Improving patient safety with digitally integrated healthcare
Need for integrated healthcare and better patient awareness
As per a study done by John Hopkins University, medical errors are the third leading cause of death in the US after heart disease and cancer; a whopping 250,000 deaths per year! Most of these deaths are due to systemic problems such as poorly coordinated care or wrong/delayed diagnosis.
Another challenging area in healthcare is the management of chronic conditions or diseases such as heart disease, cancer, diabetes, arthritis and obesity. Chronic diseases not only have major cost implications but also contribute to the top 7 causes of death in the world today. Management of health for complex and chronic conditions requires systematic collection and monitoring of essential health parameters, coordinated and continual analysis of these parameters and prompt action on signals that can lead to adverse conditions or events. Treatment plans in these cases are prolonged and need to address complex developments across time. About one-fourth of the chronic patients suffer from two or more conditions warranting treatment involving multiple specialists from different therapeutic areas. In most cases, specialists typically address each condition in isolation; adding complication and fragmentation to the entire experience. Lack of synchronized care adversely impacts health outcomes and overall patient safety.
All these nuances make healthcare a complex arena that is difficult to comprehend and navigate by patients that are typically from non-medical backgrounds. However, it is a well-proven that better knowledge and awareness can motivate patients to take active roles in managing their health as well as enable them to partner with providers in taking right and timely health decisions. Patient safety is of prime concern and developing deeper patient engagement while providing an cohesive patient-centered ecosystem can positively influence outcomes and reduce overall healthcare costs.
Role of technology in patient awareness and healthcare integration
Technology has advanced significantly in drug discovery and development, medical and diagnostic devices and personal health management, but is technology being leveraged sufficiently to provide a holistic and integrated healthcare experience to patients? How can digital transformation across the hospitals and medical ecosystem provide tools and processes to educate and alert patients so that they are well equipped to take active roles in their healthcare?
My blog explores some of the available technologies that are enabling healthcare management and increasing patient safety and also delves into possible additions that can further enhance the ecosystem.
Current trends and advances in digital health care
Digital technologies such as social collaboration tools, mobile devices and sensors, big data and analytics, cloud platforms, IoT and gamification are already enabling an enhanced health ecosystem, empowering and educating patients while allowing physicians to provide better health care. Digital transformation in healthcare has allowed for:
- A comprehensive health map of the patient with complete information that is available in an easily accessible format with Electronic Health Record (EHR) Systems: The use of Electronic Health Records (EHR) to collect patient data provides an opportunity to derive patterns, analyze risk factors and premeditate early intervention. A sophisticated EHR system can warn about drug interactions, help with diagnosis and provide guidelines on treatment options. It’s also allows sharing of data across health providers, thereby providing an integrated view of a patient’s treatment plan. An EHR at its simplistic level could provide the ability to a physician to remotely fulfill medication refill request by assessing the patient’s medical record on the EHR system via. mobile devices. Apart from helping individual patients, there are a number of success stories of use of EHR data for improving public health by analysis of collective data; a Michigan hospital system reducing vaccine preventable disease through immunization registries, community health centers in Utah improving blood pressure control in diabetes patients or the use of immunization registry in San Diego to improve overall public health.
- Cloud, big data and analytics allows collection of data across various health systems and devices and helps create a comprehensive health map for an individual or community. Analysis of collective data can provide aggregated views and patterns across an ethnicity, region or demographic thereby equipping physicians and medical researchers with valuable data and insights. Similarly, big data and analytics has also enabled significant strides in genomics and genetic data research thereby speeding diagnosis and treatment of complex conditions
- Collaboration Tools and Social Media: Patient networks provide valuable information along with much needed motivation and support to patients and their care givers. An interesting success story on patient’s networks has been told by Dave Debronkart on Health IT. On discovering that he had stage IV lung cancer, he was advised by his doctor to join the ‘www.acor.org’ community for cancer patients. Very quickly he learned about a treatment called high-dosage ‘interleukin-2’ along with a list of doctors that offered it in his vicinity from his fellow community members. After 2 doses of interleukin-2, two months apart; Dave’s tumors began to shrink and year and a half later he was cured of cancer! Patient knowledge portals and patient-provider collaborative tools encourage participative medicine and are powerful tools in enabling patient engagement and involvement in the provider’s decision making process.
