Undoubtedly, the rise of accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) will come with an added responsibility to physicians and other clinicians, who will be asked to meet specific quality metrics. In order to meet these metrics, which will be available for the world to see, patient care organizations’ implementation of clinical decision support systems (CDS) should certainly be helpful.
Is there any CDS tool that can be used before the point of care? That’s where virtual patient simulation, a web-enabled software solution that allows for diagnostic simulated training, enters the picture. Used for many years in medical school traning, patient simulation software is not by any means a new technology to the industry.
Increasingly, however, providers are looking to implement this technology for physician-based training and resource purposes. The Veterans Health Administration (VHA) recently awarded a $1 million contract to the Chadds Ford, Pa.-based Decision Simulation, to make their patient simulation software available for use for 43,000 VHA employees. Other institutions, like Duke University’s Human Simulation and Patient Safety Center, have used advanced simulation solutions, including 3D prototypes, for similar reasons. Banner Health, the 23-hospital system out of Phoenix, Ariz., also has a noted patient simulation program for providers.
James B. McGee, M.D., an assistant dean for medical education technology at University of Pittsburgh School of Medicine, is one of the leading voices on patient simulation in healthcare. McGee, also the scientific advisory board chairman at Decision Simulation, has been working on integrating patient simulation solutions into hospitals from more than 10 years, long before people were using the term ACO regularly. He says the ACO’s rising prominence provides the technology huge opportunity to grow in usage.
In a two-part interview series, HCI Assistant Editor Gabriel Perna recently spoke with McGee on how he thinks patient simulation solutions can match up with ACOs, where the challenges of adoption are, what it will take to get patient simulation solutions in hospitals across America, and whether or not there are cost issues. In the first part of the interview, McGee talked about how patient simulations fit an ACO, the clinical decision elements in a virtual atmosphere, and he goes in-depth about the VA’s system in particular, and how it can assist women in the military.
James B. McGee, M.D.
HCI: You’ve done a lot of research on patient simulations, how can this be used as an effective training method and help providers better align with the quality measures of an ACO or PCMH?
McGee: In the past, things like simulations and eLearning have been focused on trainees and medical students. But with the changes in healthcare delivery, and a lot of changes that physicians are adapting to, which are more focused on quality and outcome and meeting a performance expectation, it requires changes in the way we practice medicine. Previously, having the right knowledge and knowing the one best to test to use might have been enough to deliver good quality care. Now, it’s less about knowledge and more about making good clinical decisions that are compatible with guidelines, with evidence-based research, and that fit your own organization’s goals and quality initiatives. This idea, that making clinical decisions is more of a trainable skill and activity that you have to practice and be continuously up to date in, becomes more important. The classic approach was through continuing education; the future is educating physicians on making new clinical decisions, and adapting to new discoveries.
What kind of clinical decision elements are in a virtual patient atmosphere?
Most of the decisions are focused on two areas. One is selecting the right diagnostic tools and tests to arrive at the proper diagnosis; and then the other is selecting the right therapies for an individual set of conditions and patient. Touching on another new skill and concept for a lot of practicing physicians is the idea of personalized individual medicine. That’s where virtual patients really focus on training you to be able to better take the unique data from that particular patient and synthesize that information with the healthcare environment you are working in. It may be an ACO; it could be a rural hospital or an urban hospital, and once that’s done, you make a decision that’s individualized for that particular situation. We’re getting away from the one-sized fits all mode for clinical decision making, and that’s exactly where virtual patients can be simulations of these complex decision making scenarios.
How does the VA’s patient simulation program stand out, how does it work, and have there been any early results?
The VA has really pushed out ahead of the rest of the pack on seeing education and simulation more specifically as a tool for their practicing physicians. They’re focusing most of their efforts, not on medical schools and residencies like a lot of education in the past, but on changing the behavior of physicians on the front lines.
For example, they’ve recognized with the dramatic increase in the number of women in the military. Doctors in their emergency rooms, primary care departments, need to improve their skills in dealing with women’s issues. They have a large initiative under way already, and a few cases developed which take commonly encountered challenges and put the physician in the position of making clinical decision on a simulated patient. Perhaps you’re already well-versed on breast cancer screenings and mammograms, but you don’t perform as well dealing with other things like pelvic pain and other women’s issues that you may have not encountered as much. The software will direct your learning towards those particular topics, and after remediating you, it will test you again and give you additional opportunities to practice those skills.
They are still early in their development. They are seeing this as not only a way to train physicians generally, but also to put this patient simulation tool in the hands of regional VA health systems. If there are clinical challenges or if there are new initiatives, or more regional to a particular part of the country, educators there can develop patient simulation programs specific to their own needs. That’s one of the advantages to this kind of approach. It doesn’t require a large team of developers, and it doesn’t require the technical expertise that it has in the past, using software that is basically filling out forms through the web-browser and developing these collaboratively with experts. They are able to distribute the content development process to the various regions throughout the country.
Check back next week for part 2 of this interview