Disrupting care coordination: Turning patient-generated health data into a call to action


Leaders within the health IT space are continuously innovating to bring care outside of a hospital's walls and into patients' homes. Many questions remain unanswered, however, including how to relieve physician administrative burden related to EHRs and how to implement the necessary IT infrastructure for data sharing. Despite the many challenges at play, stakeholders across the care continuum are striving to answer these questions to elevate patient care.

In a webinar sponsored by Nokia Technologies and hosted by Becker's Hospital Review, John Halamka, MD, CIO of Boston-based Beth Israel Deaconess Medical Center, a 651-bed teaching hospital, and Alexis Normand, director of healthcare business for Nokia Technologies, weighed in on the many factors driving progress in the health IT space and how effectively leveraging patient-generated health data will transform care delivery.

Challenges and trends in the high-tech era of healthcare
"No other industry has moved so fast as healthcare in the high-tech era," Dr. Halamka said. In 2016, The Office of the National Coordinator for Health Information Technology found 96 percent of hospitals had a federally tested and certified EHR meeting CMS'  Medicare and Medicaid EHR Incentive Program. This figure is up from 71.9 percent in 2011.

"Healthcare moved a little faster than culture would allow," Dr. Halamka said. Integrating IT systems into daily workflows can take both time and energy. Other challenges with using data effectively include creating user-friendly patient portals, improving EHR interoperability and a steady decrease in innovation by EHR vendors due to government mandates.

Despite the many challenges impeding seamless data sharing, various trends are taking hold to eliminate challenges clinicians face in optimizing EHRs and other technological platforms. For example, Dr. Halamka predicted third parties will come into the mix and improve existing EHRs by adding unique functionalities. Dr. Halamka added this collaboration between EHR vendors and third parties will be the "real centerpiece of innovation."

IoT in 2017 and beyond
Many CIOs and other health systems executives are interested in IoT devices due to their potential for overcoming connectivity issues and sharing crucial information. Beth Israel Deaconess Medical Center recently implemented an application, BIDMC @ home, targeted for its congestive heart failure patients. The hospital employed middleware applications by connecting EHRs to smartphones to facilitate communication between patients and their care team. When patients open BIDMC @ home on their mobile devices, the app will show patients their care plan for that day, including medication dosages and recommended foods. The app's success in improving outcomes is contingent on a patient's willingness to engage in their care, as they are charged with inputting both objective and subjective data into BIDMC @ home. The application then shares that information with the EHR and BIDMC @ home will analyze the variances in data to see if an intervention is necessary. If the app deems an intervention is needed, it will provide patients a number to call to seek additional care, which may include sending a visiting nurse to the patient's home. BIDMC @ home also contains embedded links displaying the raw data that triggered that alert.

"Patient-generated healthcare data shows [a care team] what variance occurred. Unless you implement programs that incorporate some kind of subjective and objective patient data into care management, it will be hard to survive the transition to value-based purchasing," Dr. Halamka said.  

Patient care teams within Beth Israel Deaconess Medical Center prioritize patient education. Providers will show patients graphs generated from BIDMC @ home, which will give them a better picture of how they are doing in adhering to their care plan.

"It is not just about showing the data," said Dr. Halamka. "It is about interpreting that data to provide wisdom [leading to] a call to action."

How data is changing care delivery
To drive optimal patient outcomes and change care delivery, the industry needs to prioritize "social" precision medicine, including allowing patients to readily communicate with their care team over a secure platform. Precision medicine encompasses a social element, which entails identifying how patients and providers prefer to interact with technology; baby boomers may prefer a phone call while a 24-old patient opts for a text message.

Dr. Halamka shared his wife's personal experience with hyperthyroidism to illustrate this point. After continually experiencing an elevated heart rate of 110 beats per minute throughout the day and losing a notable amount of weight, Dr. Halamka's wife contacted her physician over a secure texting platform to say she may have a thyroid issue. The physician ordered tests at a lab in close proximity to her and she received lab results minutes after they were completed, indicating escalated triiodothyronine and thyroxine levels. Her physician used an app to locate a reputable endocrinologist nearby, who prescribed her medication that alleviated the symptoms within two weeks. A process that previously could extend months or beyond happened in a few days through collaboration and the use of a secure communication platform.

"[The industry should] knit together all the devices in a home with primary care providers, labs, pharmacists, specialists and others at almost no-cost in a system that pays [clinicians] for high-quality outcomes," Dr. Halamka said.

The power of predictive medicine — Creating care plans of the future
Innovators within the healthcare sector are devising ways to use data to change healthcare delivery to a model focused on prevention. Preventive medicine is not only key to improving Americans' health, but it also fulfills another vital purpose: slashing healthcare costs. Simply put, healthcare costs are spiraling out of control, with healthcare accounting for 17.8 percent of Gross Domestic Product in 2015 for a total of $3.2 trillion dollars. Healthcare costs accumulate in the traditional healthcare system because it is designed to treat people after they're already ill.

"In a sense, medicine is always too late," Mr. Normand said. "You always to go to a doctor when you [are] already sick. There are a lot of cases where if you have data beforehand, you can prevent undesirable health events through intervention."

Nokia Technologies is working on solutions allowing patient data to disrupt the way care is coordinated, with the overall goal of driving early interventions. The company is targeting consumers with technology they already use, including watches and other wearables. New solutions hitting the market allow everyone to be an active participant in their health. With patients becoming more involved in their care and technology rapidly evolving to meet consumer demand, Mr. Normand predicted care delivery will look vastly different in the coming years.

"Digital health will take place less in a hospital setting," he said. "It will happen everywhere. It will be less visible, but it will be more pervasive."

To view the webinar recording, click here.

To view the webinar slides, click here.

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