I recall, in the early days of laptops, commuting into Chicago and envying the rare businessman in the railcar, feverishly typing away on a bulky 286 laptop, staring at the awesome VGA screen.
I truly expected that the tech-laden businessman would, at some point, utter an emphatic, “Yes!” and then close the laptop, having solved all his company’s problems and world peace to boot. Then, a few years later, I got my own laptop (as we all did) and realized that portable computing power really didn’t solve anything.
The healthcare industry, as a whole, as gradually had the same growing understanding that electronic health records, by themselves, aren’t a grand solution. They provide the raw materials to build a new house, one being remodeled and reconfigured on the fly by the forces of healthcare reform and value-based care.
Care delivery—and particularly, bringing health to populations—requires a combination of technology and new thinking that the industry is only beginning to grasp. The good news with reform and emerging reimbursement mechanisms, is that it enables the country to take a wider, potentially more humane look at what effective healthcare will look like in the future.
For example, in a session at the National Health IT Collaborative for the Underserved, Chris Christmas described how technology fits into Keep Livin’, a collaborative effort intended to improve health. Christmas, its CEO and founder, is aiming efforts at communities that he describes as under-resourced, where 60 to 80 percent of healthcare contacts through Keep Livin’ are a result of non-clinical events.
Using a digital health platform from Microsoft, the organization is able to pull together fragmented health records of patients by first gaining their consent to gather records information from their providers. It recruits patients at events in churches, barbershops and hair salons, and has recently kicked off efforts in Miami; it contracts with payers and providers to help them reach individuals and improving care delivery and resulting quality scores from those patients.
But aggregating records is only a piece of the work. “If we’re going to be able to intermediate, we’re going to have to be aware of the social factors and lifestyle factors of patients,” Christmas said. For example, there are nuances in expectations of providers and care delivery between those from Venezuela, Cuba, Haiti and traditional African Americans, he notes. “Because of idiosyncrasies between each community, we can’t just put one solution down there.”
Keep Livin’ uses analytics, telehealth, social media and other technology as IT enablers for its mission, but the information in EHRs is only a starting point for what it needs to do in an underserved community, Christmas notes. Much involves boots-on-the-ground education that helps bring populations up to speed on the new face of healthcare. “Most people think insurance is only for when you’re really sick,” he said. “We help them through things like chronic care management, transitionary care and even just making sure they show up for appointments.”
EHRs, while an important infrastructure requirement for the healthcare industry, don’t provide enough information capacity for advanced population health management, says Nandini Rangaswamy, co-founder and executive vice president of ZeOmega, a company that provides products and services that support value-based care.
Insurers have long taken a wider view of factors that support successful episodes of care, which extends from discovery of a condition to the completion of treatment and resolution of a case. Providers, now facing risk-based reimbursement in value-based care contracts, now are beginning to understand this, and realize the limitations of EHRs.
There’s no checkbox in an EHR for a diabetes patient who won’t come to an appointment because she’s unemployed, has a young child and isn’t located near a provider. Without knowing that, the patient just won’t show up—until she’s experiencing an expensive medical emergency and shows up in the emergency department. With providers on the hook for her care costs, it makes more sense to provide her with a voucher for transportation and child care—costs are saved, and the patient’s quality of life is higher.
That’s also true for an elderly patient at risk of falling who still feels he has no alternative other than to cut his own grass. To avoid the risk of a fall and a broken hip, it may be more cost-effective to cover the $50 monthly cost of lawn care service, Rangaswamy notes.
As records systems are widely deployed at healthcare providers now, some of the infrastructure is in place. But to finish the house, much work lies ahead—fortunately, pressing on enabling new pioneers to identify new areas where managing health can make a difference in people’s lives.
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