The price of care is rising, incidence of chronic disease is going up and reimbursement models seem to be in perpetual flux. Amid these trends, hospitals and health systems are facing shrinking margins and mounting pressure to improve care quality while controlling costs.
This content is sponsored by Microsoft.
Spending on healthcare is increasing around the world. According to projections published in The Lancet in 2016, international healthcare spending is poised to increase to $18.28 trillion, up from $7.83 trillion in 2013. In the U.S., annual healthcare spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department and dental care increased from $1.2 trillion in 1996 to $2.1 trillion in 2013, according to a comprehensive analysis published in JAMA in 2017. The authors of the analysis suggested the rise in national healthcare spend was largely attributable to increases in the price and intensity of healthcare services. However, the nation's aging population and increases in the prevalence of certain diseases were also associated with increased costs.
Chronic diseases are expensive to treat and are affecting more and more Americans. The rising rate of diabetes is particularly troubling. From 1958 to 2015, the percentage of Americans with diabetes increased steadily. More than 100 million U.S. adults were living with either diabetes or prediabetes in 2015, according to CDC estimates.
However, the burden of chronic disease is not exclusive to developed nations like the U.S. Developing nations face high levels of mortality as a result of chronic diseases, such as respiratory illness. By 2020, chronic diseases are projected to account for nearly three-quarters of all deaths around the world, according to the World Health Organization.
As the incidence of chronic diseases rises around the globe, so does the pressure on healthcare providers to move the needle on population health.
The growing number of patients with chronic illness places a considerable burden on the healthcare system. Healthcare needs a paradigm shift that makes good on the promise of value-based care without overburdening clinicians. Some might characterize such a shift as unrealistic or burdensome. But the truth is the solutions needed to support value-based care and physician workflow are already used by healthcare teams, just not as part of a collective strategy.
With the rise of precision medicine and improved data sharing, clinicians equipped with the right technology and empowered by a comprehensive mission for personalized medicine can deliver care that is tailored to the individual, thereby improving outcomes and the overall health of patient populations.
Actionable information: The new data paradigm
Data collection is a crucial part of providers' work. Information on a patient's demographics and medical history is helpful in selecting the proper course of treatment. The transition from paper to digital records suggested a move toward convenience for providers, but the initial rollout of EHRs generated limited actionable data and left clinicians mired in burdensome administrative tasks.
Several studies suggest a link between the implementation of EHRs and the escalation of a nationwide epidemic of physician burnout. One such study published in Mayo Clinic Proceedings in 2016 found physicians who used EHRs experienced higher rates of burnout than those that didn't. The study was based on a survey of more 6,000 physicians.
While other research has suggested the link between EHRs and burnout was overhyped, there is little doubt that data silos, which have persisted in healthcare for years and were an aspect of early EHR applications, make it more difficult for clinicians to access the right information at the right time to inform clinical decisions.
Fortunately, hospitals are no longer beholden to data silos of the past due to the rise of cloud computing and predictive analytics. With a cloud solution in place, hospitals can access what is essentially infinite computing power. This enhanced capability allows for the storage of bulk data in a single location, and self-service analytics tools powered by cloud computing deliver care alerts to clinicians based on actionable data in real time. Additionally, the continuous analysis of bulk data can reveal hidden patterns or trends among patient populations. The recognition of such patterns allows providers to identify patients at risk for chronic illness, fine-tune personalized care plans and intervene before the at-risk patient experiences a crisis health event.
In short, clinical analytics can strengthen preventive care and help keep patients with chronic illness out of the hospital.
"When we tell health organizations that we can predict five years ahead of time whose congestive heart failure will progress and how rapidly, they have trouble conceptualizing that," said T. Greg McKelvey Jr., MD, head of clinical insights at the Seattle-based software company KenSci. "The hospital should really be a place of last resort. … Part of the reason the healthcare system is so broken is that we are obsessed with heroic last-minute care. We ignore year-over-year, boring, unsexy things that actually preclude the need for heroics."
