in 2019 3 Some other time Base: Total Physicians, Excited About Solution: Remote Monitoring for Efficiency (n=630) Remote Monitoring for Improved Care Apps and devices for use by chronic disease patients for daily measurement of vital signs such as weight, blood pressure, blood glucose, etc. Readings are visible to patients and transmitted to the physician's office. Alerts are generated as appropriate for missing or out of range readings. Evaluation among Total Physicians Drivers among Physicians where Current State Tool is Relevant, but Not Yet Used Current Incorporation 13 Most Attractive Elements Above average importance & ranking 22 50 45 Enthusiasm 66 61 72 63 Relevance (T2B) Familiarity (T2B) Base: Total Physicians (n=1359) Enthusiasm 55 52 38 44 53 42 Specialty PCP Specialist E <40 46 45 46 51+ 2016 Already using 34 24 3 6 Immediately 2. Increases patient adherence 3. Improves diagnostic ability 4. Improves work efficiency 5. Improves patient-doc relationship 6. Allows me to provide care remotely 1. Well integrated with EHR 2. As good as traditional care 3. Covered by standard malpractice * New in 2019 4. Requires no special training 5. Can be reimbursed for time * New in 2019 J E Timeline of Adoption Among Enthusiastic 2019 Increases patient safety Key Functional Requirements Above average importance & ranking 49 % Physicians Top 2 Box Enthusiasm Physician Age 41-50 1. 13 14 Next 6 months © 2020 American Medical Association. All rights reserved. 17 24 Next year Next 2-3 years 29 3 31 2 Some other time Base: Total Physicians, Excited About Solution: Remote Monitoring for Improved Care (n=674) Clinical Decision Support Modules used in conjunction with the EHR or apps that integrate with the EHR that highlight potentially significant changes in patient data (e.g., gain or loss of weight, change in blood chemistry). Evaluation among Total Physicians Drivers among Physicians where Tool is Relevant, but Not Yet Used Current State Current Incorporation 28 Most Attractive Elements Above average importance & ranking 37 45 45 Enthusiasm 69 67 73 67 Relevance (T2B) Familiarity (T2B) Base: Total Physicians (n=1359) 1. Increases patient safety 2. Improves work efficiency 3. Improves diagnostic ability 4. Increases patient adherence 5. Improves patient-doc relationship Enthusiasm 46 48 42 44 Specialty PCP Specialist 46 46 42 <40 46 43 Key Functional Requirements Above average importance & ranking 45 % Physicians Top 2 Box Enthusiasm Physician Age 41-50 51+ J E E Timeline of Adoption Among Enthusiastic 2019 2016 Already using 56 5 43 Immediately 6 Next 6 months © 2020 American Medical Association. All rights reserved. 11 Next year 10 10 21 Next 2-3 years 19 1 18 1 Some other time 1. As good as traditional care 2. Well integrated with EHR 3. Covered by standard malpractice 4. Requires no special training 5. Can be reimbursed for time * New in 2019 6. It is the standard of care * New in 2019 Base: Total Physicians, Excited About Solution: Clinical decision support (n=611) Patient Engagement Communication and sharing of electronic clinical data to consult with specialists, make referrals and/or transitions of care. Evaluation among Total Physicians Drivers among Physicians where Tool is Relevant, but Not Yet Used Current State Current Incorporation 26 Most Attractive Elements Above average importance & ranking 32 44 49 Enthusiasm 69 70 74 68 Relevance (T2B) Familiarity (T2B) Base: Total Physicians (n=1300) Enthusiasm 53 51 45 44 38 Specialty PCP Specialist E 51 45 38 49 <40 51+ J E Timeline of Adoption Among Enthusiastic 2019 2016 Already using 34 51 39 Immediately 5 6 Next 6 months © 2020 American Medical Association. All rights reserved. 12 Next year 8 15 23 Next 2-3 years 20 1 19 1 Some other time Increases patient adherence 2. Increases patient safety 3. Improves work efficiency 4. Improves patient-doc relationship 5. Improves diagnostic ability 6. Helps reduce stress, burn-out Key Functional Requirements Above average importance & ranking 49 % Physicians Top 2 Box Enthusiasm Physician Age 41-50 1. 