UNC Health's system director of digital health and innovation wants to take complexity out of the healthcare journey and give patients a simple path to care.
For many health systems, consumer activation is defined by the digital front door, and that doorway enables the visitor to quickly identify and find the resources that he or she needs for that healthcare journey.
"It's a continuing, evolving platform," says Dan Dodson, system director of digital health and innovation for the Chapel Hill, North Carolina-based health system. "What we need to know is how do we get it into [patients'] hands so they can begin their journey."
To borrow an analogy familiar to North Carolina Tarheel fans, many health systems see the patient's healthcare journey like a basketball play, with players passing the ball around until someone sinks the basket. But in today's patient-centric healthcare world, that patient wants to get to the basket in as few moves as possible, without the annoyances and stress of passing through so many different players and hands.
That's why health systems like UNC are pulling together all the apps they've launched over the past few years and combining them into one platform.
Dan Dodson, system director of digital health and innovation, UNC Health. Photo courtesy UNC Health.
"This is the use-case call to action that's relevant," says Dodson (who, for anyone still following the analogy, went to both Kansas and Kansas State). "You need to go to where the people are to get their attention."
While there are many different ways that a visitor accesses a health system, the majority of visitors are looking to connect with someone for a healthcare concern, and they want to know who to connect with, where, and when. With that starting point, UNC health partnered with digital health companies Gozio and WELL to create a wayfinding platform that sends text reminders about upcoming appointments and directions to that appointment.
That's just part of the journey, Dodson says. That appointment reminder includes a smartlink to the app, which the patient downloads. That app is pre-populated with patient-specific information on locations and other resources, even parking tips, and then synched with a calendar, giving the patient all that he or she needs for that appointment.
"That's how we start to make it efficient," he says. "The experience has to be seamless [for the patient], or they might find something that is easier next time."
This focus on the digital journey was, in many ways, shaped by the pandemic. COVID-19 prompted many health systems to jump onto the virtual care bandwagon with both feet, fashioning online portals and apps so that patients could access needed healthcare services from the safety of their own homes. In the process, they created multiple online platforms, adding new apps to those that had been launched over the past few years—but not all of them play well together.
"Digital platforms fail to meet consumer expectations because of what I call 'Frankenstein' apps," Gozio Health CEO and founder Joshua Titus said earlier this year when the company released a survey on patient engagement platforms. "This is when an organization launches a mashup of mobile features that are not cohesive, resulting in a disjointed experience for the consumer. This problem is exacerbated when an organization has multiple mobile offerings—one app for labor and delivery, one app for ortho, one app for EMR access, etc.—each vying for the consumer's attention, essentially moving from a Frankenstein app to a Frankenstein strategy, which is unlikely to deliver strategic value to the organization as a whole."
Gozio's survey found that many health systems are struggling to develop a cohesive strategy. Of the 82% of health systems reporting that they do have a mobile presence now, only 38% rated that presence as an 8 or higher in terms of effectiveness.
"Given that a health system's digital strategy impacts so much of the organization, it needs to be thoughtful and cohesive," Titus said in the press release announcing the survey. "This is only becoming more important as health systems seek a competitive edge in their communities."
At UNC Health, Dodson says that strategy is constantly evolving. Integrating Gozio and WELL was a challenge, he says, because each have specific services that hadn't been connected in the past. And now they're working to synch some of the back-office tasks to the platform, including the Epic EHR, and looking out towards new functions, like scheduling.
"We want this journey to be more robust, but we need to make sure we don’t create any new silos that make things more difficult," he says.
Dodson notes that journey also has to be measured. And that's not easy.
"One of the challenges of digital health is that it's hard to quantify," he says. Some functions may find their ROI in patient engagement or satisfaction surveys, while others hew towards clinical outcomes, which may take longer to measure. For wayfinding, the health system is charting no-show rates for appointments; for messaging, they're looking at timely responses, such as changed or cancelled appointments, and looking at whether clinicians are filling in those open time slots.
"This is the other side of healthcare: logistics and administration," Dodson says. "All of this ties into making the healthcare experience better."
According to researchers at UCLA, patients using telehealth for follow-up care after ED discharge were more likely to return to the hospital and be admitted than those who followed up an ED visit with an in-person visit.
New research finds that telehealth isn't always better than in-person care, and it can sometimes lead to more healthcare visits and even hospitalization.
A study led by researchers at UCLA and published in the Journal of the American Medical Association (JAMA) compared follow-up care for patients who'd visited the Emergency Department at the California health system between April of 2020 and September 2021, and found that patients using telehealth were more apt to seek in-person care and be rehospitalized than those who'd had in-person care.