- Continual monitoring and active patient role in health management using wireless connected devices: With the vast proliferation of medical devices and sensors, from eyeglasses that monitor critical health parameters to smart socks (http://www.sensoriafitness.com/technology) that track activity, technology has impacted the personal health space like never before. With wireless technologies, IoT, and powerful analytics it is possible to store and track vital parameters and send alerts to health care professionals in case of discrepancies. Availability of this data in real time can provide valuable insights and allow individuals to monitor their health and take timely and appropriate corrective measures
But, is this enough?
Clearly the proliferation of technology has already made significant strides in healthcare. However does the current ecosystem lack a central entity or a single coordination system that orchestrates everything related to an individual’s health? Let me elaborate with an analogy.
The management of any major complex project requires a competent project manager who plays a key role in orchestrating the entire project and ensuring that all aspects of the project are handled with careful planning and seamless coordination. The Project Manager ensures that risks are anticipated, controlled and mitigated and all activities and events well planned and executed efficiently. Unfortunately it is expensive and practically impossible to employ a human resource for an equally or even more complex situation that needs to be addressed around patient health management. With the advance in digital health can such a digital resource be envisioned? Perhaps a ‘Digital Health Manager’ that tracks vitals, sends reminders and generates alerts for patients, physicians and care providers; and possibly even arbitrates to prevent human interventional errors caused by negligence or malpractice.
Some of the missing links in the existing digital ecosystem that I believe can be plugged by the use of a ‘Digital Health Manager’ (DHM) are as follows:
Multi entity integration :
- Multiple EHR systems: While the ability to view and track all aspects and parameters related to an individual or patient on a common platform exist, thanks to EHRs; the data remains contained within the healthcare organization that it was collected. True value can be derived when multiple health organizations and entities share data and create a seamless unified profile of the patient. With the Health Information Exchange (HIE) in the US this is becoming more of a reality, but the program faces its own challenges related to technology, stakeholder engagement, and an uncertain business case for financial investment from care providing institutions.
- Multiple devices : Capability to not just capture data across EHR systems but various devices, sensors, diet and lifestyle data to create a simplified unified view of the patient’s health profile
- Multiple providers : Ability to provide coordinated care across multiple physicians and s pecialists treating a chronically ill patient taking into consideration collective treatment plans, medications, drug interactions and lifestyle parameters. The ability to allow and track dialogue between these providers with an aim to provide synchronized, non-fragmented healthcare experience to the patient.
- Intelligence to analyze collated treatment plans, pathology and radiology reports, diet, exercise etc.
- Dashboards that display health response and health trends against ongoing treatment plans to help physicians navigate and manage the course of treatment effectively in a timely manner
- Analytics supported by intuitive dashboards to observe health trends across time and treatment. The ability to track effect of medications on various health parameters (lab test reports, device data etc.) and generate real time alerts for negative readings with actionable messages to patients and care providers
- Predictive analytics built in to analyze patients historical health trends and generate alerts and messages to take preventive treatments in advance
- Sufficient and meaningful concise information nuggets to chronically ill patients regarding his/her condition, treatment plans and risk indicators
- Early reminders on periodic checkups, tests and health plans required to manage chronic diseases with an aim to preventing future adverse events
- Customized lifestyle pointers pertaining to diet, exercise etc. depending on the individual health profile
Healthcare is intensely personal in nature and even today largely dependent on the knowledge and ‘humanistic’ perceptive capacity of the provider in assessing and treating a patient, often in a limited period of time. The digital tools listed above can provide a certain scientific and holistic picture of a patient that can aid physicians in making informed evaluations during both diagnosis and treatment. The ‘Digital Health Manager’ will not only equip patients with adequate knowledge but also provide a patient centric unified approach with relevant controls to address any inconsistencies that arise. With the optimal combination of human involvement and digital intervention, we can strive towards truly enhanced patient safety and improved health care around the world!