1. Well integrated with EHR 2. Requires no special training 3. As good as traditional care 4. It is the standard of care 5. Can be reimbursed for time spent Base: Total Physicians, Excited About Solution: Point-of-care / Workflow Enhancement (n=694) Tele-Visits/Virtual Visits Communication and sharing of electronic clinical data to consult with specialists, make referrals and/or transitions of care. Evaluation among Total Physicians Drivers among Physicians where Tool is Relevant, but Not Yet Used Current State Current Incorporation 14 Most Attractive Elements Above average importance & ranking 28 40 36 Enthusiasm Relevance (T2B) 49 Familiarity (T2B) 57 65 77 1. Increases patient convenience 2. Improves work efficiency 3. Allows me to provide care remotely 4. Improves patient-doc relationship 5. Increases patient safety 6. Provides a new stream of revenue Base: Total Physicians (n=1300) Enthusiasm 44 34 37 38 43 38 Specialty PCP Specialist 39 41 31 % Physicians Top 2 Box Enthusiasm Physician Age 41-50 <40 Key Functional Requirements Above average importance & ranking 34 51+ J E E Timeline of Adoption Among Enthusiastic 2019 2016 Already using 35 45 29 Immediately 3 4 12 15 Next 6 months © 2020 American Medical Association. All rights reserved. 13 19 Next year 24 30 Next 2-3 years Some other time 2 1. Covered by standard malpractice 2. Can be reimbursed for time spent 3. Requires no special training 4. Well integrated with EHR 5. As good as traditional care 2 Base: Total Physicians, Excited About Solution: Point-of-care / Workflow Enhancement (n=694) Point-of-Care/Workflow Enhancement Communication and sharing of electronic clinical data to consult with specialists, make referrals and/or transitions of care. Evaluation among Total Physicians Drivers among Physicians where Tool is Relevant, but Not Yet Used Current State Current Incorporation Most Attractive Elements Above average importance & ranking 47 42 50 45 Enthusiasm Relevance (T2B) 1. Improves work efficiency 61 3. Improves diagnostic ability 77 59 Familiarity (T2B) 2. Increases patient safety 77 4. Improves patient-doc relationship 5. Increases patient convenience * New in 2019 Base: Total Physicians (n=1300) 6. Helps reduce stress, burn-out Enthusiasm 56 52 51 49 Specialty PCP Specialist 55 54 49 <40 46 Physician Age 41-50 Key Functional Requirements Above average importance & ranking 49 54 2. Increases patient safety 51+ 3. Improves diagnostic ability J E E 1. Improves work efficiency % Physicians Top 2 Box Enthusiasm 4. Improves patient-doc relationship Timeline of Adoption Among Enthusiastic 2019 69 7 8 10 1 5. Increases patient convenience * New in 2019 6. Helps reduce stress, burn-out 2016 Already using 4 60 Immediately 5 Next 6 months © 2020 American Medical Association. All rights reserved. Next year 7 Next 2-3 years 15 12 Some other time 1 Base: Total Physicians, Excited About Solution: Point-of-care / Workflow Enhancement (n=694) Consumer Access to Clinical Data Communication and sharing of electronic clinical data to consult with specialists, make referrals and/or transitions of care. Evaluation among Total Physicians Drivers among Physicians where Tool is Relevant, but Not Yet Used Current State Current Incorporation Most Attractive Elements Above average importance & ranking 58 53 40 42 Enthusiasm 71 72 Relevance (T2B) 87 86 Familiarity (T2B) Base: Total Physicians (n=1300) Enthusiasm 43 43 41 39 Specialty PCP Specialist E 41 41 36 41 Physician Age 41-50 <40 46 % Physicians Top 2 Box Enthusiasm 51+ Already using 79 37 2 72 Immediately 2. Increases patient convenience 3. Improves work efficiency 4. Improves patient-doc relationship 5. Increases patient adherence 6. Improves diagnostic ability *New in 2019 1. Data security assured by EHR vendor 2. Requires no special training 3. Well integrated with EHR 4. As good as traditional care J Timeline of Adoption Among Enthusiastic 2016 Increases patient safety Key Functional Requirements Above average importance & ranking 40 E 2019 1. Next 6 months © 2020 American Medical Association. All rights reserved. 3 Next year Next 2-3 years 5 4 4 10 Some other time 6 8 1 1 Base: Total Physicians, Excited About Solution: Point-of-care / Workflow Enhancement (n=694)