Connecting the Dots: A Dynamic Evolving Vision
Published March 2003 in the CAPG.org newsletter
Knowledge is powerful medicine. It reduces healthcare costs and improves the quality, effectiveness and efficiency of care delivered.
Patients and their caregivers are empowered by using new communication technologies so as to improve their access to health knowledge (and even wisdom), self-care, decision support, referral, consultation and triage services.
The current trend towards consumer-driven healthcare and capitated, integrated healthcare systems, with the assumption of financial risk-taking on the part of physicians, and patients hasten adoption of these innovative care management solutions. Providing timely knowledge through local community healthcare utilities via easy-to-access learning modules (utilizing words, pictures and sounds), to providers in their offices and homes, to patients and their caregivers at home and other points-of-care, to employees at their worksites, in the language of their choice, is an achievable objective.
Expanded use of the telephone, the most underutilized medical communications device (MCD) along with newer, more robust communication technologies (web appliances) can be expected to reduce costs, and improve access to quality care. The provision of two-way electronic knowledge services, along provider-patient networks and into and out of the home and worksite, will:
improve the efficiency of clinical data collection and reporting;
create a knowledge base that accelerates dynamic best practice guidelines;
encourage continuous care management of patients with chronic conditions;
improve patient comprehension and compliance;
increase the quality-of-care delivered (via home monitoring and surveillance of physiologic, cognitive, affective, and behavioral status on an as needed basis);
more readily assess risk status and promote earlier proactive ‘best of practice’ interventions;
reduce the frequency of unnecessary admissions, office visits and the number of 'required' home visits by allied healthcare professionals.
The increasingly integrated application of interactive telecare communications, i.e. - interactive voice response technology, personal computers, multimedia training, cable TV and secure, internet connectivity fundamentally alters current healthcare business.
The two most promising applications of these communications technologies are the management of care delivery across the highly complex and fragmented continuum of disparate providers and the initiation of services at the most appropriate place and time.
Care Across the Continuum
Five years ago, making health information available across a network of providers was only a hoped-for fantasy. Today, information and knowledge technologies (KT) is making that dream a reality. Community Healthcare Information Networks (CHINs) and Utilities (CHIUs), linking patients to patients, patients to physicians, physicians to physicians, physicians to hospitals, hospitals to other institutions, and all of them to payors, are being designed and implemented.
Demand and Disease Management Technologies
We have witnessed the design and implementation of marketing responses to consumer, employer and payor ‘wants and needs’.
These have included:
the adoption of voice and key pad data entry via the telephone and computer, the exchange of information and knowledge, counseling with support groups, the utilization of a more secure and structured internet, of interactive television, of automated home monitoring systems, of nurse advice hot lines and most recently of emerging wireless communication technologies. All of these have expanded greatly during the last years of the 20tth century.
Such user-friendly technologies enable patients to participate at new levels of involvement in their own healthcare, with or without interfacing with traditional providers. With mounting financial incentives to by-pass costly hospital and specialty service providers, true ‘managed care’ organizations (and a plethora of ‘managed cost’ entities), pharmaceutical companies and numerous start-up vendors now offer a wide range of care management strategies for virtually every chronic care condition.
Unfortunately, many of these strategies were implemented in an ad hoc, and fragmented manner. A comprehensive, integrated approach to the deployment of these rapidly emerging management solutions could be consolidated so as to avoid confusion, costly duplication and conflicts among key stakeholders.
Opportunities for Managed Care Connectivity
Appropriately designed, implemented and maintained communication channels make it possible to provide inexpensive, efficient and engaging linkages across the local healthcare community. Many companies, integrated delivery systems, pharmaceutical and managed care organizations recognize that the telephone and the internet are excellent marketing and connectivity tools for:
instant and comprehensive dissemination of timely, provider specific knowledge such as health plan costs and benefits, physician site locations and biographical profiles, and urgent care advice from call centers staffed by competent professionals . . .
access to clinical guidelines and decision support……
access to an individuals longitudinal personal health record ……
(provided authorized consent has been obtained)
member health status and risk assessment information gathering by robotic voice response via outbound telephony. . .
structured and secure e-mail messaging between providers across the care continuum and directly into patients homes . . .
a communications forum or professionally moderated chat rooms (typing rooms) for patients with chronic disease conditions wishing to communicate with other patients about common conditions, experiences and treatment strategies . . .
enrollment for self-help training programs, on-line teleconferences and participation in regularly scheduled healthcare seminars by telephone, television or via internet connectivity . . .
secure areas of communication channels (intranets, virtual private networks) used to disseminate information to select audiences, e.g., clinical updates, management reports, and marketing promotions . . .
cost effective connectivity to private WANs, and public CHINs and CHIUs to access geographically remote care sites or other providers anywhere.
Perhaps the contemplated deployment of the National Healthcare Information Infrastructure (NHII) will accelerate the manifestation of this evolving vision. In the interim providers and payors would do well to come over to the solution side of this growing healthcare challenge.
Ronald J. Pion MD