Está en la página 1de 13

BECKERS

HOSPITAL REVIEW

In Pursuit of Collaborative Medicine:


The Power and Promise of Digital Health
Executive Summary

Digital technologies have promised to offer physicians faster and more


meaningful ways of interacting with their colleagues and patients.
Yet while they were designed to enhance organization and increase
efficiency, some technology systems have actually diminished physician
efficiency and added substantial costs to providers. These drawbacks
are compounded by a general lack of interoperability between different
tools and systems.

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 2


However, emerging digital technologies that enhance communication
and mitigate challenges in physicians daily workflow have the poten-
tial to substantially improve their overall job satisfaction and enable
them to spend more time on what they do best helping patients.

Today, almost everything and everyone is connected through the


cloud. Digital health technologies that access the cloud, such as re-
mote monitoring devices and web-based forums, enable users to se-
curely exchange text messages, images and health data from a range
of smart devices. Providers can take pictures on their smartphones
and share images through the cloud to get a second opinion from a
radiologist halfway across the world. Home-bound patients can better
comply with their care plans by using tablets, laptops or computers to
video-chat their therapists, health counselors and nurse practitioners.

Technology is driving new avenues of communication, which support


the transformation of fee-for-service healthcare into collaborative
medicine. Successful care management is contingent upon teamwork
and shared decision-making between physicians, caregivers and pa-
tients. This rings especially true for high-need, high-cost patients who
achieve better outcomes when their social, mental and clinical needs
are met. Digital health technologies that streamline communication,
like interactive decision aids, mobile apps and web-based resources,
are changing how physicians and patients talk about health manage-
ment both inside and outside the exam room.

This ebook examines how todays digital technology enhances physi-


cians day-to-day lives and mitigates problems in care coordination. It
addresses providers anxieties surrounding the growing adoption of
digital health and key opportunities for improving overall quality and
efficiency, including reduced clerical burden, interoperability, more
targeted interventions, enhanced patient-physician relationships and
lower readmission rates.

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 3


I. Combating Digital Snake Oil of the 21st
Century

C
onsumers and providers are generally optimistic about digital healths potential to
improve physician-patient interactions and enhance the delivery of high-quality
care. However, there is an equal amount of clinical skepticism related to digital
health, especially given the challenges of some direct-to-consumer health devices that
have lead uninformed consumers to pursue unnecessary care. Recognizing the physician
perspective in the design, implementation and evaluation of new technologies is key to
realizing digital healths full potential.

Some providers have good reason to be skeptical of digital health technology. James
Madara, MD, CEO of the American Medical Association, aptly described the anxieties
surrounding digital transformation in healthcare in his remarks to the House of Delegates
in 2016.

Today, we have really remarkable tools robotic surgery, new forms of radiation
treatment, targeted biologics, Dr. Madara said. But appearing in disguise among these
positive products are other digital so-called advancements that ... actually impede care,
confuse patients and waste our time. To Dr. Madara, ineffective apps and misleading
products are the digital snake oil of the early 21st century.

The mention of snake oil refers to a popular product sold for its medicinal qualities,
which are unsubstantiated by scientific evidence. And as pointed out by Dr. Madara,
consumers are not the only targets of todays digital snake oil. Many early digital health
technologies sold to hospital buyers, though aimed at improving care, werent designed
around physicians unique workflow or professional needs and unintentionally created
additional barriers to efficiency and care coordination, core competencies healthcare
organizations require for success under value-based reimbursement models.

For instance, poor interoperability between different EHRs has challenged providers
ability to share patient information in real-time between outpatient, inpatient and
ancillary caregivers. Manual or time-intensive workarounds increases the chance
information will be lost or wont arrive in a timely manner.

Physicians are optimistic about digital technologies


Despite many physicians frustrations around some health IT, physicians are largely
motivated to adopt digital health tools they believe will improve current clinical
practices. Physicians indicated digital technologies that could improve work efficiency

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 4


(82 percent), increase patient safety (80 percent) and improve their diagnostic ability
(79 percent) were most appealing, according to a 2016 AMA study. Younger and female
physicians in particular said they also look for tools to help reduce burnout (66 percent),
improve the patient-physician relationship (73 percent) and increase patient adherence
(75 percent).