In addition to informing preventive care for patients with chronic conditions, analytics platforms enable providers to augment patient data with information available in the public domain, such as community health data, social demographics and trends in communicable disease, among many other types of information that carry implications for individual health.
Analytics platforms that incorporate patient's genomic data can help facilitate early treatment interventions. In 2012, the National Human Genome Research Institute, part of the National Institutes of Health, defined genomic medicine as "an emerging medical discipline that involves using genomic information about an individual as part of their clinical care (e.g., for diagnostic or therapeutic decision-making) and the health outcomes and policy implications of that clinical use."
Genomics have already shown promise in several areas of medicine, including oncology, pharmacology and the treatment of infectious disease. As more healthcare organizations incorporate genomics into patient profiles, the field is poised to have a significant influence on the way medicine intersects with population health management. Providers with easy access to comprehensive, actionable patient data can take a more cost-effective approach to care that is likely to yield better outcomes.
Genomics and the rise of precision medicine
Precision medicine is an essential piece of personalized care — some may even see the two terms as synonymous. However, precision medicine specifically refers to the medical treatment of patients, whereas the term personalized care represents an overarching philosophy for patient care.
In the U.S., the NIH-backed Precision Medicine Initiative defines precision medicine as "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person." While precision medicine is a relatively new term, it has existed in aspects of healthcare practice for years. One obvious example would be blood transfusions: A patient in need of a transfusion is not given blood from an arbitrarily selected donor, but rather a donor with the same blood type. This staple medical practice suggests it is possible for healthcare delivery to naturally evolve toward more precise, personalized care.
A patient's genomic profile is a powerful resource for providers. Previously, treatments have been assigned to patients based on what worked best on average among the population as a whole. With genomic information, a provider can tailor a treatment to what works best for individuals with similar genomic profiles. However, for such therapies to be successful it's not enough for providers to collect genomic profiles; they also have to be able to understand the genomic information, which requires widespread collaboration and massive computer power.
Clinicians and researchers working with genomic data may find the volume of information exceeds their organization's in-house computing resources. In a 2015 paper published in PLOS Biology, researchers wrote "as much as 2 [to] 40 exabytes of storage capacity will be needed by 2025 just for the human genomes."
This is where cloud computing comes in. Cloud technology serves as a democratizing force for precision medicine and genomic data sharing, filling in what only a supercomputer could do before. The further commercialization of cloud services will allow healthcare organizations big and small to leverage genomics in the pursuit of better care.
At Baltimore-based Johns Hopkins Medicine, scientists and physicians are relying on cloud computing and machine learning technology to analyze data on patients treated for prostate cancer, multiple sclerosis, pancreatic cancer, cardiac arrhythmias and amyotrophic lateral sclerosis (ALS), among other conditions. The research will help improve treatments, diagnoses and prevention efforts.
"Precision medicine focuses on using revolutionary tools in measurement, computation and connectivity to reimagine and reinvent medicine," said Antony Rosen, MD, director of rheumatology and vice-dean of research at Johns Hopkins Medicine. "This really is a moment when the tools are going to allow humans to reclassify disease based on subgroups and totally change the face of disease."
Improved care coordination and provider collaboration
Over the last 10 years, care delivery has experienced dramatic changes. Medicine looks fundamentally different than it did generations ago. Long gone are the days of house calls. Patients now rely on multiple providers for their care, meaning communication and collaboration among clinicians is now an essential component of care delivery. These changes have occurred simultaneously with the increased specialization of medicine. For patients to truly receive the best care possible, multidisciplinary teams must work together to coordinate care across the continuum.
To facilitate effective collaboration, healthcare organizations must find a way to make care coordination as seamless as possible for clinicians. Providers who spend more time mulling over the details of care coordination are at increased risk for burnout. According to a study published in the Journal of Internal Medicine in January 2018, researchers determined "spending more than 8 [hours] per week coordinating care was significantly associated with a 0.21-point increase in reported provider stress compared to spending 8 [hours] or less per week."
