How is IT being used to transform healthcare delivery at the community level? At the annual meeting of the New York State Chapter of HIMSS, on April 23 in New York City, which was attended by Healthcare Informatics, Mary Ann Christopher, MSN, R.N., president and CEO of the Visiting Nurse Service of New York (VNSNY), gave an insightful presentation of IT-driven initiatives, which she said are crucial to transforming care delivery in her organization.
Christopher said that VNSNY, as the nation’s largest not-for-profit community-based healthcare system in the nation, occupies a unique place as it meets challenges inherent in healthcare delivery. It is both a payer and a provider organization, giving it “access to upstream dollars that allows it to innovate and deliver care in unique ways,” she told an audience of several hundred. It encompasses 50,000 providers, an inter-professional team of physician, nurses, rehab therapists, social workers, pastoral care, home health aides, and strong staff in IT, who deliver care to 70,000 patients in their communities. Information flow and continuity is critical to ensuring good care, she said.
“We are in a place in healthcare delivery that is cataclysmic, with the passage of the Affordable Care Act (ACA),” with both opportunities and challenges with the 30 million Americans having access to health insurance and care, Christopher said. “There are opportunities to come together as a health system that we didn’t have before.” Delivering care in a silo environment focused on discrete events and episodes is no longer acceptable. “Much of our intervention has been on the tertiary level of care, less on health promotion and disease prevention,” she said.
Christopher sees opportunities embedded in the financial pressures brought on by the ACA. “Value-based purchasing means we need to come together in more intentional ways to bring together the healthcare delivery system in ways that are aligned, both financially and in terms of their quality outcomes of patients and populations,” she said. Under the new healthcare scenario, caregivers need to consider what is happening to patients in the primary physician’s office; acute care, post-acute and sub-acute care settings; home and hospice care, as well as where patients live, she said. The challenge is transforming healthcare in a way that reaches all of those environments.
Consolidation among provider organizations and physician practices—either through acquisitions or virtually—is offering the opportunity to avert patient safety issues, as well as to get the cost structure in place to deal with declining reimbursements, she said. At the same time, policymakers are increasingly cognizant of the healthcare needs of marginalized people. Meeting that imperative means focusing on the needs of the most vulnerable populations, particularly the dual-eligible, who fall outside traditional treatment modalities in terms of quality outcomes, she said.
Technology as an enabler of better care
In Christopher’s view, the only way to achieve those goals is to rely on the greater application of technology. She said that the healthcare industry has a “burning platform” to come together in ways that engage people where they live and put the patient and the community at the center of care. “More and more we see a system where we are called to function inter-professionally, where those who have clinical informatics expertise are as critical as the physicians and nurse in that team of care,” she said.
She said VNSNY has embraced its role as a virtual integrator, putting the information in the hands of the providers and VNSNY staff to make better decisions. She expressed a vision that information technology will enable better care. Among her examples: more treatment in place rather than moving a patient to an ED; less isolation from frailty as patients use web-based apps to engage them and participate in round tables with other patients; less diagnostic uncertainty by using home-based tests, with results that can be transmitted to providers in real time; and texting to provide motivational cueing to patients.
For example, VNSNY is using texting to provide motivational cueing to teenage mothers in its Nurse Family Partnership program. “They are not likely to pick up the phone when the visiting nurse comes, but they will respond to texting and cueing, and that’s a modality that we are using increasingly,” Christopher said.
In another initiative, VNSNY is using predictive analytics in its Outcome and Assessment Information Set (OASIS), a federally mandated tool to assess patients for home care. Using predictive models, it is able to identify, based on characteristics of those patients, what other services they might need beyond a traditional home care, she said. “For instance, we know that based on certain diagnostic characteristics, there are frailty indices. We are able to extrapolate that data and able to predict that that patient will benefit from an intensive rehab program to avert falls,” she said.
The OASIS assessment also predicts patients who would be more appropriately managed within a palliative care environment of hospice rather than traditional home care episode that is focused on acute intervention and then discharge. “This is an important set of analytics to make sure we are providing the appropriate care for the patient at the time they need it,” she said.