Healthcare IT October 8, 2013

Evolving to Health 3.0

by Barry P Chaiken, MD

The dramatic shift to value-based reimbursement requires all providers to completely disrupt their care processes and workflows to ensure the delivery of high quality, safe care at a reasonable cost. For more than four decades these same providers thrived in an environment where providing more care easily generated higher prices and profits. In that former reimbursement model, a serious and dangerous moral hazard existed where the instinct to “do no harm” clashed mightily with a similarly powerful driver to maximize income.

Due to this shift forced by provisions of the Affordable Care Act (ACA), hospitals, clinics, physicians, and others in the healthcare marketplace find themselves scrambling to reinvent the way they provide care. In competitive markets, large changes, such as those dictated by this new reimbursement model, provide opportunities for those nimble enough to design new, adaptive paths forward that allow them to emerge as winners. Organizations and individuals that fail to change will find themselves the losers, either acquired by those able to adjust or simply out of business.

Organizations that will survive under the new realities of ACA recognize the power of healthcare information technology (HIT) to assist them in reworking their business processes and clinical workflows to achieve the goal of high quality, affordable care. Effective approaches to change include leveraging recent HIT investments and the reinvigoration of legacy systems.

Health 1.0

Due to these dramatic changes, healthcare is emerging into Health 3.0, a natural evolution of increasing value obtained from the use of a broad swatch of HIT tools. Health 1.0, begun decades ago, encompasses the period where business and administrative systems became regular fixtures in every healthcare facility. ADT systems digitized admission, discharge, and transfer of patients. Financial systems computerized patient billing and the general ledger. Most recently, organizations used HIT to assist with enterprise resource planning (ERP), staffing, and management of the supply chain. All of these transactional systems produce “data exhaust” that could be collected in a data warehouse for later analysis.

Health 2.0

Although many organizations planned or already deployed clinical HIT systems, the HITECH act drove the dramatic expansion of the era of Health 2.0, represented by the deployment and use of these computerized clinical systems in both acute and ambulatory care environments. Economic incentives and the fear of soon-to-be implemented financial disincentives helped fund these HIT investments, while Meaningful Use qualification criteria ensured that the new technology was configured to delivery-targeted results. In addition to the traditional focus of Health 2.0 on leveraging web tools, Health 2.0 represents the utilization of electronic medical records (EMRs), radiology picture archiving and information systems, patient and physician portals, laboratory systems, and other clinically focused HIT. As seen in Health 1.0, these Health 2.0 transactional systems also generate “data exhaust” that, if collected in a data warehouse, provides a valuable source for later investigation.

Health 3.0

The era of Health 3.0 ushers in new, disruptive uses of HIT that leverage past technology investments to obtain maximum value from newly created technologies and digital trends. Health 3.0 pioneers the innovative use of information technology’s proved valuable in other industries to enhance the quality and safety of care delivery while delivering superior cost outcomes. This new way of using HIT offers great value in multiple areas including care collaboration, population health, and cost accounting.

Two key principles underlie Health 3.0 thinking:

    1. Leverage existing transactional systems to provide a data source for in-depth meaningful analysis.
    2. Focus on the user experience and its impact on workflow and outcomes.

Use of transactional data sources allows organizations to better understand and manage their processes and workflows, leading to an iterative approach to continuous improvement of those activities and related outcomes. More importantly, utilizing these data sources within an environment that emphasizes the user experience allows for the development and implementation of processes and workflows that can quickly and dramatically impact outcomes while delivering an HIT tool that compels its use.

Social networking technology is just one example of a generally available technology focused on the user experience that can transform the use of HIT in care delivery. For example, consider the success of Facebook’s timeline feature. Lost friends who one day “friend” on Facebook can utilize the timeline feature to discover many things about each other during the time they were out of contact. Similar to clinicians flipping through the pages of a paper or digital medical record, clinicians utilizing a Facebook timeline-like application could digitally flip through a patient record, with each of the data points drawn from various clinical transactional systems and represented by attractive and meaningful icons and colors.

Vital signs, obtained from an EMR or directly from a medical device, can be represented with a specially defined blue icon, physician notes with a green icon, STAT orders with a blinking red icon, and procedure reports, a grey icon. Similar to the way newly connected friends can learn details about each other’s family, work or travel, clinicians can rapidly understand the important factors that describe the patient’s current condition.

Synchronous communication – such as a call from the radiology department to the floor nurse to arrange to transport a patient to the department for a procedure – is transformed to asynchronous communication through text messaging or similar functionality. Connecting devices to the “social network” allows them to participate in the conversation and facilitate patient care. For example, a connected IV pump signals the social network that the antibiotic infusion is complete and the patient is now available for transport.

Other examples of Health 3.0 tools include the application of customer relationship management systems that impact consumer behavior through text messages, outbound calling, and emails, to change patient behaviors to more healthy ones. This might include variously formatted reminders to seek flu vaccine, follow medication instructions, or visit a primary care physician for a quarterly HbA1c test.

Many other uses for disparate new technologies within the Health 3.0 framework exist and require exploration. Newly introduced technologies in the months ahead will offer further capabilities that also require exploitation. While the technologies developed and deployed in eras Health 1.0 and 2.0 delivered great value in the age of volume-based reimbursement, Health 3.0 offers promise that technology investments from these previous eras can be leveraged within a new user experience that delivers easy to use and compelling applications that satisfy the needs of a value-based reimbursement world. As our society embraces and further demands IT tools that are both meaningful and pleasurable, organizations that embrace the Health 3.0 framework for their HIT tools will be better positioned to thrive.

Excerpts from “Evolving to Health 3.0” published in Patient Safety and Quality Healthcare

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