For physicians to adopt digital tools into their daily practice, physicians said technology
must meet four essential criteria, according to the same AMA survey: The tools should be
covered by standard malpractice insurance (81 percent), the vendors must ensure data
privacy is protected (82 percent), it should integrate seamlessly with EHRs (81 percent)
and data privacy should be assured by the purchasing hospital system (81 percent).

Digital health continues to play a greater role in the practice medicine, regardless of a
physicians age, gender or specialty. Understanding physicians concerns and satisfying
their user preferences is integral to achieving the potential of digital health to improve
physicians professional lives through reduced administrative burden, improved
professional and patient-physician relationships and more effective clinical care.

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 5


II. Enhancing Patient-Physician Relationships

T
echnology and market conditions have transformed the traditional patient-
physician dynamic into one of patient-centered care. The patient today plays an
active role in managing his or her health alongside medical professionals. Digital
health technologies that teach health literacy help chronic-needs patients feel better
prepared and more confident in their decision making about treatment options and self
care, and contribute to a positive patient experience.

Promoting shared decision-making


Good communication is the cornerstone of consumers making sound, informed
decisions about their health. In fact, meaningful physician-patient communication is
associated with improved patient satisfaction, improved rates of adherence and better
health outcomes among patients with chronic disease, according to a 2017 study in
American Journal of Medical Quality.

Striking the right balance of compassion, rationality and trust is difficult for some
physicians, especially when it comes to discussing complicated or sensitive topics.
Patient-physician communication in the exam room is ripe for misunderstanding due
to time constraints, medical jargon and emotions. Studies show up to 80 percent of the
medical information patients receive during an office visit is forgotten immediately, and
half of the information patients do takeaway is incorrect.

Some providers are reinforcing conversations by adopting digital, interactive decision


aids to enrich patients understanding of and engagement with their health.

Decision aids are informational tools meant to help individuals understand their medical
conditions, treatment options and associated risks by presenting complex information
in an easily digestible format. These tools can walk patients through different treatment
options, translate complicated medical statistics into simple language and visual aids,
and give patients access to their health information. Once limited to print pamphlets
and brochures, decision aids now include web-based resources and interactive apps
and videos patients can view on their smartphones or tablets in the convenience of their
own home.

For shared decision making, providers and patients must work together to balance
clinicians expertise with patients preferences and values. Patients can be overwhelmed
by massive amounts of [health] data they now have access to, says Jamie Roots,
Healthcare Cloud Solution Architect at Microsoft. The easer it is for them to understand,
the more personalized the information, the more likely they will use it.

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 6


For instance, studies have shown patients better understand risk when it is presented
visually rather than numerically. A medical school in Michigan developed a web-
based application that allows providers to create graphics that represent patients risk
information. Their research found patients felt more confident making decisions about
multiple treatment options when risk was represented using columns with separate yes/
no icons, The Wall Street Journal reported.

Other digital decision tools are designed for physicians and patients to use side-by-side.
Digital visual aides in the exam room, for instance, can support physicians dialogue
about potential side effects of treatment options. Touch-enabled screens that feature
detailed anatomical renderings of organs, body systems and medical conditions help
physicians visually explain how a certain treatment works by rotating the organs up,
down, right or left and adding or removing layers of tissue, muscle and bone to reveal
whats underneath.

Studies have shown shared decision making can lead to better health outcomes, fewer
invasive procedures and lower costs. Patients who were encouraged to review decision
aids had 5.3 percent lower medical costs, 12.5 percent fewer hospital admissions and
were less likely to choose invasive elective surgeries compared to their peers who didnt
use aids, according to a 2013 study in Health Affairs.

Digital tools that allow caregivers to spend more time with the patient and communicating
about treatment options can improve both provider and patient satisfaction. Because
of its ability to connect remote users in real time, digital technology is also used by
healthcare organizations like accountable care organizations to keep caregivers informed
of changes in a patients health status and provide timely interventions.

The silent enabler of the latest digital


revolution in health is the cloud. There is a raft
of more visible technologies disrupting health,
but almost all of them are using the scale,
availability, performance and importantly
security of the cloud.

