By Rick Halton, vice president of marketing and product, Lumeon.
For the past decade, EHR investments have been touted as the key to unlocking a transformative, cost-effective, and efficient healthcare industry. A recent study found that spending on EHR systems will continue to dominate healthcare’s technology spend in 2019. But if budgets continue to be prioritized towards optimizing EHR systems, why are there still so many issues related to delivering coordinated care? EHR vendors often do not clearly explain that new issues can arise after implementation, and even make certain processes more complex.
Despite significant investment of EHR systems over the years, care processes continue to be inconsistent and labor intensive. Not only does this result in overwhelming operational costs for hospitals, but it also leads to massive variance in outcomes.
EHR investments are important, but they aren’t a silver bullet. EHRs can only go so far towards improving care outcomes and operations, as they do not address the true problem: disjointed care process issues. Hospitals must consider the broader context that EHRs play into, including investing in greater orchestration and automation of patient care.
By directing investments toward automated digital care plans that are supported by EHRs, hospitals can more effectively connect patients along their entire care journey, and only engage the care team when necessary. Just as the airline industry found success with their equivalent, the “flight plan,” the healthcare industry must provide its own “care traffic control” to deliver coordinated care. This approach is increasingly recognized as care pathway management (CPM).
Opting for “care traffic control?”
The airline industry has successfully crafted and fine-tuned the entire digital trip experience for passengers, which the healthcare industry can utilize in its own way. For example, airline passengers can find out real-time flight status, receive automated updates about seat availability, find information on airports, and be sent data on flight delays.
Both boarding and takeoff are efficient and seamless procedures, with airlines connecting preflight checklists to central airline and airport IT systems. This gives flight crews current policies, procedures, and alerts, while traffic control systems coordinate which planes can take off at which times.
This same approach can effectively be used in healthcare. Automated protocols throughout the care plan can help providers pull relevant information from all necessary care teams and orchestrate operational processes in the background. Tasks can be completed in an efficient and timely manner, with managed expectations creating a seamless care pathway.
With a “care traffic control” approach, care teams manage by exception. Care plans are digitized, automated, and orchestrated across teams and settings, letting care teams be efficiently tasked at the right time and at the right place. Additionally, care teams can capitalize on virtual patient engagement techniques and will intervene only when manual engagement is needed.
Guest post by Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Telemedicine is about reaching out to patients in remote locations, but limited to videoconferencing between patients and health providers. It is similar to a face-to-face service with the exception that the patient and primary care provider are not physically together. Such efficiency is limited in term of scope and only addresses the geographical challenge and scarcity of physician availability, a far cry from what CMS wanted for its Chronic Care Management Services (CMS), which would fundamentally change telemedicine as it is practiced.
CCM services bring the telemedicine definition to the next level – a quiet continuous monitoring and collaboration from all care services to the patient, given the ability to anticipate and engage in care issues. Such ability not only curbs care costs, it would also increase care provider bandwidth, giving them the ability to cover more patients with better efficiency. The challenge is not on the requirements part of CCM services, but the lack of an IT solution to really address all CMS guidelines, including its intent to enforce the concepts through the healthcare industry.
The New England Journal of Medicine has covered the major challenges from the new CCM guidelines, touching on all the major shortcomings in today healthcare IT offerings. Healthcare providers recognized that the fee-for-service system, which restricts payments for primary care to office-based visits, is poorly designed to support the core activities of primary care, which involve substantial time outside office visits for tasks such as care coordination, patient communication, medication refills, and care provided electronically or by telephone.
The time has come for a paradigm shift to re-engineer how we deliver care and manage our patients. To arrive at a new plateau requires rethinking the needs of our patients and how to meet these needs in an already resource constrained, proprietary, inoperable systems. Unless we develop solutions that both integrate with and enhance the technologies currently available and those yet to be realized, we will not realize a return on health IT investment. That has now changed since one Healthcare 2.0 innovator has been able to connect the CMS guideline dots.
Huge Market Opportunity
According to the 2010 Census, the number of people older than 65 years was 40 million with increasing trends to 56 million in 2020 and not reaching a plateau until 2050 at 83.7 million. With two-thirds of Medicare beneficiaries having two or more chronic conditions while one-third has more than three chronic conditions according to CMS data, putting the number of patients who qualify for CCM services at 15 million. This number is predicted to continue on an upward trend until 2050.
The World Health Organization (WHO) recognized the growing burden this trend in chronic disease places on the healthcare system and addressed the need for innovative solutions in their 2002 report. While the potential market is huge, in the billions of dollars yearly, healthcare organizations have been struggled to address the CMS guidelines with key requirements from CMS. We can no longer afford not to address the needs of patient with chronic medical conditions along with engaging them in their healthcare decisions.
The CMS guidelines are as follows:
24×7 access to clinical staff
Patient care continuum
Collaboration, coordination between primary care providers and other care services
Electronic management of care transition among care providers
Coordination between home and community care services
Here is how these guidelines are now being addressed: