As the purchasers and payers—both public and private—of U.S. healthcare continue to push providers forward to deliver value for the monies spent on providing care to patients (the employees and enrollees of said purchasers and payers), provider leaders are increasingly drilling down towards the core of patient care delivery to improve the clinical and financial outcomes demanded. In that, they inevitably are coming to recognize the need for clinical transformation—the reworking of care delivery and clinical practice—to make those deeper changes.
Clinical transformation was cited by the editors of Healthcare Informatics as one of the Top Ten Tech Trends the magazine named in its March issue, which will be published in print in the coming days. And this week, the Trends are being presented online, including the clinical transformation Trend. It was in that context that Editor-in-Chief Mark Hagland interviewed Brian Patty, M.D., CMIO at Rush University Medical Center in Chicago, in February; Dr. Patty was one of several clinician and industry leaders interviewed for the Trend. Below are excerpts from their interview.
What does clinical transformation look like to you right now, out in the field?
I think one of the coolest models I’ve seen is at Ochsner Health, with their digital medicine model. They’ve formed a unit called their digital medicine unit. They asked, what are the two biggest barriers to home monitoring? Because we really feel we can drastically improve outcomes among our high-risk patients through home monitoring. And the two biggest barriers they found were that primary care doctors didn’t know what to do with the home monitoring-based data, and patients didn’t know how to set it up. So they created the Ochsner bar, the O bar, modeled after the Apple genius bars in the Apple stores. And basically, patients can go there. They have all the equipment available, like weight scale, blood glucose monitor, fitness tracker, etc., and they set it up to connect with the patient’s phone, the Epic MySite, and they set up the patients. Then they set up this group to monitor these key patients and do virtual coaching of these patients in between their primary care visits. So the PCPs write an order to refer patients to a virtual medical group they’ve set up. And the virtual medical group fills out a form. And then they monitor the patients. And they started out with hypertensives who have never been in blood pressure control and who are seen several times a year. They had 400 patients referred to them, and within three months, they had 76 percent of those patients under control.
And how do you interpret what they’ve done, in the context of clinical transformation?
It’s a great example, because here, you’ve taken a difficult patient population that has not improved through traditional medical care delivery, and you’ve applied a new way of managing those patients—patients who had been chronically out of control for years. As a result, the patients are going to live longer and better, and will cost less.
And you had mentioned a virtual medical group aspect to this?
Yes, they’ set up an integrated practice unit—physicians, physical therapists, pharmacists, dieticians, nurses, social workers, etc. And this group of people said, what are the needs of these patients? What kind of team do we need? So this team manages these patients in between their physical visits with primary care docs, and they make recommendations, including for referrals to social workers, etc.
Is that where we have to go to achieve clinical transformation?
Yes, absolutely. And the side effect of this is that the patients become more engaged in their care.
In hospital organizations where it’s happening, what are the key elements?
The organizations where I’ve seen clinical transformation efforts work well are using Lean methodologies. And where we come in, it has to work in and through the EHR [electronic health record]. And if we can make a care delivery process work through the EHR, we can hardwire it. At HealthEast, we focused on that, on hardwiring processes through proper setup in the EHR, so that the easiest way is the right way. And whether you’re using care pathways or workflow navigators, or all the tools in your EHR, you have to understand those tools.
So now, you can support the organization by designing the workflow and care steps in the EHR, to make it flow, and to make it the natural workflow of someone who wasn’t initially involved in the design of this workflow, but as they walk through their workflow, it’s natural to the way they do it.
One thing that many leaders talk about is the continuous “blessed cycle” of gathering data, analyzing that data, sharing it with clinicians and using it to inform and guide the reworking of care delivery processes, and then beginning the cycle again through gathering data on the reworked processes.
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