By Tom Gordon, senior vice president and chief information officer, Virtua.
Virtua’s first and foremost priority is providing quality patient care, and providing easy and fast patient access is one of the first steps in ensuring that quality. Automating patient access would give them the easy and fast solution they wanted, and would give us the solution we were looking for. We decided to move forward with an online appointment scheduling system, which took roughly ten weeks to implement and was an easy and seamless transition.
First, we rolled online patient scheduling out for our primary care physicians. After its immediate success with patients booking appointments online, we expanded this to other areas of our health system, starting with our urgent care centers.
When you think about how you, as a consumer, want to schedule a service or appointment, you want to book it quickly and easily. Today, the preferred way to book an appointment is online. You do not want to be restricted by the time of day you book, and you want the ability to book it in as few steps as possible.
We worked with DocASAP, the online appointment scheduling solution provider, to develop urgent care workflows that patients would need to schedule an immediate appointment.
We want to make sure that patient’s experience is as easy, quick and comfortable as possible. In our urgent care centers, patients have the ability to check in online which allows them to jump into the queue to see an urgent care provider. Moving forward, patients will have the ability to check wait times after they book an appointment from their phone so that they can come at the appropriate time to receive immediate care. While this functionality exists in many industries, it’s a rarity in healthcare. The more we evolve with technology, the better we can provide timely and quality care to our patients.
As a result, Virtua has experienced these results in the seven months since going live:
46 percent of bookings done via mobile allowing patients to book appointments with a digital medium of their choice.
44 percent of bookings are after-hours providing 24/7 access to patients at a time that is convenient for them.
48 percent of appointments are booked within same day or next day allowing for immediate appointments for urgent care.
Guest post by Andy Ridinger, director of client experience, MyHealthDirect.
Despite much of the uncertainty facing the future of the health care industry, the shift to value-based care is not going to go away. Regardless of what new laws may decide, organizations need care coordination tools now more than ever to be successful. Doctors and hospital officials continue to cite care coordination as a key advantage in accountable care models, which seek to more tightly integrate providers and maintain joint financial incentives that deliver better-quality and lower-cost services.
In the United States, more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Referrals are the crucial link between primary and specialty care. Yet despite this frequency, the referral process itself has been a great frustration for many years. The transformation to value-based healthcare is well underway with a shift away from the quantity of patients to the achievement of better health outcomes.
The current state of the specialty-referral process in the U.S. provides substantial opportunities for improvement, as there are breakdowns and inefficiencies throughout. These are inevitable when the process hinges on a patient following through on a slip of paper. It is no wonder that of the one third of patients that receive referrals, 20 percent never follow through to schedule a visit. Of the referrals that are completed, a host of other challenges often result. Sometimes it is just a disconnect of information between the two providers but can be an incorrect provider altogether. The final outcome is poor for everyone involved; patient, referrer, and target provider alike.
To improve the referral process and care coordination, here are four strategies to facilitate greater convenience in care coordination initiatives:
Make it digital
Just by enabling online booking, referral lead times (time between a PCP and specialist office visit) decrease by up to 36 percent, and show rates improve by 20 percent. Additionally, on the spot booking to a specialist reduces patient leakage for health systems. It can guarantee that care is rendered by the best-suited physicians within your preferred network.
Make it best-fit
The most effective appointment maximizes show rates and minimizes lead times. A provider must select the preferred physician with the earliest availability at a time the patient is likely to show up. Optimized scheduling can yield up to a five times increase in referral completion rates.
Make it measurable
The best way to improve referral completion rates and reduce lead times is to capture the relevant data points in a timely manner so that you can track changes over time. Presenting the data in an easily consumable and actionable format is equally critical.
Connect the docs
To know if patients complete visits, it is critical that all parties share the right information and facilitate two-way communication in real time. A primary care physician making a referral is far better equipped to manage a patient’s health if she receives show status and notes back from the specialist visit as soon as that information is entered into the specialist’s electronic health record.
