Health systems are feeling the pressure from digital disruptors coming into the market along with the increasing demand to be more consumer-focused, noted one healthcare CIO during a recent healthcare innovation conference.
“We are going to be disrupted by Apple and Amazon, if we don’t change,” Adam Landman, vice president and CIO of Boston-based Brigham and Women's Hospital, said during a panel discussion at the FT Digital Health Summit in New York City last week.
At the same time, however, many forward-thinking healthcare executives see digital technology as a tool that can be leveraged to support value-based care with the aim of better patient outcomes at lower cost.
During the FT Digital Health Summit, sponsored by Financial Times Live, a panel of healthcare industry leaders, including Landman, along with Chet Robson, medical director, clinical programs and quality for Deerfield, Ill.-based Walgreens and Nelia Padilla, global lead, digital health at IQVIA, a company that provides technology solutions and contract research services, discussed the role of digital technology in achieving value-based care as well as the significant barriers to adopting digital solutions and the headway their organizations are making with digital innovation.
Speaking to the challenges, Landman, who also is an emergency physician, noted the oft-cited analogy that the leaders of healthcare provider organizations have one foot in two canoes—fee-for-service and value-based care. “A small percentage in most healthcare systems right now are in value-based care, and, in most health systems, in general, a much larger component is in fee-for-service. Many of us truly want to go to value-based care and embrace those practices, but I think it’s just very challenging. We’re only seeing some of the potential to the movement to value-based care.”
When asked by an audience member about why the adoption of digital technologies in healthcare was not occurring at a more rapid pace, the panelists cited a number of barriers, including the current lack of an evidence base around digital tools and health outcomes.
Operationally, digital innovation needs to be a priority, Landman said. “It takes a leadership mandate and it takes funding along with it, and it needs to become a strategic priority,” Landman said. “One of the challenges we face, on the provider side, there are a lot of competing priorities right now, and some are non-discretionary.” He noted the investment in implementing and optimizing electronic health records (EHRs). “That’s going to provide the base for this next stage of digital health. That’s one example of a must-do, and there are others in the regulatory and compliance space that need to be done.”
Digital technology adoption requires a balanced approach in healthcare, Robson noted. “It’s not only about, is it convenient for the consumer, but in healthcare, it’s also about, is it going to provide the best outcome for them?” he said. The Walgreens app has been downloaded 55 million times and the company fills about 3 million prescriptions a day through digital refill services, he said. Walgreens also operates 9,500 retail stores. “When you have engagement that solves a need for a patient, it definitely gets adopted,” he noted.
Progress with Digital Innovation and Unlocking the Value of Disruption
Padilla noted that healthcare is ripe for disruption from consumer-facing startups and digital companies because the space has lacked a consumer focus, citing startups that have developed apps to triage patients. “It’s difficult for institutions and for long-established players in the industry to go beyond the innate barriers, or some of the incentive systems, to actually offer some of these services."
Healthcare providers often engage the "worried well," Landman said, "or the patients that will adopt the Fitbits and who have their records going to Apple Health, but not the really sick patients, the ones who need additional monitoring and care." He added, "That’s been a continued challenge, along with trying to align the incentives so that we focus more on sicker patients. And we have been working with behavioral economists, psychologists and the whole team to think of creative ways to truly engage patients who need care the most."
Bringing to the discussion his experience as both an IT leader on the health system side, including formerly chief medical information officer (CMIO) at Adventist Health Partners, and an execuive leader on the retail side, Walgreens' Robson said, “As health systems, we tend to look at patient engagement as a push, we’re going to push the patients towards what they need to do. Being on the retail side, we try to attract patients and we are looking at it as a pull; we’re trying to make it fun, easy and meaningful to them. Then it’s about trying to connect those things together, both from the outpatient side and the hospital side, I think that’s how we can help to move the curve.”
At Brigham Health, clinical and IT leaders have found that data and analytics can be used to develop personalized approaches and “direct the right tools to the patients that need them the most,” Landman said.
