There’s so much talk across healthcare about electronic medical records (EMRs). For many, it seems to be the answer to every question, solving all problems of healthcare. At a recent Health Information Technology WA (Western Australia) conference in Perth, for example, three plenary speakers on the main stage were touting its benefits. Unfortunately, the reality is quite different.
Looking at global trends and the shift to value-based care, I believe there’s ample reason to question whether electronic medical records (EMRs) are actually the right approach, especially when the objective has changed 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 it is a sound investment. For example, since 2011, the United States has spent $38.4 billion implementing 30-year-old EMR technology in hospitals, according to a 2018 Centers for Medicare & Medicaid Services report. Yet despite successfully computerising health practices, data is still largely locked into hospital systems, and sharing data across health systems remains difficult.
With the healthcare model shifting towards prevention and personalized care, providers and payers are rethinking their approach, and instead are turning to technologies such as the internet of things (IoT) to engage patients, improve outcomes and bring down the cost of care.
From patient to customer
One healthcare organization that took a truly innovative approach to a customer-centric healthcare model is an academic health centre based in the United States. Renowned for its population health studies, the centre’s former chief executive officer wanted to engage patients as consumers, based on a simple objective — to keep those with chronic diseases out of hospital.
The project began with the creation of an innovation group, headed by a chief experience officer overseeing a multi-disciplinary team from customer-centric industries, such as hospitality, publishing, entertainment and automobiles. Most notably, there are no technologists from EMR/EHR (electronic health records) vendors within this group. To this progressive team, the health center added clinicians, who were given access to over 30 million patient records dating back 30 years to analyze the social determinants affecting chronic illnesses such as hypertension, diabetes, chronic obstructive pulmonary disease (COPD) and heart disease.
Based on a set of algorithms, the team was able to identify three social determinants that have the greatest impact on chronic disease:
- Access to transportation – Can you get to and from your job and school easily?
- Access to good food – Do you have access to quality produce or is the only store accessible from your house a 7/11 selling “convenience” food?
- Access to education – Is there a good school in your area with good teachers?
But how do you get good information from patients/consumers on these issues, given that surveys typically have low participation, with only 30 to 40 per cent of people taking part?
Mobile apps and IoT devices are part of the solution. Unfortunately, most apps are focused on a single condition or health issue, rather than factors that influence the patient’s overall health: socio-economic determinants, your environment, health behavior, as well as the quality of healthcare you receive.
Three months later, the innovation group released a mobile app as a proof of concept.
As part of the programme, patients were given a kit that included a Microsoft wristband, a Bluetooth blood pressure cuff, inhaler and weight scale, all connected to the app. In addition to health monitoring data, the app also captured data on life style, such as whether the patient smokes, exercises, etc.
Scaling outcomes
The pilot was a huge success, but the next step was to scale it to 4,000 patients, which was going to be another significant challenge, considering that the nurse-to-patient ratio is about one nurse for 20 to 40 patients. So, the centre started looking at customer relationship management (CRM) solutions.
Once the digital platform was in place, the innovation group had to redesign a new operating model that would support these 4,000 patients. After testing a few configurations, the team landed on a “pod” model that consisted of one nurse and two health navigators — non-clinical support staff focused on customer relationship management. Because the system works by exception, the care coordinators are notified by the platform when an interaction with the patient is required. The rest is automated by the platform, sending reminders and analysing patterns by using IoT monitoring devices and advanced predictive analytic models.
Success with such a large group of people requires engaging with patients where they are and in a way they can relate to. Thanks to the data gathered, the center knew a lot about these consumers. For example, they knew that most prefer to be contacted by text messages and most were fans of the show, Game of Thrones. With this knowledge, on the evening of the season finale, they reached out to hypertension patients with a simple message: “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!” As trivial as this seems, it is details like this that engage people and empower them to make life style changes.
After 12 months, the new platform and engagement model has given the center huge insights, including enabling providers to predict future chronic disease patients with high levels of accuracy, and it has delivered significant outcomes. Here are a few numbers that I find very compelling: The centre has achieved 95 per cent of customer satisfaction, a 23 per cent reduction in emergency services costs, and reduced the total cost of care by 36 per cent.
Increasingly, no matter the healthcare model, the objective must be to improve health outcomes and keep patients out of hospital as much as possible, not only because it’s better for the patient but also to improve financial outcomes and allow health centers and hospitals to focus on truly innovative, cutting-edge care delivery. That’s not something that can be achieved with an EMR.