Shifting from one electronic health record (EHR) system to another can be a highly disruptive and anxiety-filled process for a health system. Often, among the largest obstacles encountered is the need to migrate legacy EHR data between the old and new EHR systems. But a good understanding of this data migration process — and a strong technology vendor relationship — can help overcome this challenge and lead to a successful EHR transition.
There can be many reasons for a health system to transition between EHR systems. The original EHR system could be missing key features, or it might have reached its end-of-life, or perhaps it is not certified to meet evolving meaningful use requirements. The old EHR may not have kept up with new population management requirements on health systems, such as the need for more support for value-based care models. Whatever the reason, all health systems will want to find a solution that not only meets their projected operational and patient care needs, but which also minimizes disruption to the health system during the transition.
Conceptually, most EHRs capture the same types of information. However, when early (and still market-dominant) EHRs were first introduced, there were very few mature medical content standards, even for important categories of medical content, like diagnoses, lab results, medications and allergies. As a result, many of these early systems created their own proprietary terminology. When current standards (as incorporated into Unified Medical Language System – UMLS) began to coalesce, these early EHR systems typically struggled to migrate to the new terminology standards. Often this resulted in vast corpuses of legacy/non-standard historical patient chart data remaining in the EHR. Understanding and mapping this blend of standard and proprietary legacy data, for the purpose of coalescing each patient’s history into a new EHR, can be a tremendous challenge. Trying to fully automate this mapping process with a high level of accuracy and with larger patient volumes is a still greater challenge.
To give a specific example of this mapping problem, an older EHR may have a patient listed as having a “seafood allergy.” In meaningful use certified EHRs today, that “seafood allergy” description as such might not exist; that patient’s allergy entry would need to be accurately translated & codified into a new standardized term, perhaps referencing a either a specific shellfish allergy, or perhaps for any number of non-shellfish seafood allergies. Trying to faithfully automate terminology mapping decisions like this when there isn’t enough information to make an accurate determination can be nearly impossible. Yet not properly translating and mapping this allergy means the new EHR cannot properly use this information to trigger important patient safety system alerts (e.g., a drug-allergy interaction alert). Further, without accurate translation & coding, the new EHR will not be able to properly transfer this important part of a patient’s record to another healthcare system, like a patient portal, a clinical decision support service, an HIE, or another EHR.
In my experience, it is possible to identify three types of data migrations.
The first type of migration involves shifting to a newer version of the same product, perhaps running on a new technology platform. This type of data migration will typically allow the most comprehensive transfer of data with the least amount of disruption.
Another type of migration involves switching to a new EHR from another vendor, but with the aid of a cooperating & generally supportive EHR vendor. Although migration from one vendor’s EHR system to another’s is more complicated, if the original EHR’s vendor is willing to share information about their data structure and ontology with the new vendor, it will typically ensure access to a larger subset of key data elements are and more reliable data mapping. Look for established migration pathways, since EHR-to-EHR migration processes often improve each time they occur. This class of migration is often suggested by an older EHR vendor when they decide to sunset or end-of-life an EHR product.
Finally, the most difficult type of migration, involves a move to an EHR with very limited inter-vendor cooperation. This also happens to be the most common type of migration, especially when a health system chooses to migrate to an EHR vendor’s competitor’s EHR. The vendor of the current EMH system is often not willing to share more than the legally-required level of information, so the new vendor must rely on either a proprietary data extract or a batch of patient CCDA files (CCDA is an export format for patient summary data, which all EHR vendors must supply.). In either case, these patient data extracts will then need to be manually loaded, reviewed, and electronically (or manually!) reconciled for every patient chart.
Health systems planning this third type of migration should allot many additional months to work with the new vendor’s IT staff as they determine how to transform and load the old EHR’s patient data. Further, the health system must be aware that the transition will require a much higher investment of staff time for the data to be cleaned up and reconciled. This type of transition can take months or even years to complete.
If upgrading to a newer version of a current is not a viable option, a health system should follow these general guidelines for a successful transition to a new system:
Find an experienced vendor partner.
