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INTERMOUNTAIN HEALTHCARE
Clinical Staff at Intermountain Healthcare use telehealth to bring specialists from afar into patient visits.
Healthcare executives are planning for a future that revolves around delivering care to patients where they are in their daily lives, rather than expecting patients to visit a clinic or a physician’s office. But while the technology might be there, a host of challenges still stand in the way of this vision becoming mainstream. “Everyone’s trying to move toward what I call ‘healthcare at the doorstep,’ ” whether that means telehealth and virtual care, or a move toward hospital-at-home and house calls from clinicians, said David Chou, chief information officer at Harris Health System in Houston. That’s “where the future lies,” he said. Kevan Mabbutt, a senior vice president and chief consumer officer at Salt Lake City-based Intermountain Healthcare, agrees. “Clearly a lot of what people will expect … is care in the home and care on the go,” Mabbutt said. “Some of this already is beginning to come to healthcare.” Patient engagement and connectivity—particularly connecting to patients at home—has been a growing area of focus for healthcare organizations. Fifty-two percent of chief information officers from hospitals and health systems indicated patient engagement would be their biggest focus for 2021 outside of COVID-19 response, according to a survey by Stoltenberg Consulting. That connectivity is moving beyond central patient apps and portals that patients might check intermittently, and toward more regular and personalized interactions. Healthcare experts who spoke with Modern Healthcare painted a vision of using apps to become more deeply integrated into patients’ lives, wearable sensors and devices to continuously monitor patient health, and other technologies like video visits to meet patients where they are, at home, work or on the go. “Really, on the horizon is more connections with the patient,” said Adam Seyb, a director in the healthcare practice at consulting firm West Monroe, moving away from an “episodic relationship” to a “true relationship on an ongoing basis with their patients.” But to get to there, the industry will have to do some heavy lifting over the next few years. Executives face a number of major hurdles to see this vision come to fruition, including interoperability, payment, and underlying social determinants and patient preferences. Linking it all together Myra Davis, chief information and innovation officer at Texas Children’s Hospital in Houston, envisions a future where we don’t “assume all patients will need to come into a hospital.” That’s “the overarching theme,” she said. As a children’s hospital, Texas Children’s is increasingly seeing parents from the Millennial generation, and Gen Z—those born in the mid- to late- ’90s—won’t be far behind. “They want convenience,” Davis said. Younger patients tend to be more open to virtual care than their older counterparts, according to a 2020 report from consultancy Accenture. While only 19% of total patients indicated they preferred virtual or digital experiences with providers over in-person appointments, 41% of Gen Zers and 33% of Millennials said they preferred virtual or digital interactions. Healthcare organizations should continue to think about meeting patients where they are through virtual care, whether one-off telehealth visits or apps for certain issues, or sensors and wearable devices that continuously monitor patients for follow-up care, she said. That can make care more convenient for patients who no longer need to travel or take time off work. But it’s not as easy as just deploying new digital health tools. While wearables can help to monitor patients and provide insights into their health, there needs to be a way to connect that data to clinicians’ existing workflows so they can easily act on it. Unless apps, wearables and other remote patient-monitoring tools are interoperable with a hospital’s electronic health record system, they can’t truly become part of a patient’s care plan. Such technologies need to be “tied back into their care team,” with a clear outline of what to do with the data so that it becomes a real point of connection—and not just a self-monitoring tool that a patient uses on their own, said Jeff Johnson, vice president of innovation and digital business at Phoenix-based Banner Health. “It’s probably no surprise that things like better exchange of data, open systems and interoperability will be key to this,” he added.
INTERMOUNTAIN HEALTHCARE
Intensivists and critical-care nurses at Intermountain Healthcare remotely monitor intensive-care patients across the system’s sites through its tele-critical care program.