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 7


III. Closing Communication Gaps: Digital
Technologies in Team-Based Care
Digital health technologies that promote efficient communication and collaboration
among physicians, nurses and other caregivers are crucial for coordinating and
delivering medical care. The importance of seamless, real-time communication cannot
be overstated, especially given the increasingly mobile nature of todays clinicians and
the evolution of the ACO model, which holds all participating healthcare organizations
equally accountable for resource utilization, outcomes and costs. Integrated healthcare
organizations and ACOs have seen value in partnering with technology developers to
leverage cloud-based platforms to achieve interoperability.

ACOs are groups of physicians and caregivers who jointly assume responsibility for the
quality and cost of healthcare for a defined population. ACOs can include governmental
and commercial payers and a range of provider organizations, from clinically integrated
health systems to multispecialty group practices.

Much of the effort and expense of the past decade has been directed toward increasing
the sophistication of hospital information systems, says Simon Kos, MD, CMO of
Worldwide Health at Microsoft. Dr. Kos is responsible for providing clinical guidance,
thought leadership, vision and strategy for Microsoft technologies and solutions
in healthcare. What this has led to, unfortunately, are deep silos of patient records
between care providers and no effective way of coordinating them.

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 8


Interoperability is a chief concern among ACOs because it is the first step to building a
comprehensive, holistic view of a populations health. A single EHR from an independent
physicians office represents just one portion of a patients medical history. Patients are
likely to see dozens of primary care providers throughout their lifetime in addition to
multiple providers for behavioral health, specialists and nurse practitioners. It is highly
unlikely a single care setting or EHR possesses a patients entire medical history, let
alone the complete medical histories for an entire community. This is especially true for
patients with complex or chronic disease who regularly receive care in multiple settings
to manage their health.

Overcoming barriers to communication with cloud technology


To support the team-based care that determines an ACOs success, some providers
deploy cloud-based technology to overcome barriers to data sharing. A cloud-based
platform is designed to support the aggregation, integration and harmonization of
data. It can collect and translate data from multiple systems and devices, then make the
information available in different formats.

Some cloud technologies unite information streams from diverse sources fitness
trackers, mobile nutrition apps and remote monitoring devices, for example into
a single, secure, shared thread that patients and care teams access and update in
real time. Shared information platforms like this engage an array of caregivers whose
contributions can give the acting physician insight into factors influencing patient health
outside their institution.

The silent enabler of the latest digital revolution in health is the cloud, Dr. Kos says.
There is a raft of more visible technologies disrupting health, but almost all of them are
using the scale, availability, performance and importantly security of cloud.

Patients can be overwhelmed by massive


amounts of [health] data they now have access
to. The easier it is for them to understand, the
more personalized the information, the more
likely they will use it.

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 9


IV. From Meaningful Use to Meaningful Insights:
Targeting Patients with the Greatest Needs
Providers traditionally made care decisions on an episodic basis, with little visibility into
which interventions may have the greatest impact on a population as a whole. Now,
physicians are using data-driven forecasting and predictive algorithms to better identify
and manage health risk in their communities.

ACOs must address the health needs of their total patient population but by personalizing
each interaction to the appropriate level, site and quantity of care. ACO providers must
find ways to proactively engage patients who rarely interact with the healthcare system
in addition to those who use health services regularly. The extent to which the ACO can
identify hard-to-reach patients at risk for developing a chronic illness, and then either
prevent or treat that illness, is central to the ACOs and patients outcomes.

One way provider organizations proactively manage risk is through forecasting tools
that facilitate targeted interventions aimed at high-risk patients across the community.
Predictive analytics tools can trawl large stores of health data to identify patients at
risk of any number of events, such as developing chronic conditions, acquiring hospital
infections, requiring hospital readmission or being overdue for a mammogram.

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 10


For example, some health systems across the U.S. have adopted analytics tools that
identify patients at risk for developing serious infections, such as sepsis. The ability to
recognize these patients gives care teams time to make course corrections. Providers
can also employ data-driven tools to better address patients nonmedical needs for
safe housing, sufficient food, child care, behavioral health care, or other factors that
have an outsized impact on health.