In addition to finding an EHR system that meets your health system’s operational/functional needs, try to find a vendor partner with experience migrating data from your current EHR vendor.
Focus on your staff workflows.
The new EHR will not do everything the same way as the old EHR. Your goal is to ensure new EHR vendor understands and supports the various workflows in your health system: billing, scheduling, pharmacist, physicians, etc. Ensure the new system can load enough data from your old system that the impact to your staff’s workflows will be tolerable.
Create an internal implementation team with a blended skill set.
The best EHR transitions occur in health systems that assemble an internal team with members representing all disciplines & workflows within the organization. This transition team will typically:
Guest post by Dean Wiech, managing director, Tools4ever.
Passwords are everywhere. Despite the endless headlines about their death and sure destruction in countless publications across the globe, passwords are and will continue to be used in nearly every business setting for the foreseeable future. Whether you’re a physician making the rounds in a hospital, a mechanic at a service garage, a CIO for a major software firm, a bank teller logging into several applications to assist customers or an employee at a manufacturer, chances are better than average that you access these systems with a user name and password.
Organizations of all sizes use credentials for their employees to ensure security of the information in their systems, and to protect against unwanted access to the data in the systems. As with any solution used, once in play there’s bound to be some issues incurred with these passwords. Regardless of how many passwords employees need to remember and how often they need assistance to reset them, passwords remain crucial ingredient to a network’s security protocols.
Passwords: Where We Have Come
The first passwords were created in the 1960s for MIT’s Compatible Time-Sharing System. Passwords were first used because several users needed to access the system as unique entities. Each user created a password, which were then stored on the computer system. However, program leaders soon learned that this method of storage did not work after one user who wanted more time on the computer simply printed out the passwords from the machine and logged in as a different user than himself – since each user was only granted so much time per week under their identity. Thus, program leaders discovered that program needed more secure methods for password usage and storage. This also was likely the first recorded data breach anywhere in the world.
The next phase led to encrypted passwords so that no one could easily go in to steal all of the users’ credentials, as was the case at MIT. Passwords began protecting secure information rather than just taking on a gatekeeper role. As they spread into business and workplaces worldwide, passwords became encryption devices that could not easily be hacked or pilfered.
Finally, millions of organizations began to rely on computers, obviously, for all of their business needs and users needed to enter credentials for each system they needed to access. To easily remember all of these passwords, users began to either user very simple passwords or the same password for each system. Again this became an issue since hackers utilized tools to easily compromise the password and gain access to the systems.
Where We Are Today
Welcome to today. As we know, organizations are overwhelmed by the issue of password breaches. Solution? To mitigate this problem, organizations often require employees to use complex passwords, each unique to the different systems they are using. To say the least, this process has evolved into a difficult mental exercise. According to a recent Tools4ever survey, end users access up to an average of 12 different systems and applications to perform their jobs. Humans are usually only capable of remembering about six complex passwords at the most. The rest get written down or filed on some random Excel sheet on the computer’s desktop. So what are they doing to remember all of their credentials?
Of course this defeats the purpose of the use of complex passwords for security, and often leads to frustration of users who take their anger out on the help desk, which is usually overwhelmed by such problems already. Think customer service is considered quality in these organizations? Usually not when these types of processes are in place.
The problems don’t end there. Employee productivity is cut when they must deal with these types of password maintenance issues. For example, every day in a typical healthcare setting, 91 minutes are wasted because of inefficient systems and workflows. On average, healthcare providers login to workstations and applications 70 times per day and spend an average of only 46 percent of their time on direct patient care.
Think of the great things your teams could do if they didn’t have to worry about logging in and out of workstations as they care for patients. While the data accessed may differ from department to department and facility to facility, what remains the same is the fact that, if multiple passwords and login credentials are in-play, there is a high probability that productivity is being negatively impacted. Providing direct access to systems and tools when and where it’s needed is key.