That’s why Banner this past spring rolled out a new platform through which clinicians can assign digital health programs to patients and monitor the patient’s data via the health system’s EHR. The first digital therapeutics program Banner Health added to the new platform is for expectant mothers, and involves prescribing a mobile app called Babyscripts to help patients manage pregnancy. The app shares educational content and remotely monitors data like weight and blood pressure, which are shared with clinicians through the EHR. Such digital programs will fuel more connections between the patient and care team, which organizations will have to learn to manage, according to Johnson. Even though patients may not be coming into the clinic as frequently, they’ll more frequently be interacting with and constantly sending data through system-branded apps, chatbots and other programs. “We might have thousands of interactions, some of them being just really small pieces of data,” which providers will have to bring together for personalized care and outreach, Johnson said. He said Banner is looking into adding digital health programs for behavioral health, heart failure and follow-up care after bariatric surgery to the platform. Across the continuum There’s also the matter of coordinating and exchanging data across different sites of care. There’s an emerging market of options for patients seeking convenient care, including urgent care, retail clinics and direct-to-consumer telehealth services. Millennials and Gen Zers, in particular, have expressed dissatisfaction with traditional healthcare services, and are less likely to have a primary-care physician and more likely to turn to virtual care and retail clinics for many of their health needs. Consumers are now “getting more portable, more personalized, more convenient experiences in other aspects of their lives,” said Intermountain’s Mabbutt, who previously worked as global head of consumer insight for the Walt Disney Co. Those expectations have spilled over into healthcare, where more patients may prefer a one-off urgent care or telehealth visit. To solidify their positions, health systems can carve out a space at the center of a patient’s healthcare journey by integrating data from those outside experiences into a “full healthcare journey,” Mabbutt said. That’s historically been complicated, since various care settings may not have an easy way to share patient data with one another—often sending that information on paper and still using fax machines. New data-sharing regulations could ease that burden, as many healthcare organizations will be forced to adopt common ways to share data electronically. Tying together data from various organizations can also help care teams to inform care and outreach. Outreach “really depends on two things: intuition and data,” said Dr. Emily Maxson, chief medical officer at Aledade, a company that partners with primary-care practices to form accountable care organizations. While physicians who have longitudinal relationships with patients are skilled in the first area, they may run into challenges with the second if data isn’t sent electronically and using common data standards. Even if a practice gets sent relevant data from providers and insurers as part of value-based care arrangements, it can be difficult to get the information in a way that easily integrates with clinical systems. “If you still have messages coming in on a fax machine, they have to be updated and scanned—and those PDFs aren’t searchable,” Maxson said. “You lose the option to do sophisticated things that integrate those data elements because they’re hiding in an attachment, so to speak.”
A move toward sharing data electronically
Starting in December 2022, electronic health record vendors and other software companies will be forced to make application programming interfaces that meet specific standards available to customers if they want to receive certification from HHS’ Office of the National Coordinator for Health Information Technology, because of interoperability and information-blocking regulations from the agency. APIs are protocols that allow different applications to communicate and share data with one another. Ideally, if two healthcare organizations are using EHR systems capable of exchanging data through the same standard API, it will be easier to electronically send information on shared patients from one organization to the other, as well as to subsequently integrate that information directly into the patient record.
