June 30, 2015
The Way to Transform Quality: Innovative Disruption in the Delivery of Healthcare

Sometimes, it’s hard to tell whether healthcare is in such turmoil because the people on the inside of the system — administrators, physicians, nurses — are leading the charge to do more, and more efficiently for a growing number of patients; or if it’s because the institutions outside the system — government, payors, patients — are demanding more from administrators and clinicians who are already time- and energy-strapped. Either way, the picture of healthcare in this decade has become clear: Traditional models of delivering healthcare won’t cut it — it’s time to think outside the box on data, patient engagement and physician support.

1. Data integration is the future

Nearly every provider, hospital and healthcare facility has electronic health records (EHR) now. Yet, 80% of electronic healthcare information is unstructured — that is, patient data are incomplete, trends in symptoms and/or reasons for visits are not connected to create a full picture, and information is not shared between providers — all of which leave huge gaps in the healthcare record. What’s more, only 33% of facilities and providers use some sort of data-mining solution that would let them fit these pieces of the patient data puzzle together. And that’s why we need integrated data, to create a post-EHR world where we not only have EHR, but we maximize its value. To do so, however, “Providers must have access to information originating from different sources, systems, formats, and hosts. Patients … and their healthcare providers require a comprehensive patient record,” says one expert. Complete data starts in the exam room, at the point of patient contact — for example, using scribes to record the information shared during those visits, thoroughly and directly into the EHR. While the Centers for Medicare and Medicaid Services (CMS) promote greater EHR interoperability, it’s your responsibility to ensure comprehensive data are there to share.

2. Make access easier for patients

Much like data, care also tends to occur in siloes. There’s the GP, who refers the patient on to the specialist, who works in another location and requires that the patient go through the appointment dance again. The specialist might order some blood tests, but those have to be done another day, on the other side of town, in a center set up in a strip mall. You get the idea: Even if patients can afford care and have made the effort to participate in their own health, access remains difficult. New models aim to change that. In Florida, one insurer is launching integrated-care facilities, which house primary care, specialty services, labs and diagnostics, all in one building. This way, the patient doesn’t have to make three separate appointments, on different days or even weeks, losing time at work or forcing them to arrange transportation from friends or family. And corner pharmacy chains are offering clinic services, let by nurse practitioners, so that patients can visit after business hours, or on weekends — the times that may be most convenient for them. There’s also the model of population healthcare, which emphasizes more-standardized healthcare approaches for chronic disease management, making it easier for patients to be seen by a specialist or even to move providers, while ensuring continuity of care.

3. Provide physicians the right support

Physicians want to treat patients — it’s what they’re best at, and what they spent many years training to do well. CMS-driven quality indicator and payment reforms are encouraging integrated and patient-centered care. But successful patient-centered care relies on well-planned team-based care. In other words, even the most engaged physician can’t disrupt healthcare alone. Care teams should include physician assistants, specialist nurse practitioners and other clinicians, as well as non-clinicians who provide support services during a patient visit or in between patient visits with clinicians. These workers — who can include medical assistants, scribes, health coaches and educators, care coordinators, patient advocates, peer counselors and community health workers — should be tasked with creating the best patient experience possible. And a large part of a good patient experience is reflected in the perception of a good relationship between the patient and the physician. Removing administrative burdens and communication obstacles where possible supports physicians, letting them feel engaged in their work so they can foster those relationships.

It’s perhaps ironic that we think of the personal physician-patient relationship as something that existed in a bygone era. Similarly, integrated care systems are considered “traditional” in some countries. Being good at sharing was something we were taught in kindergarten. Maybe “disrupting” and “transforming” care delivery is about bringing back some of the values that were once hallmarks of healthcare, and re-adopting them in a healthcare system that’s in flux.