Password issues can also have a huge effect on your employee’s productivity. Think about how long it takes to resolve an issue when an employee is locked out of their account and needs to get a password reset? They need to contact the helpdesk, start a ticket, request that the helpdesk team resets the password, log in then get back to the work they need to accomplish. All of this is time that is taken away from the project they are working on, or the patient they are supposed to be helping. On the technical side, depending on the size of the organization, password management can require a full-time position at a large organization, since one of the top calls to the helpdesk is for password resets.
Another problem with passwords: all the steps, or “clicks,” and authentication processes some employees need to take just to access their applications. When time is critical, such as in hospitals, or when customer service is a priority, every minute counts and passwords can become a deterrent. If nothing else, they can be a time waster, as the 91 lost minutes suggests.
When these issues start to effect productivity of your employees is when it becomes an issue. So as the password and authentication process has evolved and become increasingly complex, how can organizations easily resolve the issues that have come about?
A new study from HIMSS, unveiled today at the 2017 HIMSS Conference & Exhibition, reinforces the positive impact health IT has on the U.S. economy while signaling challenges ahead for the expansion of health IT’s footprint.
Weaving together two historically seminal HIMSS research efforts (the annual HIMSS Leadership Survey and the biennial HIMSS Workforce Study), the new HIMSS Leadership and Workforce Survey report details the health IT priorities of key stakeholder groups and their linkages to various strategic initiatives (e.g. employment of select IT leaders) and economic measures (e.g. workforce projections). In an era of maturing EHR adoption, the study finds health IT leaders continue to report positive market growth metrics. Yet, health IT staffing structures and experiences in provider sites outside the hospital, coupled with their unique clinical IT priorities, point to a need to address the challenges faced by these types of providers in order to propel the sector’s growth.
“Health IT continues to be a bright spot in the U.S. economy,” said Lorren Pettit, vice president, health information systems and research for HIMSS. “Health IT workers continue to see strong demand for their skills, as employers across the provider and vendor/consultant spectrum embrace various health IT strategic initiatives. But the specific hurdles faced by some sectors suggest that the health IT field will need to creatively address its expansion outside the hospital walls.”
Key findings include:
Demand for health IT talent leaves employers struggling. The majority of health IT employers (61 percent of vendors/consultants and 43 percent of providers) have positions they are looking to fill. The findings suggest the demand for health IT workers is strong, as evidenced by the fact that only 32 percent of vendors / consultant organizations, and 38 percent of provider organizations, claim they are fully staffed.
The majority of health IT employers grew or at least maintained the size of their IT workforce over the past year. 61 percent of vendors/consultants and 42 percent of providers reported IT staffing increases, and the majority of respondents across both groups expect to further increase or hold steady over the next year.
IT budgets continue to rise. Although projections are not uniform between the two groups, the majority of providers (56 percent) and vendors/consultants (87 percent) project increases in their IT budgets this year.
A significant disconnect exists between providers and vendors/consultants on certain select clinical IT priorities – notably electronic health records (EHRs). Vendors/consultants seem to be “moving on” to other issues, whereas providers appear to be wrestling with how to best leverage their existing EHR investments.
However, the stakeholder groups are generally aligned on the biggest priorities facing those leveraging clinical IT, including privacy/security, care coordination, culture of care and population health.
The 2017 Leadership and Workforce Survey reflects the responses of 368 U.S. health IT leaders between late November 2016 and early January 2017. Download the complete report.
Guest post by Abhinav Shashank, CEO & Co-founder, Innovaccer.
Whatever we do in the healthcare space, it is eventually meant for the greater good of patients, which is why today the aim of modern healthcare is shifting towards value-based reimbursement and with that the process is getting modified accordingly. Gradually, patient-centric care is becoming prevalent. The current standards require enhanced patient experience, and that comes with improved quality, coordinated care at a reduced cost.
CMS when releasing the fact sheet for Hospital Value-Based Purchasing Program for the year 2016, said in a statement, “We now pay hospitals for inpatient acute care services based on the quality of care, not just the quantity of services provided.” Backing this statement was the fact that out of the four quality domains, patient experience of care bore 25 percent of the weight. This led to hospitals working earnestly towards enhancing the patient experience and utilizing the massive potential to qualify for the bonus and improve on current standards.
