The Journal of mHealth Vol 3 Issue 5 (Oct/Nov)

How Care Pathway Management Can Connect Operational & Care... How Care Pathway Management Can Connect Operational and Care Processes By Larry Roshfeld, US General Manager, Lumeon Medicine is a science, but the actual practice of medicine across the care continuum is of ten less consistent and less quantifiable than patients and practitioners would like or expect. Some of this is because treating people is more complex than a standardized production process such as manufacturing or repairing a car, but much of the variance in treatment is because the delivery of healthcare is managed on an ad-hoc and manual basis, even as discrete steps in the process are automated. The result is reduced visibility and ongoing difficulty in measuring both individual patient outcomes and improvements in population health. Integrated care pathways (ICPs) were introduced more than three decades ago, but until the digitization of healthcare records and administration systems, it had been difficult to design optimal pathways due to the siloed nature of clinical data and the inability to share knowledge across clinical areas, let alone between providers of healthcare services. This lack of data sharing has often led to the use of complicated paper trails, which can result in duplication of effort and missed appointments, overburdening healthcare providers with administration tasks and leading to inefficient treatment processes and poor outcomes for patients. Applying technology to clinical pathways is of increasing interest to healthcare providers, and a tremendous amount of time and money has been spent automating individual steps in the healthcare delivery process, including not only Electronic Medical Records (EMR) systems, but also scheduling systems, billing systems, and even patient portals. By integrating the organizational knowledge of pathways with existing siloed information systems, healthcare providers can manage pathways in a more proactive way. This approach also supports the development of patientcentric processes, which in turn leads to better coordination of care and reduces the negative outcomes of past approaches. In most cases, multiple software products have been deployed in a single hospital, practice or surgery center, each automating one or more of a provider’s previously manual processes. However, the automation of separate silos leaves process gaps between the different software systems, gaps which are typically bridged using people and paper. The goals of implementing much of this technology, often driven by regulatory incentives such as Meaningful Use, were to increase efficiency, visibility and interoperability, with the 24 October/November 2016 end result being better, more consistent and more cost-effective care. And while the effort was well intentioned, the results were sub-optimal. In many cases, technology that was supposed to be automating processes and making them operate more efficiently consumed a lot of time and money with no visible or quantifiable improvement in outcomes or efficiency. Physician interaction with these systems highlights the broader problem. Physicians consistently report that they now spend half of every patient visit typing and clicking. One physician I spoke with counted 72 mouse clicks during the course of a single 15-minute follow-up appointment. Many patient satisfaction surveys note that patients feel that clinicians don’t pay attention to them, just to the laptop screen. As a result of the documentation process, a physician is now spending time with patients manually manipulating information that should be automated as part of a workflow process. Ironically, rather than in a single “old fashioned” paper chart, data about a patient now lives in multiple disconnected systems. Practitioners automated individual steps instead of automating a complete end-to-end care pathway. Many would argue that automation within silos was a step backward in terms of actual patient care, and since the resulting data is now isolated in separate silos, it is difficult to use as a source for analytics to view the big picture. Consequently, there is no improvement to visibility within and across the care continuum at the patient or population level. Rethinking Healthcare Delivery How do we rethink the automation of healthcare so as to deliver value both to the patient and to the broader community? The problem isn’t technology, or motivation. The fundamental problem is that most of today’s systems were designed in the 20th Century for pay-for-volume processes, while the 21st Century is evolving to pay-for-value. How do we get there from here? The key is to understand the need to target the automation of horizontal care pathways rather than vertical functional steps in the process. The good news is that some healthcare organizations are taking this approach, and are achieving measurably better results. They’re seeing better care outcomes, at a lower cost and with greater predictability and patient satisfaction. They’re enabling a repeatable and cost-effective delivery of quality care at scale. The result? Care delivery is effectively system driven. Clinical and administrative steps that can and should be automated are automated. Providers’ time is spent managing complexity by exception, not as a rule. Configurable automated rulesets drive predictable and manageable care for patients. Clinicians get a consolidated view of patient care, while providers design, implement and scale new models of care that deliver better outcomes How Care Pathway Management Can Connect Operational & Care... at lower cost. And patients are happier, healthier, and more involved in their own care. occupational health services for high profile corporations such as Bloomberg, PwC, Clifford Chance and Lloyd’s of London. Care Pathway Management (CPM) provides a single, real-time view of the entire patient journey, from referral to outcome. It is a process automation layer on top of existing software systems, integrating existing clinical and administrative systems without having to remove or replace them. CPM gives providers the ability to design, automate and measure their own pathways, rules and processes. The result is that each patient automatically progresses through their personal care journey based on their individual data. Blossoms, in competition with “free” healthca re services in the UK provided by the NHS, wanted to provide superior customer service and competitive differentiation by personalizing every element of the patient journey. The goal was to maximize clinical capacity, increase flexibility, integrate care across specialties and facilities, and improve the sharing of actionable data, all while improving patient satisfaction and outcomes. For providers, a CPM approach to healthcare delivery is measurable, predictable and eliminates variance. The key is that it transforms isolated units of data into quantifiable and actionable information. Patients see the right doctor or specialist more quickly because their referral is tracked and triaged electronically. Patients never have to re-enter information, can manage appointments online, and have ready access to relevant information on treatments, follow-on care and outcomes, all based on data currently residing in existing systems. CPM allows you to achieve greater value from your existing investment in systems such as EHR/EMR and scheduling. Blossoms/HCA Increases Clinical Capacity 20% with CPM Let’s consider an example. Blossoms/HCA is part of the prestigious HCA group, and pride themselves on offering expert care and patient service. With five sites across the UK, Blossoms acts as a ‘one stop shop’ for appointments, health assessments and Using the principles behind Care Pathway Management to leverage their existing systems and data, Blossoms fundamentally changed their business. For example, Blossoms had been losing approximately six percent of their appointment income on noshows and cancellations. Their new approach measurably reduced this loss. Not only were profits improved, but clinical capacity increased by 20 percent, meaning that doctors were spending more time with patients. Against a background of failed and expensive EMR implementations, this is a remarkable achievement. The market shift in the U.S. to value-based care presents an opportunity for providers to significantly improve both quality of care and financial performance. Providers can benefit from greater efficiency and cost savings, driving improved results in terms of cost, quality, and outcome measures. Patients can benefit from a better overall experience and improved outcomes. Care Pathway Management is an approach that healthcare providers can utilize today or implement in increments, to ensure success, helping deliver better care, for more patients, at a lower cost. n

The Journal of mHealth Vol 3 Issue 5 (Oct/Nov) | Page 26