In addition to supporting patients health, analytics drive efficiency in the hospital.


One health system in Pittsburgh deployed an algorithm to predict whether a patient is
likely to miss their next appointment. The algorithm uses past behavior detailed in the
patients medical record along with other data sources external to the EHR to make this
forecast. The provider team uses those insights to proactively reach out to potential no-
show patients and address obstacles preventing them from getting to the office, such
as the lack of a ride to the office.

V. Managing Patients with Complex Needs


Patients with complex medical conditions require more than an annual visit to their
physicians office. Managing health needs such as diabetes or heart disease requires
patients to make changes in lifestyle and behavior, and maintaining these changes
requires vigilance on the part of both patients and the medical professionals who
oversee their care. Digital technology like wearable sensors and remote monitoring
devices that capture and relay changes in biometric measures to monitoring nurse
teams help chronic needs patients understand the connection between their behaviors
and their health.

Active condition management includes lifestyle changes, adherence to medications and


regular dialogue with the care team to ensure the care plan is going smoothly. Essentially,
this version of patient engagement involves the patient taking on responsibilities that
traditionally belonged to clinicians and carrying them out between physician visits.

Providers are using innovative, digital tools to monitor patient progress from afar and
help them to sustain positive self-care.
Remote patient monitoring devices use digital technologies to collect medical and other
forms of health data from individuals in one location and electronically transmit that
data, via the cloud, to healthcare providers in a different location for consultation in real
time. Monitoring programs can collect a wide range of health data from the point of
care, such as vital signs, weight, blood pressure, blood sugar, blood oxygen levels, heart
rate and electrocardiograms. Devices include blood pressure cuffs, two-way virtual care
devices, glucometers and heart-rate monitors.

Remote patient monitoring systems have empowered providers in team-based care


models like ACOs to monitor and manage the health of high-need patients from
anywhere, at any time. These tools signal providers when a problem or pattern emerges
that suggests a decline in health. Monitoring nurse teams then initiate the appropriate
response, such as a medical intervention or patient education via videoconferencing,
text message, email, phone call or home visit.

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 11


The mobility and convenience afforded by these digital devices is invaluable, especially
considering that many patients with chronic or complex health needs have been
underserved by the traditional healthcare system due to geographic isolation, low
socioeconomic status or limited mobility.

Groups underserved by the traditional health system can be effectively reached by


more proactive services like virtual care models, which can be far more convenient and
cost effective, Dr. Kos says.

When implemented properly, remote monitoring programs positively affect patients


emotional and physical outcomes. Biometric trackers give patients the confidence to stay
on top of their care management, allow older and disabled individuals to live at home
longer, and even reduce the number of hospitalizations, readmissions and lengths of stay
in hospitals all of which helps improve the patients quality of life and contain costs.

Conclusion
Digital technologies have transformed the way consumers work, shop and socialize.
Now healthcare providers are beginning to deploy digital tools to better understand
and serve their patients, especially those with the greatest health needs who typically
incur the highest costs.

Connected technologies do not replace direct communication between patients and


their providers. Rather, digital communication tools enhance the patient-physician
relationship by enabling providers to offer better education and personalized feedback.
The results: higher patient satisfaction, higher physician satisfaction and better quality
health outcomes.

Digital technologies continue to play a greater role in hospital exam rooms, board
rooms and waiting rooms. To be sure, not all technologies will add value to promote
better health. But from the digital ashes of past electronic failures, healthcare technology
developers are learning how and what physicians need to improve their everyday lives
in practice as well as the tools they need to pursue long-term goals with their patients.

In Pursuit of Collaborative Medicine: The Power and Promise of Digital Health 12


About Microsoft
Microsoft is the leading platform and productivity company for the mobile-first, cloud-
first world, and its mission is to empower every person and every organization on the
planet to achieve more. We believe in what people make possible. Visit Microsoft at
www.microsoft.com.

About Beckers Healthcare


Beckers Healthcare is the leading source of cutting-edge business and legal information
for healthcare industry leaders. We take advantage of multiple channels to reach these
industry leaders and decision-makers.

BECKERS

HOSPITAL REVIEW

También podría gustarte