Why does Patient Experience Matter?
Patient experience is an essential component of the IHI Triple Aim, a schema for elevating the standards of providers’ performance:
Improving the patient experience of care.
Improving population health.
Reducing the per capita cost of healthcare.
Fortunately, health systems know that patient satisfaction isn’t just a tool for a performance bonus. Improving patient satisfaction is a way to identify gaps in care delivery and develop quality services. Also, according to a survey conducted by a health system found that out of 1,019 adults interviewed, 85 percent were dissatisfied with at least one aspect of their providers. Creating a patient-centric industry where experience and satisfaction of patients are overlooked is almost impossible!
Improving Patient Experience
A lot of researches have established that improving patient experience directly results in higher quality of care. Healthcare systems have realized the importance of the Triple Aim, and here’s how they can start working in this order on improving one of the fundamental aspects:
Patient Engagement a Priority
Patient engagement has been one of the most talked-about aspects of healthcare and unquestionably a way to improve the care experience. What we need to ensure is that the patient is willing to participate in the decision-making and the provider advocating this intervention. Even though healthcare providers are making efforts to improve patient engagement at their end, a survey revealed that only 34 percent of the patients are highly encouraged. Some effective methods patients found useful are:
59 percent of the surveyed people found increased physician-patient time vital.
54 percent of the patients favored being part of the decision-making.
36 percent promoted the growth of patient access to services.
Using Data Analytics
Data analytics have proven their worth in healthcare, and we have only scratched the surface of the immense sea of possibilities that can be realized using data analytics. When it comes to advancing patient experience, data analytics can be used in several ways:
Gathering data and creating actionable follow-up plans for patients.
Leveraging data analytics for accurate analysis of patients and reducing readmission rate.
Data analysis can zero in on inefficiencies and medical errors and help reduce avoidable expenses.
In the current era, it is important to understand the role technology plays in different industrial sectors. The different verticals of the medical industry have adopted technology and identified the benefits associated to it. Healthcare and other medical services can be easily accessed with the help of a smart phone. It has become more convenient to track, regulate, and monitor several medical cycles such as medicine intake, therapy, and treatment. The communication gap between the patients and doctors has reduced over the years owing to advancements in technology. Progressive Markets recently added a market report that offers useful insights related to the global telemedicine market such as market share, size, and growth. The digitalization in medical field is set to facilitate enhanced healthcare and medical services in the coming years.
Technology has revolutionized several industries worldwide over the last two decades. The onset of innovative and modern technological advancements have made a notable difference in the medical field and has made telemedicine a game-changing way to serve people throughout the world. The adoption of telemedicine has increased significantly in the last decade although there are a few concerns regarding its reliability and precision. Approximately more than 70 percent urgent illness conditions can be taken care of with the help of telemedicine according to the American Telemedicine Association. A simple physician training enables providers to diagnose and treat minor problems such as pharyngitis, sinusitis and upper respiratory illnesses with the help of video chat.
General awareness related to telemedicine technology is growing
Telemedicine technology has not flourished largely yet as it is still in the nascent stage. However, as awareness related to the telemedicine is growing, the adoption rates are set to grow. The benefits associated to telemedicine are gradually making a mark in the medical industry. Telemedicine has largely helped to save time. With the help of telemedicine, a patient does not have to travel to the provider and save time.
Further, telemedicine eliminates any chances of transmitting infectious diseases from a patient to the health care professional. Telemedicine saves time and offers time-efficient solutions. However, there are additional benefits associated to it. It reduces costs significantly. The most important aspect of telemedicine is its ability to cater to the needs of the patients from any place at any given time. This is highly beneficial for occupational medicine. Telemedicine helps to formulate an efficient and reliable healthcare plan.
Benefits of telemedicine
Telemedicine is making its mark worldwide and it is important to realize that the technological advancement does not eliminate visits to traditional doctors. There are a few medical conditions that cannot be diagnosed without the presence of the patient. However, with data such as medical history of the patient, visual exam and an interview with the patient along with the providers training of pattern recognition, it is convenient to treat patients without them being physically present in the room.
