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A Potential Passport for Care Coordination

April 27, 2012
by Gabriel Perna
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Doctors at Beth Israel Deaconess are trying to succeed in patient engagement where others have failed

Steven D. Freedman, M.D. is looking to improve communication between patients and physicians, not only during the office visit, but beyond it as well.  Freedman, chief of the Division of Translational Research at Beth Israel Deaconess Medical Center in Boston and a professor of Medicine at Harvard Medical School, started up the Passport to Trust foundation alongside Mark Aronson, M.D., Professor of Medicine at Harvard Medical School, to do just that and improve the overall patient-physician encounter.

“One of the problems and barriers in healthcare is that generally the office visit is a black box,” explains Freedman. “You may get a great doctor. You may get a not so great doctor. It’s a one-way communication where the doctor says to you, ‘Here’s the test that I recommend, why don’t you see me back in six weeks.’ They and their families generally are not informed partners in their care. And then we wonder why patients may not follow our recommendations.”

For improving in-visit interactions, Passport to Trust physicians created paper-based written summaries of the patient’s plan of action during the visit. The results, according to a study done by Passport to Trust, were successful, with 97 percent of the patients finding the written summary of the plan able to address their concerns. However, to get patient engagement and interaction ramped up in between visits, Freedman and those at Passport to Trust are looking to go digital with the initiative.

Going Digital

Freedman and Aronson are joined by Camilia Martin, M.D., director for cross-disciplinary research partnerships in the Division of Translational Research, as well as a professor at Harvard Medical School. Martin has assisted Freedman and his colleagues in developing the digitized Passport to Trust process, using customer relationship management (CRM) vendor, NexJ Systems (Toronto) to create the virtual platform. The result is the Digital Passport to Trust, an online medical dashboard, currently in development, aimed at creating a constant two-way communication platform for physicians and providers.

The Digital Passport to Trust dashboard, which will launch in the next 6-9 months, will aim to create a care plan that is easily accessed by patients and providers, with an easy-to-understand, mapped out step-by-step, week-to-week guidance plan. This monitoring will allow for real-time, evidence-based medical work by the provider, rather than just continuously bringing the patient back to the hospital for a visit time-and-time again. The platform will store cloud-based aggregated information, so, Freedman says, physicians can use case-studies of what works, what doesn’t for future patients.

The dashboard will allow patients to talk to other medical professionals, according to Martin, which in turn can allow physicians to gain a more comprehensive understanding of a patient within the system.  More than anything else, Martin says, the platform will give both patients and doctors an opportunity to go to the same portal to have an open discussion. Some of the other personal health engagement platforms have failed to gain adoption primarily for this reason, she says. 

“We were at a conference where we were able to see a lot of different applications, health applications, things that you use to monitor and track your health,” Martin says. “I applaud those efforts, it’s amazing technology…but what we both realized at the conference is that the physician was completely missing. If I want to use that application on my device, who is looking at it? Who is acting on that information? The physician isn’t because they aren’t equally armed with those systems to react to it.”

As Freedman says, Passport to Trust’s digital platform is aiming to be at the intersection of empowering the patient and the provider, rather than one or the other. “If there’s a Venn-diagram and the patients are one side and the providers are on the other side, no one is trying to bring them together. We’re trying to live at that intersection,” he says.

All Over the Hospital

Both Martin and Freedman say this platform will appeal to all types of patients at a hospital. While developing the platform, they both realized this after discussing how it could apply to their divergent backgrounds, Martin from neonatal care and Freedman from gastroenterology.

“Everything Steve was talking about to incorporate this into the outpatient world of adult medicine, I felt we were practicing in the NICU (neonatal intensive care unit),” Martin says. “And so I started to think how we structured that day-to-day, and how we kept all parties involved, and how can we apply those principles, even though it’s a different setting, in the outpatient as well. It takes more coordination but that’s where the technology will help.”

Across the entire hospital, the regulatory implications for patient engagement are well known. Stage 2 of meaningful use under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA/HITECH) Act asks providers to have 10 percent of their patients view their health record. Other reforms, such as reducing readmissions and building Accountable Care Organizations, also rely on strong patient-provider interactivity.

Along with engaging patients and giving them a care plan, Freedman sees Digital Passport to Trust as a way to bring about other regulatory-based changes for providers. “It would allow, by forcing physicians to justify tests and treatment, I think that it would provide higher quality care and potentially decrease costs,” he says.

While those benefits may eventually come, Freedman and Martin are focused now on continuing development of the platform, which they say comes with a HIPAA compliant multi-layered, encrypted security model. The platform will be tested for a one-year clinical trial, using outpatient physicians at Beth Israel Deaconess, and ensuring it can be incorporated into a physician’s workflow.

“We’re going to focus on the hot-bed areas, like diabetes, where we know pay-for-performance is an issue and patient compliance is not so good,” Freedman says. If all goes well, he says, the possibilities for enhancement on the platform are endless.

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