Technology platforms that allow disparate teams to coordinate care across sites can break down information silos and greatly streamline care coordination. These platforms provide clinicians with quick and easy access to comprehensive patient data, such as information on physical activity and nutritional habits, which inform the coordination of personalized care plans. Also, having the right patient monitoring solutions in place can activate patients in their care and greatly ease the burden of care coordination.
Elements of effective care monitoring include:
- Personalized patient health data
- A "next best action" digital prompt for every care team member that interacts with a patient
- A mobile-accessible patient portal
- Provider alerts based on care gaps
- Workflows furthered by event triggers, such as the recent availability of test results
Additionally, providers should not treat technology platforms as passive, record-keeping instruments in care delivery, but as tools that facilitate information-sharing and teamwork. Teams of providers should be able to look at the same data and communicate insights about the same patient — all in one place. These solutions bolster a culture of support and collaboration, and ultimately allow for the continual improvement and personalization of care through the open sharing of best practices. For a comprehensive approach to personalized care to be truly successful, providers need to be supported. Streamlining care coordination can help unburden clinicians, allowing them to better serve patients.
The real-life benefits of digital patient engagement
Just as providers need to be supported, patients need to be activated. For personalized care plans to succeed, health systems must prioritize digital patient engagement.
Patient engagement is more than just a healthcare buzzword, it's a means of improving outcomes and thereby reducing costs, especially among chronic disease patients. In a comprehensive analysis of previous research published in the journal Health Affairs in 2013, researchers found engaged chronically ill patients were "more likely than those with lower levels [of engagement] to adhere to treatment; perform regular self-monitoring at home; and obtain regular chronic care, such as foot exams for diabetes."
When looking for a patient engagement solution, it's important for healthcare organizations to find technology that allows for the continuous engagement of patients and encourages them to actively collaborate in their own care.
Girish Shirali, MBBS, a pediatric cardiologist at Children's Mercy Hospital in Kansas City, Mo., has witnessed the benefits of digital patient engagement firsthand. His hospital used patient engagement technology to improve care for infants born with hypoplastic left heart syndrome, a form of single ventricle heart disease. These infants often require multistage surgical interventions and, on average, 20 percent of infants die before the second surgery can be performed. At Mercy, parents would be sent home with three-ring binders, in which they would record vital signs. The parents would return to the hospital once a week with these binders for clinician review.
"If the team is doing weekly evaluations on Monday, then maybe a baby's chance of surviving is better if something happens on Sunday versus Tuesday, which is a really sad issue in the care paradigm," Dr. Shirali said.
Dr. Shirali decided to implement a digital approach to the at home care of these patients in hopes of improving outcomes. Dr. Shirali collaborated with a software architect to create a Cardiac High Acuity Monitoring Program, which allowed the infants' vital signs to be documented digitally from home.
CHAMP was implemented at Mercy in 2014. Over the course of the following three years, all 70 of the hospital's single ventricle heart disease patients survived the interstage period between surgeries.
A call to action for personalized care
The current challenges facing the global health system — rising costs and increasing incidence of chronic disease — require improving the overall health of patients. Prioritizing patient engagement and care coordination while empowering providers with actionable analytics and genomic data can help achieve the aspirations of the quadruple aim: improve both the patient and provider experience, improve the health of populations, and lower the overall cost of care. Microsoft healthcare technology solutions were designed with these aims in mind. These solutions are built to help healthcare organization evolve toward a more personalized approach to care.
Personalized care is not simply the application of precision medicine in tandem with a dash of patient engagement. Personalized care is a comprehensive approach to medicine, executed with the help of emerging medical science and technology and underpinned with a value-based ethos. Many providers today already embrace different aspects of personalized care disparately, but how many providers simultaneously prioritize genomics, clinical analytics and leading-edge patient engagement solutions?
It's time healthcare got a little more personal.