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

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

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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