What’s the winning formula for improving federal health care? For the Department of Defense and the Veterans Administration, the best future involves more than investment in new technology. It demands an investment in doing things differently regarding patient care, patient engagement, and clinical operations.
The news is full of headlines about escalating health care cost, physician and nursing shortages, and changing models of care. There are lots of discussion about not only standardizing care—that is, providing evidenced-based care—but about best practices for health care transformation in clinical operations.
I think caution must be taken when calling something a best practice, when the assumptions and drivers of why something is considered “best” is unclear. Much of what we do in medical practice is based not on the highest level of evidence, but on opinion. Similarly, how we practice medicine and operate health care is built around in-office appointments and clinic visits, and payment models that are taken from current models of care delivery.
Recently the VA won a huge victory for expanding proven health care options by changing the rules for video-based telehealth encounters. In considering how to provide high-quality care at lower cost for better patient outcomes, we need to organize and execute differently.
Take the annual physical exam. With evidence clearly showing limited value from this practice, why is it still occurring? Why is it still funded? Can we achieve value from the concept in a different manner? Perhaps the physician and nursing shortage is not as dire as predicted. After all, it is based upon current (and perhaps increasingly outdated) assumptions about care.
Amazon reinvented the shopping experience to add a fundamentally new wrinkle to retail purchases. As a new-age retailer, the company didn’t analyze the parking lot or, or determine how long a drive a customer was from the nearest store. It used the customer experience to change how people shop, and gave them tools in the digital age to help them do it.
Now think of health care. We have traditional notions of office and hospital care, and providing best medical practices for our patients. Patients arrive, they see a doctor or nurse practitioner, have their blood drawn, perhaps have their labs and tests conducted that day onsite.
Is this a best practice for the patient? Within federal health care, is this the best course for the service member, for the veteran, or for readiness? Not necessarily.
Let’s take the Amazon analogy a step further. How do we offer our patients better care, a more accessible and streamlined experience, at lower cost? How do we provide our stakeholders (Congress, taxpayers, service members, veterans, and their families) a better return on their investment?
We should not be talking about optimizing current processes any more than Amazon was wasting time analyzing parking lots. Instead, we should be ensuring that true evidence-based medical care is delivered while supporting patient engagement in their health, built on evidence-based practices.
It will require the use of technology as an enabler and for ongoing analytics. Modern EHRs should be based on outcome achievement. Technology and standards for interoperability are also required. There must also be patient engagement technologies beyond the EHR, as less than 1 percent of our lives are spent obtaining healthcare.
People are already actively engaged in using such tools, which must be applied to address the greatest impact on health—personal choice and social determinants. We need to think about how to communicate at a different time and with a different purpose over various channels. That way, we get to a different outcome.
Implementing new technology and changing health care models are a great opportunity for transformation, not just optimization of old practices or, worse, entrenchment of old behavior in new technology. I advocate, and the evidence supports, moving to new models of care that reflect decision-making for the patient first—what is needed for health, not for how it affects the clinician’s practice.
We see this accomplished through telehealth, effective EHR use, meaningful interoperability, and thinking more creatively about how to schedule and treat patients. In other words, thinking from the outside in, not the inside out.
The time is right. The tools are available. There are clearly policies and practices that need changing. Let’s execute a different vision.
I’m a grateful veteran, and always a soldier. So tell me—how do the best practices around you and any plans you see for change square with my view of where we should be going?