Tuesday, June 4, 2013

Addressing the Empty Seat at the Healthcare IT Table: Next Steps in Patient Engagement

Written by Fauzia Khan, MD, FCAP, CMO and Co-founder, Alere Analytics | June 04, 2013

The healthcare industry has made great strides in patient-centric, IT solutions such as electronic health records, personal health records, health information exchanges  and clinical decision support platforms. These platforms are finally enabling physicians, providers and payors to improve their care coordination, while increasing the quality of care for patients. While this is definitely an exciting time for healthcare IT, a very important group is conspicuously left out of the conversation — actual patients.

As we move toward value-based healthcare, there is a tremendous opportunity to engage patients in their own health. Meaningful use stage 2 and 3 has made patient engagement an industry buzzword and a checkbox to cross off, but active patient engagement could be a real game-changer. With real-time solutions such as CDS and mobile patient devices, as well as patients being engaged earlier in their own treatments, physicians would be able to provide personalized and immediate care recommendations, triggering earlier interventions, reducing avoidable errors, improving overall health outcomes and even lowering costs.

Despite all the potential benefits, we are still in the very early stages of empowering patients. The healthcare industry has made great strides in processing, accessing and reporting on patient data. But hospitals are struggling to overcome hurdles as they inch towards volume-to-value shift that requires  adopting data-based, outcomes-driven approach. Additionally, the challenge of interoperability is ever-present in today’s healthcare delivery system, often hindering the comprehensive capture and management of patient data and adding a difficult semantic layer to conveying disparate information in a simple and relevant manner.

So what's next for healthcare and increasing the role of the patient? The following are key areas to address to create a healthcare system that truly engages patients in their care process.

The role of connectivity

Although the healthcare industry has made significant strides in making sure that patient data can be captured, accessed and reported on in a timely manner, we still have a ways to go. Technology innovations have created a wealth of patient-centric solutions, but many of these innovations are struggling with how best to capture patient data and build a longitudinal care record needed to make the most informed, evidence-based decisions in real-time, and at the point of care and beyond. Once we have figured out the connectivity piece as an industry, clinicians will be able to focus on the best treatment plans using intelligent and actionable information to improve care quality while reducing costs for each patient. 

Utilizing  standards

In an effort to make data more actionable, CDS breaks down data into open formats and industry standards. These standards can specify the structure and semantics of "clinical documents," whether delivered through the EHR, PHR, HIE, or even device data, for the purpose of improved exchange between providers and their patients.

By using industry standards, data can not only be extracted easily from any format, but since the data is bi-directional, the information can also be pushed to any source, including the patient. For example through a rules-based system, the data can be redirected to any point, enabling doctors to engage with their patients and patient populations, both from a preventative and referential manner. This ability can assist clinicians manage their high-risk patient populations with chronic conditions such as diabetes, heart disease, COPD and many others.

Inviting patients to drive development

Despite all the attention paid to improving efficiencies around care, patients are continuously left out of the conversation when it comes to their own health. With ubiquitous use of mobile devices and more people opting for home healthcare, many patients want to take a more active role in managing their own health, so why not invite them into the conversation? As technology companies work to develop cutting-edge, patient-centric solutions, it will become increasingly more important to actually involve the patient in the process of developing their individualized treatment plan.

Increasing role of the "connected home"

Connecting hospital systems has been an IT priority, and during the last decade, a good amount of resources were focused on inpatient, outpatient, and ambulatory data integration and interoperability. Although we have just barely embraced this model in the clinical world, we can look beyond the hospital setting to see that these technology platforms could also be effectively used in the home as more telehealth options emerge each day for patients. Moving treatment closer to the individual closes crucial gaps, provides greater visibility, and accelerates decisions that lead to better outcomes. And with the surge of mobile technologies, internet and smart devices, the boundaries between the home, hospital, ambulatory and long-term care facilities will start to erode away and ultimately disappear.  

In addition to data interoperability, there needs to be an emphasis on information availability. Whether that data is delivered through an HIE, EHR or a smart device, patient data needs to be accurately captured and widely available. In the same way that CDS technologies facilitate decisions in the hospital setting, data in the home should also be actionable, comprehensive and increasingly accessible to patients, physicians and payors alike. This approach will allow for the best healthcare decisions to be made by both patients and providers, ultimately leading to better health outcomes. 

With new regulations pushing the healthcare industry forward to ensure better patient management and care, it’s clear that CDS will be influential to changing the way care is currently delivered in the hospital and beyond. The vision is clear: identify efficiencies, while maintaining high clinical quality to ensure delivery of the right care, at the right place and time. However, the execution seems to be elusive, and most hospitals do not know where to even start. 

As healthcare innovation continues, we must remember that the key is to deliver high-quality, collaborative patient care. This requires collecting, analyzing and sharing information, working across silos and engaging patients in an unprecedented and innovative manner. Likewise, it is our responsibility as technology providers to develop solutions that work together to enable transparency, collaboration and information-sharing. Like many shifts in healthcare, changes won’t occur overnight. It will take time. However, by making efforts today to move treatment closer to the individual, and involving patients in the development of technologies enabling this shift, we as an industry can accelerate decisions that can lead to better outcomes.

Fauzia Khan, MD, currently serves as chief medical officer of Alere Analytics, formerly DiagnosisOne, where she provides direction and leadership to develop practical and scalable technologies that allow clinical decision support and analytic capabilities to be seamlessly incorporated into clinical workflows. She has expertise and passion for algorithm design, knowledge acquisition and engineering as well as data mining and leveraging these capabilities to improve outcomes. Prior to forming DiagnosisOne, Dr. Khan was the director of informatics at UMass Memorial Medical Center with ten years of experience in the hospital practicing pathology. She is the author, editor and primary visionary of the “Guide to Diagnostic Medicine” (Lippincott Williams & Wilkins, 2002).

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