The study analyzed almost 17,000 ED encounters from roughly 13,000 patients at two hospitals, and found that 16% of those who'd had in-person post-discharge follow-up visits returned to the ED and 4% were rehospitalized within 30 days, while 18% of those using telehealth for a follow-up visit returned to the ED and 5% were rehospitalized.
The study isn't necessarily earth-shattering, in that telehealth advocates have stressed that virtual care doesn't replace in-person care and isn't appropriate for all services. But it does highlight the need to compare the two treatment modes and study when and where telehealth is appropriate.
"While telemedicine has been heralded for its potential to improve health care access and convenience, the findings of the study … highlight the need to better understand the limitations of this care modality," Charlie Wray, DO, MS, of the University of California, San Francisco and San Francisco VA Medical Center, said in an accompanying editorial. "Like any other medical intervention, telemedicine can have unintended consequences that eclipse its benefits. Some of these limitations include diminished patient-clinician relationships, decreased efficiency of health care delivery, and lower quality of care."
The study was led by Vivek Shah, MD, of Harbor-UCLA Medical Center, and colleagues from UCLA's David Geffen School of Medicine and Fielding School of Public Health, and the University of Pennsylvania's Perelman School of Medicine and Leonard Davis School for Health Economics.
Shah and his colleagues noted that telehealth studies have seen good results in the treatment of people living with chronic conditions, while the results are mixed in the use of virtual care in acute care settings.
"A potential mechanism to explain increased healthcare utilization after telehealth visits is the inherent limitation in the ability of clinicians to examine patients, which may compel clinicians to have a lower threshold for referring patients back to the ED for an in-person evaluation if they have any ongoing symptoms," the study noted. "It is also possible that independent of the lack of a physical examination, telehealth clinicians may not be able to communicate as well with patients, leading to an inability to fully evaluate or intervene on evolving illness and leading to deterioration in patient condition and subsequent need for hospitalization."
It's also worth noting that ED visits that require follow-up care tend to involve more acute concerns, such as chest pain, abdominal pain, and shortness of breath—all of which could be serious and would need an in-person exam.
This doesn't mean the use of telehealth in the ED is a complete waste of time or money, either. Health systems have seen success using the platform to screen and even treat patients with less-acute health concerns, thus enabling ED staff to more quickly treat those who need in-person care.
The conclusion here is that health systems have to understand the benefits and limitations of telehealth in different departments and for different patient populations, so as to know when it will work and when in-person care is required.
The health system is contributing $250,000 to quadruple the size of an community health clinic in Denver, part of a project that includes 150 affordable living units and space for fresh food providers.
Health systems are investing in innovative partnerships that not only improve access to care but address some of the social determinants that affect access and outcomes.
The latest example is taking place in Denver, where Intermountain Healthcare is funding the expansion of a community health clinic serving the Hispanic/Latinx community, which accounts for almost 30% of the city's population. The $250,000 grant will quadruple the size of the Tepeyac Community Health Center, which sits in the middle of an even bigger project that will include 150 affordable housing units and 5,000 square feet of space for fresh food providers.
“Intermountain has a reputable legacy of standing in the gap to serve our communities that are most in need," Tiffany Capeles, Intermountain's recently appointed chief equity officer, said in a press release. "This is fulfilled through offering health care options that are both high quality and affordable.”
The expansion will quadruple the clinic's size to 24,500 square feet, add imaging and pharmacy services, and expand annual patient visit capacity from 20,000 to 37,000.
The clinic has operated in East Denver for roughly 25 years, offering primary, behavioral and dental care services in an area that has seen an 88% increase in growth over the past 20 years.
Tepeyac Community Health Center is the first line of care for the fast-growing community, and sends patients in need of more services to nearby Intermountain St. Joseph's Hospital, which is coordinating the grant.
“For the past 28 years, Saint Joseph’s Hospital has been a steadfast partner of Tepeyac Community Health Center and has stood with Tepeyac at every stage of our growth," Jim Garcia, the health center's founder and chief executive officer, said in the press release. "As we prepare to open our new clinical facility, Saint Joseph’s has once again demonstrated their unwavering support, as we continue our mission of serving (or 'of providing high quality, affordable healthcare') to the most vulnerable members of our community."
A digital health company has unveiled an app and platform that can help consumers identify flu-like symptoms at home and access resources for treatment.
With experts predicting an extremely hectic flu season, a digital health company is marketing a direct-to-consumer platform designed to help consumers identify flu symptoms at home and access resources for recovery.