“What we also found is that technology alone is not an answer. An app is just one component of a larger program and you really need to invest in the people resources around that program, which is typically a nurse coordinator or a social worker,” he said. “You’re engaging the patient with the app, and you’re offering tech support and services to make sure they are up and running and know how to use it, but then you are interacting with them. A social worker or care coordinator is monitoring the feedback and engaging with the patient. I’ve seen very few [programs] that will succeed with digital alone; it’s a bigger program commitment.”
Landman added, “We found this model, and the general principle is that all of us need to work together to truly achieve the vision of the quadruple aim, or value-based care. We need technology, we need the insurers and payers, we need the providers, the pharmaceutical companies, to all come together and be open to collaborating and thinking about new things. And then we need to try things and for things that we do get up and running, then iterate on them, and when we do find success, scale them.”
The panelists also noted that new data sources, such as patient-reported outcomes data and data from consumer wearables and sensors, will play a key role in driving value-based care forward, but there is more work that needs to be done to make that data clinically meaningful to physicians.
“We haven’t scratched the surface with new data sources that we can pull together, things as simple as sensors detecting if a patient has moved,” Landman said. He cited Brigham Health’s ongoing Home Hospital program to bring acute care to the home for patients who would normally be admitted to an inpatient facility. As covered in a July 2017 Healthcare Informatics article, the Home Health program, which is overseen by David Levine, M.D., a practicing general internist and research fellow at Brigham and Women's Hospital and Harvard Medical School, entails placing patch wearables on patients at home to monitor patient vitals as well as steps taken.
Citing the results of that program, Landman said, “What’s most predictive of how well a patient is doing is actually how ambulatory they are, so a simple sensor and an accelerometer that’s measuring how often they are getting up and how many steps they are taking, that’s extremely predictive of how they are doing,” he says. “As we connect and link these data sources, we unleash a whole new world of possibility. If we can partner with our academic colleagues and do the rigorous scientific studies and validate them, I think we can start learning a whole lot more about how to better manage patients and how to measure surrogate markers of clinical outcomes.”
Walgreens is making headway to engage patients using digital tools, Robson said. For example, the company developed an online tool called Find Care Now that helps connect consumers with healthcare services—whether in-person at a pharmacy, via phone or virtual consultation—based on the individual’s location, by zip code. “The idea is, how do we begin to take that information about individuals and make it actionable to help connect people to the correct resources to address whatever issue they are having,” Robson said.
At Brigham Health, a multidisciplinary team has been using a texting tool, developed by a company called Medumo, to enhance colonoscopy screenings. The tool provides patients with a digital colonoscopy prep guide in advance of their procedure, through instructions sent via text messages. The tool also sends appointment reminders and links to Brigham’s digital wayfinding system on the day of the appointment. Patient feedback indicates that patients feel more prepared for the procedure.
“With this simple use case, which we piloted both at Brigham and Women’s colonoscopy and endoscopy clinics as well as MGH (Massachusetts General Hospital), we saw decreases in no-show rates of over 30 percent. That’s a significant ROI,” Landman says. “We have some very encouraging results and we’re starting to expand that tool to other procedural areas and use cases. This is an example of where it’s meeting a real need and there are some palpable ROI that resonates with our CFOs that lets us then build this platform out.”
Panelists also noted other examples of health systems providing services to patients to support their use of digital technology at home. Ochsner Health System in southeast Louisiana introduced an “O Bar” service, a health information “genius bar” concept, at its Center for Primary Care and Wellness. “We’re going to see more of that as these interventions gain traction,” Landman said. In fact, Robson said Walgreens is considering a “genius bar” concept at retail locations.
On the technology side, panelists also noted that no one digital technology company currently offers a consolidated platform that integrates with health systems while also providing patients the ability to seamlessly share their data. “Right now, we’re in the fertile field stage of innovation where lots of best-of-breed solutions are popping up. But, I do think soon we need to see some consolidation. I hope over time that we’ll see some convergence of some of these great solutions into a true platform that you can buy that offers a seamless platform for both the system and the patients,” Landman said.
He also noted, “I think these aggregation tools that take sensor data, patient-reported outcome data, and pull that together and create displays for clinicians that are easy to access and layer clinical decision support on top of them, those tools are going to be quite powerful.”