What if health systems really worked like systems?

When I started primary care practice in a regional health care system, providing the right care for my patients was my top priority. Just like I did when I was in my residency, I had to learn how to get things done. This required a ton of non-clinical scrambling around—building relationships, finding workarounds and calling in favors.

Nothing about the patient journey was standardized, either for the patient, or for me. It was manually intensive, relationship-based and largely opaque. And it could be exhausting. Despite all the medical and information technology advances since then, providers and patients today still have the same challenges navigating care that we had 20 years ago.

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A chasm, not a gap

The Institute of Medicine (IOM) once called the difference between what we have in healthcare and what we could have a chasm, not a gap¹. This is still true. As I see it, this chasm continues to exist because health “systems” rarely resemble anything system-like. They are loose collections of federated environments and functions. This is the case in community-based health systems, world-renowned academic medical centers, and everything in between.

The inefficiencies that result from our “non-systems” lead to huge costs in leakage, dissatisfaction, redundancy and adverse outcomes. The same IOM report² estimated more than 100,000 lives are lost annually in the United States due to errors, for example.

Navigating this challenge is difficult, but the conditions for addressing it have changed substantially in the last five years, with the advent of mainstream cloud technologies and intelligent automation, interoperability standards, and customizable “off-the-shelf” solutions. New capabilities allow us to reexamine the constraints that we’ve taken for granted for decades in delivering a new experience. The current experience is full of friction due to three primary factors: 

1. Experience isn’t managed predictively. The vast majority of what we do in healthcare is reactive, not proactive. Imagine how different outcomes would be if we were getting in front of problems in real time. Most care teams don’t have the tools, time, resources—or necessary insights—to make decisions predictively based on contextual risk. Provider systems are still largely provider-centric instead of patient-centric. Legacy use cases need to shift toward more patient-centric, proactive and data-enabled solutions, even leveraging existing data. This is not as far from possible as one might think.

2. Communication is necessary, but not sufficient. We talk about “better communication” being the solution. But think about how complex communication is for care teams. In my practice, I had to learn who to call when certain issues arose with my patients. My colleagues had to answer the call, process and absorb what I needed—and figure out the best solution for my patient while taking care of their own. Nurses on the floor or techs in the radiology suite had to do the same. And most importantly, people would then have to execute, often outside their ordinary workflow.

3. Legacy applications are constrained by their own design. Whether it’s an EMR, workforce management solution or some other technology that provider systems rely on every day, these applications are designed to answer narrow use cases. Because of this, increased data availability doesn’t necessarily mean more functionality. If you add more data into an EMR system, it’s still just an EMR, not a solution to the problem of the patient journey. What’s needed is an integration environment that creates visibility and capability for action at a level beyond any single legacy application’s potential. This will occur in a cloud-enabled platform that elevates data and process integration to an enterprise level while supporting much more sophisticated capability through artificial intelligence (AI) and machine learning.

A different kind of patient journey

The key to enable real-time experience management and outcomes transformation in a patient-centric and provider-friendly way is a new approach to the integration of AI and automation. Visibility into key information that enables action within workflows is at the core. This allows for a strong partnership between humans and machines, as the AI-enablement platform elevates exceptions to managers and executives for higher-level decision making, while keeping routine and repetitive manual tasks on track with minimal intervention. Core legacy systems and applications are used at a much higher level of value to build a powerful environment that can deliver outcomes at a much lower cost—both in dollars and in health.

Care teams and hospital executives can manage risk earlier and in a much richer way, based on contextual and static factors. With context in play, we can understand not just that our patient is being discharged, but that due to the time of discharge, medication profile, and home address, we may want to add home monitoring, transportation and delivery options to avoid readmission. Not only does this predict problems and bottlenecks, it allows for real-time action within workflow through process integration.

This level of intelligent integration also allows for personalization and precision in the experience that goes far beyond “standardization,” which only incrementally drives aggregate outcomes. It provides the opportunity to deliver the best possible individual outcome. Influences like social determinants of health, patient mindsets and behaviors, and genomics become key drivers which can deliver unprecedented personalization.

What does this look like in a real healthcare setting? Imagine a nurse manager has a dashboard that makes it possible to see where patients are coming from, going to and the critical pathway for each patient in the flow of their experience. She can address barriers before they occur right in workflow, including clinical factors, bed availability, staffing and transportation. Imagine if a system could predict cardiac arrest in a patient more than an hour before it happens, send an alert automatically to the crisis team wherever they are in the building, and hold and express elevators for each team member, while the system locates ventilators and moves the nearest one into position to avert the episode. Or what if the handoffs between environments could become much lower risk for patients thorough seamless monitoring of clinical, operational and social factors, keeping the key players informed in real time through digital tools, and even automating the blizzard of paperwork required to move a patient?

The future is already here

If all of this sounds like it’s at least a decade off, here is some good news: All the necessary technology exists right now to make these scenarios a reality. In fact, many health systems have invested in several of the point solutions discussed above. For example, one can accurately predict cardiac arrests for many patients in ICUs more than an hour in advance. The challenge is that these solutions are not integrated into a broader solution platform that delivers a differentiated, predictive, personalized experience journey. With apologies to William Gibson, who said, “The future is already here—it’s just not evenly distributed,” in this case, it’s just not properly integrated.

To be fair, you can’t reimagine the entire patient journey all at once, nor do you need to. We can start with strategic focus to deliver major rewards targeted to strategic priorities in a few key domains. You’ll be taking the first steps to create a whole new future of care. It’s a future we need to bring closer every day.

Sources:
1. Institute of Medicine, “Crossing the Quality Chasm: A New Health System for the 21st Century,” 2001
2. Institute of Medicine, “Crossing the Quality Chasm: A New Health System for the 21st Century,” 2001