Schumpeter considered it the “essential fact about capitalism,” that things have to fall apart so better things can take their place. The familiar is violently displaced by the unfamiliar, but superior, alternative.
Buggy whip makers are sent out of business as car makers take over the transportation space. Typists go extinct as word processing becomes cheap and ubiquitous. Blockbuster goes bankrupt, so Netflix and all its streaming peers can take over the space. The notion that the New can mean bad news for the Old is nothing unique to our modern era, though perhaps the speed and distribution of change thanks to globalization and digital technology means we see this more and more.
Well, 2017 may well be the beginning of the end for primary care as we once knew it.
The “Who’s on First” of Healthcare
As with any other example of creative destruction, the signs in primary care have been there for anyone to read, though perhaps the conclusion they point to hasn’t been quite as clear as the contributing forces.
Nursing, as a profession, has been on a long arc over the last century or so, transforming patient care as well as clinical organization and even leadership. Nurses have evolved from subordinates to doctors to, in some cases, replacements–notably, in primary care clinics, especially critical access hospitals or in areas where patients might not otherwise get to see a doctor outside of an emergency room.
Primary care provider shortages aren’t strictly limited to rural or remote areas. Thanks to demographic trends, more people are living longer and managing more chronic conditions. Keeping this swell of aging patients from charging into Emergency Departments en masse was part of the logic behind elements of the Affordable Care Act shifting resources to clinics run by NPs as opposed to MDs. While nurses face a shortage of their own, they have still been tagged as a key element of preserving and expanding access to primary care. In 2007, the shift in nursing toward a more central leadership role was codified by the Association of Colleges of Nursing with its designation of the Clinical Nurse Leader as a new official role for nursing professionals.
Simply put, consistent access to primary care supports prevention strategies, which are altogether cheaper and more effective than sending everyone through an ED or into a long-term care clinic. While many–notably, the American Academy of Family Physicians and the American Medical Association–muckrake over this disruption of scope of practice, the change is one of necessity. Nurses today provide critical care, and lead diverse clinical and professional teams to coordinate whole-person health.
With or without the Affordable Care Act, the shortage in primary care will persist. Expanded access through insurance only exacerbated the underlying issue. As Millennials enter middle ages and Boomers carry on retiring and living longer than ever, primary care will be stretched. Whatever comes out of the Trump administration or the ongoing scope of practice debates, primary care requires providers, and nurses are showing up to work.
Guest post Ken Perez, vice president of healthcare policy, Omnicell.
During the 2016 presidential campaign, Democratic candidate Hillary Clinton reiterated the longstanding Democratic pledge to allow Medicare to negotiate drug prices and demand higher rebates for prescription drugs. In response, and aware of the general public’s mounting concern about rising prescription drug prices, Donald Trump shifted to the left and repeatedly called for Medicare to directly negotiate drug prices. For example, at an MSNBC town hall on Feb. 17, 2016, Trump said, “If we negotiated the price of drugs, Joe, we’d save $300 billion a year.”
However, none of Trump’s three most substantive policy statements issued in the fall of 2016—including the healthcare section of the Trump-Pence Campaign website, his “Contract with the American Voter,” and his healthcare plan issued two days after the election—mentioned the challenge of rising drug prices or the idea of Medicare negotiating drug prices with pharmaceutical companies.
On Jan. 31, 2017, President Trump met with a group of pharmaceutical industry executives, including the CEOs of Amgen, Celgene, Eli Lilly, Johnson & Johnson, Merck, and Novartis, as well as Stephen Ubl, head of the Pharmaceutical Research and Manufacturers of America (PhRMA).