‘Opportunity cost’ Hospitals and other healthcare providers will need support from outside their walls to create the care systems of tomorrow—chiefly, through new payment mechanisms. In the next five years, Dr. Shafiq Rab, chief digital and information officer at Burlington, Mass.-based Wellforce Health System, said he expects most patients will be part of programs that let clinicians monitor patients’ health from the home, either through the patient’s traditional care provider or through a company that provides the service. That could involve tracking health metrics with voice assistants, mobile apps, or devices and sensors that gather and share data with care teams. “Things have to be catered to (the patient),” Rab said. “Whoever does that will have that patient.” Much of that technology exists today, and will get better with emerging technologies like 5G wireless internet, which promises to speed data transmission and allow multiple connected devices to operate without slowing down internet connection, Rab said. Improvements in artificial intelligence, so that digital health programs can automate messages to patients based on their data, could also bolster such programs. But for this technology to become more widely used in healthcare, the industry needs to move away from the fee-for-service payment system and toward a value-based care environment, so that preventive care and care that keeps patients home is rewarded. “Our payment structure needs to change,” Rab said. Such technologies likely won’t be fully adopted until healthcare moves to pay for programs that reduce emergency visits, preventable surgeries and worsening chronic conditions. That said, even without reforming the payment system, there are reasons for providers to start moving toward a more connected environment. When weighing financial risk and reward, it’s important to keep in mind there’s an “opportunity cost,” according to Mabbutt. If health systems don’t invest in tools and services that make it easier and more convenient for patients to access care, those patients might turn to competitors like urgent-care clinics, concierge medical practices and telehealth startups—leaving hospitals behind. But while technologies like apps and virtual care sound like a promising future—one many patients and providers got a taste of during the COVID-19 crisis—healthcare executives will have to grapple with the fact that not everyone has access to internet and devices that underpin many of these programs, a reality the pandemic exposed as some struggled to access virtual healthcare, online schooling and remote work. While a large majority—95.6%—of the U.S. population had access to broadband that met the Federal Communications Commission’s speed benchmark in 2019, according to the agency’s most recent report on the subject, that continues to leave 14.5 million people without access to such services. That’s especially pronounced in rural areas, where 82.7% of people had access to broadband at speeds that met the FCC’s benchmark. “There are a lot of areas that don’t have access to broadband,” said Brian Gragnolati, CEO of Morristown, New Jersey-based Atlantic Health System. While the number of people in areas with mobile wireless internet is higher—99.9% for the U.S. population as a whole and 99.4% specifically for rural areas—not everyone has a device to access it. Ninety-seven percent of Americans have a cellphone but only 85% of Americans own a smartphone, according to a report issued by the Pew Research Center this year. Older adults (29%) and those making less than $30,000 a year (19%) are more likely to own a cellphone that’s not a smartphone, compared with the population at large (11%). That’s a challenge that Cityblock Health, a spinout from Google parent company Alphabet, has tackled by reaching out to patients in a variety of ways, based on ability and preference and often less dependent on smartphone or internet access. Cityblock, which describes itself as a “value-based provider,” contracts with health insurers to provide services to low-income and other underserved members that improve health, whether through better coordinated medical care, getting access to behavioral healthcare or addressing social determinants.
Keeping it simple
Phoenix Children’s has found success with using text messages to connect with patients, as some just prefer not to use a new-fangled artificial-intelligence chatbot or mobile app. Phoenix Children’s sends to-do lists to patients before and after appointments, which can include forms to fill out, educational videos to watch or discharge instructions. The tasks are sent via text message with a link to a web app; data, such as intake forms, are then integrated into the hospital’s EHR system. If a patient doesn’t want to receive text messages, they can instead opt for email messages or phone calls from the hospital. “What the families like (about texting) is it’s all in one place,” said David Higginson, executive vice president and chief innovation officer at Phoenix Children’s. The process doesn’t force patients to download a new app or check a patient portal that isn’t part of their daily routine. It’s “interacting with (patients) the way they want to be interacted with,” Higginson said.
The startup’s community health workers reach out to patients in person through its hubs and clinics and by visiting members at home, as well as through phone call and text messages. Simply text messaging members to ensure they have medications and food has proven particularly effective, according to Dr. Sylvia Romm, chief health officer for virtual care at Cityblock. “Almost all of our members have phones,” she said. “The baseline access to text messaging is very high.” While many members have smartphones, too, they may not have a data plan that covers enough internet access for the entire month or may not have enough storage on their devices to download as many apps as they’d like. And it isn’t just about the technology they have access to. It’s also listening to understand what they prefer and are most comfortable with. Atlantic Health is in the midst of building up its patient portal—adding a so-called “digital front door” that links in services like billing, remote monitoring and other programs—but still lets patients reach a call center to schedule in-person visits. Hospitals can’t “abandon what our patients are used to,” Gragnolati said. “We have to meet patients where they are.”
Tags: Patients, This Week in Healthcare, Information Technology, Medical Technology, Social Issues, Interoperability, Transformation, Transformation Hub, MH Magazine
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