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Patient Simulation: An ACO’s Best Friend? (Part 2)

May 11, 2012
by Gabriel Perna
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In a two-part interview series, James McGee M.D., talks about the value of patient simulation tools for an ACO

Last week, HCI Assistant Editor Gabriel Perna spoke with James McGee, M.D., an assistant dean for medical education technology at the University of Pittsburgh School of Medicine, on the topic of virtual patient simulation, a web-enabled software solution that allows for diagnostic simulated training. McGee, also the scientific advisory board chairman at the Chadds Ford, Pa.-based patient simulation vendor Decision Simulation, thinks the technology can help providers create accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).

In the first part of that interview, McGee explained why he says patient simulation tools line up perfectly for ACOs. He says making clinical decisions is becoming more of a trainable skill and activity that you have to practice and be continuously up to date in. Patient simulations allow for better evidence-based care in this regard. He also says virtual patients can be simulations of complex decision making scenarios. Lastly, he talked about the Veteran’s Health Administration’s recent patient simulation investment, and what the technology will entail.

In this part of the interview, McGee talks about what it will take to get widespread adoption for virtual patient programs, what are the challenges of the technology, and how does cost play into everything. Here are excerpts from that interview.

James McGee, M.D.

What will it take to get virtual patient programs in every hospital across the country?

The [patient simulation] software, since it’s a hosted application, is fairly straightforward and since it can run on any work station, it’s really a no-brainer. It’s more the development of cases for your own institution that requires some planning and additional effort beyond just licensing the software. We’re recommending, either through workshops at some of the national meetings or some of the training programs we put on, that your team of educators spend some time developing a process of identifying the decision-making and performance and quality related activities that would benefit from on-screen simulation. Then it’s working with your local subject matter experts, perhaps bringing in your own instructional designers, which you can use and adapt to your local needs, and use to also to get an idea of the decisions your clinicians are making now.

Right now, we’re right at that stage recognizing that we have to track performance and know how well we are doing. So things like dashboards and regular reports are becoming a part of practicing medicine. The next logical step is to engage in activities that change the way we practice medicine in a positive way, so we can recognize where there’s a deviation in quality, performance, or patient satisfaction. Then we can use these tools to affect a change in healthcare providers. And it’s not just me saying that. If we look at the traditional continuing education or even e-learning, it’s linear and didactic in nature, and relatively ineffective in changing the way healthcare providers carry on their day-to-day business.

But if you put it into an active learning experience, once that is case-based and responds dynamically to a learner’s decision-making and delivers the remediation on the fly, that’s where research shows you can actually translate new skills to the real world and see improvements in performance. That’s exactly the standard we’ll be expected to work within. Someone will measure outcome of our patients, and it’s going to affect us in pocketbook if we don’t meet national standards and improve in areas where we’ll need to be able to do better.

What are some of the challenges of the virtual patient program environment – and how can those get addressed?

I think one of the early challenges we’re seeing is this is a new type of learning. It’s well-accepted and clinicians and educators take as face-value that it is a logical way to teach people, and in particular, branching type scenarios, where there is more than one outcome and path that you can go down. The problem is they are used to teaching linear ways: PowerPoint, textbook, journals, etc. These are linear teaching experiences. This adaptive, branching-out way is a new concept that we need to wrap our arms around. Beyond that, there’s a lot to be taught, there are a lot of guidelines coming out and we’re learning more and more on how we perform not as individuals but as groups with an organization and how that impacts a patient organization.  What I hear over and over again is that the software is really easy to use and the concept makes sense, but getting used to teaching in a different way takes a little bit of time. 

What about the possible concerns, from a physician and provider standpoint, about time and possibly cost?

With any educational program, there’s bound to be some cost involved. In the case of virtual patients, because there is some production cost in creating your cases, you want to select topics and audiences that are fairly broad. You want to use large audiences so you get more benefit for greater number of people. The other piece of that’s kind of new concept for us is the investment by an organization, like an ACO, to be able to see an investment in education and training, that will have an outcome that is both financial and in quality of care. That’s something, in the past, that wasn’t easily measured. We thought education was a good idea, but it wasn’t easy to see how it affected things, but now we will. If anything, the cost equation will be easier to justify than it has been in the past. It will be necessary for those performance metrics, that not only the third party payers will be expecting, but patients as well.

How should CMIOs and CIOs approach implementing a virtual patient training environment for their hospital or healthcare system?

These types of decisions, to use a virtual patient environment, it’s essential for the CIO, CMIO to get the buy-in of their constituency to get validation for the technology. Make sure it’s compatible not only with the hardware and software that’s currently being used, but the workflows that their doctors are engaged with. It ends up being a multiple perspectives that have to buy into this. Where the CMIO might lead the initiative, the leadership of the healthcare organization, the physician constituency, and even the patients have to buy into the concept that improving clinical decision making and the quality of care is worth the investment. The technology is easy. Changing the way we think about how we practice and our responsibility to train ourselves in providing best quality care, using some tools that might be new but we know are more effective, that’s where it’s more of a cultural change than a technology. I think CMIOs are used to those being one of their challenges.

It’s an exciting time for virtual patient technology, which like many technologies has been around a long time. They’re easy enough to develop and the technology is mature enough, now it’s a responsibility of the organizations that are trying to improve healthcare outcomes and performance, to take the risk and make the effort to use these new educational tools that research shows will be more effective.


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