While during the meeting Trump called drug prices “astronomical” and said, “We have to get prices down for a lot of reasons … for Medicare and Medicaid,” he stopped short of the aforementioned negotiation of drug prices by the federal government. Trump pressed the pharmaceutical companies to bring drug manufacturing and production back to the United States. In return, Trump pledged to work to reduce corporate taxes, support deregulation, and streamline the FDA to expedite drug approvals. One can interpret those broad statements as a draft outline of the deal with pharma that will be struck by the Trump administration.
Where would such a deal leave the drug pricing issue? While Trump clearly expressed concern about high drug prices, the drug makers can offer him something else that he may want even more: jobs for U.S. workers that come from boosting production at existing plants and opening new plants on U.S. soil. Imagine the photo ops!
The Center of Medicaid and Medicare Service (CMS) continues to increase emphasis on care collaboration, ranging from Chronic Care Management (CCM) to the recent announcement from the US Surgeon General’s landmark report on alcohol, drug and health. Derived from many aspects in healthcare, the authors’ examine the challenges of integrating physical and behavioral healthcare, addressing the Care Collaboration Model outlined by CMS and the Surgeon General.
The author’s, beginning with the interdependency between physical and behavioral health, bring case scenarios supporting the challenges of today’s healthcare, and then introduce an innovative Health Collaborative Ecosystem addressing the many challenges of a care collaboration model.
Interdependency Between Mental and Other Chronic Disorders
Research has demonstrated bidirectional links between mental disorders and chronic conditions. Depression and anxiety are heightening the risks towards hypertension and diabetes. Depression roughly doubles the risk for a new coronary heart disease (CHD) event. We can go further on other mental disorders such as PTSD, drug addiction and alcoholism. Such interdependencies have limited solutions today due to the lack of a collaborative environment. We refer to this as a ‘revolving door care environment’, a vicious cycle compounding the effects of chronic and mental disorders.
A detox center can only retain the patient for detoxification for a limited time. Without collaborating with other behavioral services, the patient will inevitably return to the same habit – either drug addiction or alcoholism. Depression can stem from a social environment or from a recently developed chronic condition such as CHD.
The primary care provider will continue to address the chronic condition without the knowledge of what may actually feed into the patient’s chronic condition. It is yet another ‘revolving door’ for the physical care environment. Such interdependency requires a care collaborative environment between care providers.
Care Collaborative Model and Bidirectional Information Flow
A team-based care collaborative model uses a multidiscipline group of care providers supporting and implementing treatment with the patient at the center. A bidirectional information flow is an absolute must to put the model into realization and operation in healthcare institutes.
Today, healthcare lacks the support of a closed-loop system, one that emphasizes a bi-directional flow of information. Healthcare is muddled with reactive care, instead of preventive, anticipated care. It is that lack of prevention and anticipation that have an adverse impact on the overall healthcare cost and patient outcomes. EHR and EMR systems are the main ‘anchors’ of today’s health IT.
However, there are two EHR components that are non-starters: the boundary of the health institute and unidirectional systems. HIEs (Health Information Exchange) address EHR limitations with their capability to provide support across health institutes, but actually worsen the unidirectional character of the EHR. Neither EHR or HIE can address the requirements for a care collaborative model.
Reaching The State of Homeostasis As A Desired Patient Outcome
The objective is to improve patient outcomes, but how do you define a patient’s outcome?
Homeostasis is a biological term, referring to the stability, balance, or equilibrium within the body. Homeostasis is the process of maintaining a constant internal environment by providing the body with what is needed to survive for the well being of the whole. While disorders (physical or mental) reflect the abnormal condition of the body, homeostasis is the normal, stable and well-being state.
Each disorder is well documented with what would be a normal condition or the state of homeostasis. This state of homeostasis also deviates based on race, demographics, and above all, the relationship with other existing disorders afflicting the patient. It is then noted that each patient outcome requires a personalized state of homeostasis.
From the disorder, the process towards the state of homeostasis consists of genetics, nutrition, physical activity, mental health and an external environment. Genetics is the internal influencer in with medicine’s physical care plays a role in adjusting the disorder toward homeostasis. For healthcare, it is the care plan for a disorder.
