Change is hard. Those vested in the status quo have a lot to lose from progress. However, healthcare change is upon us. Value-based healthcare isn’t going away; providers and hospitals need solutions in order to survive.
In part 1 of this series, I outlined some reasons for the imperatives. In part 2, I discussed some of the required cultural changes to succeed under the ACA. In this, the final installment, technology enablers are discussed.
I have been accused of being a geek. In my youth, I played more chess than football, and I’m old enough to know what a computer punch card is. I also realize most people would rather go to the dentist than hear about healthcare IT, but I’d like to offer a simplified model I’ve found useful.
Every opportunity for enabling value-based care falls into one of four basic categories: data, data exchange, patient self-report, and collaboration.
Data garners most of the attention from both hospitals and patients. Data includes the electronic health record (EHR); dashboards; wearables and monitors like FitBit and the soon-to-be-released Apple watch; personalized medicine/DNA, etc. And yes, we need data moving forward. Without data, there is no “value-based reporting” related to outcomes.
However, there are several things worth noting. First, data management is still early in its evolution. Most people—doctors and patients alike—grow frustrated when adapting to new technology. Some, for example, would like to pitch the EHR. It distracts from the process of care and makes doctors into librarians, curating information rather than caring for patients. Second, we haven’t figured out how to truly personalize data yet, to understand which treatment plans work for which patients. When we do, expect big gains in outcomes. Third, federal data reporting requirements may be the death of private practice. Reporting issues are growing and exceeding the ability to keep up for most small physician groups. Expect a move away from self-employed physicians and smaller practices (with limited record keeping) to bigger providers and in-house physicians, all due to data.
Data Exchange (Coopetition in Healthcare)
Have you ever arrived at a doctor’s appointment only to find that they don’t have your recent records (lab, X-Ray, etc.)? You are asked to reschedule your visit, or worse, your doctor reorders the test you just had. Until recently, there were no real penalties for such wasteful behavior. However, within the ACA, doctors are incentivized to do less, not more.
To date hospitals have made only half-hearted attempts at data exchange, a form of collaboration with hospital competitors (a form of coopetition). However, with new federal mandates requiring that patient information be made available to patients, expect to see a boom in this area.
Patient Self-Report & Personal Health Records
Like every other human being, doctors convince themselves their decisions are right. However, for far too long the only voice defining “value” has been the doctor’s, with little or no regard for the patient’s perspective.
The best example may be treatment for prostate cancer. With surgery, a patient might live a few more years, but those years may be spent impotent and incontinent. End of life care is another visible example. Patients can be kept alive but to what end? For chronic conditions, I’ve often wondered whether doctors, when prescribing the seventh or eighth drug for a patient, are treating themselves, (and assuaging their “worry” about being right), or the patient, who is either going to obsess over the drug regimen or not follow it as directed.
This is where the patient self-report comes in, currently in the form of the Personal Health Record (PHR). The PHR, owned by the patient and extending across healthcare systems, addresses the deficiencies in the EHR, which leaves no place for patients’ input, no room for data from home, and in particular, no space to collect information related to subjective issues such as depression, all of which clearly influence our overall wellness. The PHR adds a critical voice to the decision-making—the patient’s.
I spend the majority of my time thinking about how to improve collaboration. Today, expensive tests and transfers, often ordered by less-experienced providers, are offered as treatment. However, by getting the right person involved at the right time, the reassurance that comes with collaboration can often replace the fear and anxiety patients and their families feel when sick. However, healthcare collaboration remains limited by reliance on 1970’s technologies (fax, phone and pager) rather than the more typical tools of modern business (text, voice, and video).
Happily, things are moving forward on this front. Recent experience with virtual clinics and video home visits for the chronically ill is beginning to have an impact. Legislative changes are slowly happening at state and federals levels. Value-based care with shared risk should also catalyze change.
Granted, this is just the beginning. In addition to efficiency, there needs to be improved documentation of collaboration if we hope to hold our most expensive healthcare assets—the providers—accountable, while effecting a reduction in medical legal risk. But collaborative technology will clearly provide solutions here as well.
Change is here. In the Wonderland that is our current healthcare climate, we look to the roadmap of technology to help us navigate the tangle of options. We will rely on it even more with the bigger changes to come as the current largely hospital based care gives way to more community-based, care team approaches.