This article was originally published in the Spring 2019 issue of The Record. Subscribe for FREE here to get the next issue delivered directly to your inbox.
Many in the healthcare industry seem to consider electronic medical records (EMRs) as the tool that will solve any problem. However, looking at global trends and the shift to value-based care, it’s clear that the reality is quite different.
There’s ample reason to question whether EMRs are the right approach, especially now that we’re moving from a hospital-centric approach to a patient-focused model that goes beyond the walls of the hospital. There’s also every reason to question whether EMRs are a sound investment. For example, the US has spent US$38.4 billion implementing 30-year-old EMR technology in hospitals since 2011. Despite successfully computerising health practices, patient data is still largely locked into hospital systems, so sharing it across the wider health system remains difficult. With the healthcare model shifting towards prevention and personalised care, providers and payers are rethinking their approach. They are now using technologies such as the internet of things (IoT) to engage patients, improve outcomes and reduce the cost of care.
One academic health centre in the US has taken an innovative approach to a customer-centric healthcare model after deciding it wanted to engage patients as consumers based on a simple objective – keeping those with chronic diseases out of hospital. The centre created an innovation group, which was headed by a chief experience officer and comprised a multi-disciplinary team from customer-centric industries, such as hospitality, publishing, entertainment and automobiles. Clinicians also joined the team and were given access to over 30 million patient records dating back 30 years to analyse the social determinants affecting chronic illnesses such as hypertension, diabetes, chronic obstructive pulmonary disease and heart disease.
Using a set of algorithms, the team identified three social determinants that have the greatest impact on chronic disease: easy access to transportation, high-quality food and good education. To get useful information from a trial group of patients on these issues and other lifestyle data, the team created a proof-of-concept mobile app. Patients also received a Microsoft wristband, a Bluetooth blood pressure cuff, an inhaler and a weight scale that all connect to the app.
Following the success of the pilot, the centre wanted to roll the app out to 4,000 patients. As the ratio is about one nurse for 20-40 patients, the centre looked at customer relationship management (CRM) solutions, choosing DXC Technology’s DXC Health360 platform built on Microsoft Dynamics 365.
Once the digital platform was in place, the innovation group created a pod model that consisted of one nurse and two health navigators – non-clinical support staff focused on CRM – to support the 4,000 patients (one pod caters to 2,000 patients). The platform automatically uses IoT monitoring devices and advanced predictive analytic models to identify patterns and send reminders. Meanwhile, care coordinators are notified by the platform if they need to interact with a patient.
To ensure success, the centre used data about the patients to engage with them in a way they would relate to. For example, the centre knew that most patients prefer to be contacted by text message and most are fans of TV show Game of Thrones. Drawing on this knowledge, the centre sent the following text message to hypertension patients on the evening of the season finale: “Tonight is the big night for Game of Thrones and we know you might get excited, so don’t forget to take your blood pressure before the show and take your meds if required. Have a good night and enjoy the show!”
A year on and the new platform and engagement model has given the centre significant insights. For example, it has enabled providers to predict future chronic disease patients with high levels of accuracy. In addition, it has reduced emergency services costs by 23% and cut the total cost of care by 36%, while 95% of patients/consumers are satisfied with their care.
No matter what the healthcare model, the objective must be to keep patients out of hospital as much as possible. Not only is this better for the patient, but it also improves financial outcomes and allows health providers to focus on truly innovative care delivery. That’s not something that can be achieved with an EMR.
David Paré is the chief technology officer for Healthcare and Life Sciences at DXC Healthcare Australia and New Zealand
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