The state of homeostasis should be used as the measure of a patient’s outcome, resulting from the care collaborative model addressing the integrated, coordinated care from multiple care providers.
Health Collaborative Ecosystem
The Health Collaborative Ecosystem is the delivery process that supports the care collaborative model, with the objective of bringing the patient to the state of homeostasis. This system would include all providers of health-related services to the chronically ill patient diagnosed with one or more of the designated chronic and debilitating diagnosis that utilize the most significant percentage of health care spending. Such a system would be:
Capable of integrating physical and mental care environments.
An integrated layer complementing (including EHR-agnostic) existing health IT infrastructures, supporting care activities beyond the brick and mortal walls of their facility or clinic.
Consensus among providers to standards of care and bidirectional information flow that encourages innovation, compliance with regulations, secures privacy and adopts a continuous process of improvements to better reach a patient’s state of homeostasis.
Why an Ecosystem?
An Ecosystem is a collective system, including a health IT solution and consulting guidance, and support, for hospital operations in order to maximize the benefits of care collaboration, through efficiency and scalability of a care providers’ bandwidth.
It is an Ecosystem because it must include an auditable compliance component to provide crucial measurements and enforce quality guidelines for the model according to hospital and clinic management.
It is an Ecosystem because it must include the ability to track and monitor progress towards the state of homeostasis for all attributes contributing the patient’s overall well being.
As noted in one case study, Maria Viera, age 75, takes a dozen medications to treat her diabetes, high blood pressure, mild congestive heart failure, and arthritis. After she begins to have trouble remembering to take her pills, she and her husband visit her primary care physician to discuss this and a list of other worrisome developments, including hip and knee pain, dizziness, low blood sugar, and a recent fall. Maria’s primary care doctor spends as much time with her as he dares, knowing that every extra minute will put him further behind schedule. Yet despite his efforts, there is not enough time to address her myriad ailments. She sees several specialists, but no one talks to all her providers about her care, which means she may now be dealing with conflicting recommendations for treatment, or medications that could interact harmfully. As a result, Maria is at high risk for avoidable complications and potentially preventable emergency department visits and hospital stays.
The care team for the above patient would potentially consists of: a primary care provider (high blood pressure and care coordinator), a cardiologist (congestion heart failure), an endocrinologist (diabetes), dietician (diabetes), a rheumatologist (arthritis), physical and/or occupational therapists (arthritis, falls, hip and knee pain), and a psychologist or a psychiatrist (depression).
The above case brings challenges to the health care system on multiple fronts:
More time from primary care providers with limited result outcomes due to the lack of collaboration with other care providers, specialists and community services.
Potential conflicting recommendations for treatment due to the lack of coordination and bidirectional medical information flows from multiple care providers and specialists.
The patient’s risk for complications, emergency visits and hospital stays significantly increases.
As conditions worsen, the patient develops symptoms for behavioral health conditions.
Today’s solution for the above scenario is based on care management. The care manager would work with all care providers, manually “pulling and pushing” the patient’s medical conditions and updates to all involved care providers. Error prone, high cost, and low efficiency are some of today’s deficiencies for healthcare attempts in implementing the care collaborative model, outlined by CMS.
Net New Revenue Focusing on Preventive Care
This is the challenge of a ‘revolving door care environment’ in addressing the need for integration between physical and behavioral health services. The Health Collaborative Ecosystem is the answer for such a challenge.
However, to support such a revolution, healthcare, as an industry, needs to have the financial incentives. As stated in the introduction of this paper, CMS is not encouraging a transformation through financial incentives.
The authors’ propose a roadmap to roll out the Health Collaborative Ecosystem without upfront risks and budget planning, but to generate new revenue for the institutes. The implementation roadmap leverages these CMS initiatives:
Annual wellness visits
Chronic care management
Integration of physical and behavioral health through the care collaboration model
With the Health Collaborative Ecosystem’s objective is to create a patient state of homeostasis, rural and community hospitals and clinics can accomplish multiple goals – better services to the community, better defined patient outcomes and open new avenues for health services with behavioral health and filling the revenue gap.