California-based Evidation, which has developed digital health tools in the past to support organizations like Merck, Sanofi, the US Department of Veterans Affairs, and the Michael J. Fox Foundation, says its FluSmart technology analyzes data from wearables to identify flu-like symptoms and offer personalized insights and links to resources.
The platform is the latest in a surge of digital health products designed to help consumers—and their care providers—identify health concerns like infectious viruses at home, before they go to work, school, or a public location like the mall, and help manage their care instead of going to the doctor's office or hospital.
These products can help health systems in reducing waiting room and ED traffic and speeding up time to treatment, while businesses, schools and government offices can monitor employee health.
HealthLeaders spoke virtually with Christine Lemke, co-founder and co-CEO of the company, about the new offering.
Q. How is FluSmart used by the consumer? What technology is used?
Lemke: To get started with FluSmart, individuals download the Evidation app for iOS or Android and sign up for FluSmart via the app or an online link. FluSmart participants have the option to connect a wearable—the program is device-agnostic—but it is not required. Participants answer questions about how they’re feeling on a weekly basis, in addition to being prompted when an Evidation algorithm notices changes in their wearable device data that suggests they may have influenza-like-illness symptoms.
More broadly, the FluSmart program relies on models Evidation has built over many years engaging directly with hundreds of thousands of individuals over the course of their experiences with flu, COVID, and other influenza-like illnesses.
Q. How are you marketing this, i.e. getting the word out that it’s available?
Lemke: Evidation is recruiting participants for the program from its network of almost 5 million members from all over the country using the Evidation app. The Evidation network is one of the largest, most diverse virtual pools of research participants, and there are already 90,000 individuals enrolled in FluSmart this year.
Q. How might healthcare providers (health systems, hospitals, clinics, etc.) or payers take advantage of this service? In other words, can this be integrated into a primary care practice, health plan or some other provider-based strategy or program?
Lemke: This program can help identify individuals with meaningful changes in wearable data or survey data that are correlated with flu—in a key window of early symptom onset. This could be used to do things like identify individuals and prompt them to consider getting screened for flu or COVID, generate awareness for available interventions in an especially relevant moment, precisely recruit people for a clinical trial, or send targeted messages around self-care and when to contact or see a healthcare provider.
Evidation is able to collaborate with health systems, providers, and other partners to use FluSmart with their population. As with every partner, Evidation utilizes industry-leading privacy and regulatory practices, and requires every individual participant to consent for any use of their data.
One day, our hope is that providers could integrate this to help guide their patients into preventive or proactive care journeys to ensure care is delivered at the right time. This technology has the potential to reduce emergency room visits and find patients who need extra support at the right moment.
Q. How do you check or ensure that a consumer knows how to use this technology properly?
Lemke: If someone is able to use an app and answer basic questions about themself, they can use FluSmart. Participants only need to enroll in the program via the app, connect any wearables or other devices they want to contribute data, and respond to prompts for self-reported information as desired. The app walks them through the enrollment process and how to contribute, and there is no special equipment required.
If a participant has a connected activity tracker, FluSmart will alert them when it detects a change in activity data that suggests they might be feeling under the weather – no special setup is needed beyond enrollment. Engaging with this alert will route the participant to the next best action for them.
Q. How might this product or program evolve? How might it be used to address other health concerns or populations?
Lemke: FluSmart is emblematic of the work Evidation does. The core principle underlying Evidation is to help guide individuals toward healthy actions or information when it is most useful to them—and their care teams and broader community. In addition to flu and other infectious diseases, Evidation has explored the utility of data collected from smartphones and wearables to more effectively identify, track the development of, and return insights regarding Alzheimer’s Disease and cognitive impairment, Parkinson’s, and heart health, among other health conditions. There’s great potential for this sort of data to provide better understanding about health in everyday life across a range of therapeutic areas.
Additionally, connecting with a geographically, racially, and ethnically diverse group of people in their everyday life, continuously and longitudinally, offers a profound opportunity to a) generate high impact real world data and evidence and b) offer personalized health programs by being able to identify which individuals a study or program may be most useful for.
The health system's vice president of innovation and IT applications says innovation strategy has to be very flexible.
To Michelle Stansbury, innovation is a necessity at Houston Methodist. It certainly involves thinking outside the box, and now it also means thinking outside of the hospital.
"We're either going to disrupt ourselves or somebody's going to do it for us," says the hospital's vice president of innovation and information technology applications, noting the large number of healthcare organizations in the Houston area and the growing threat of competition from telehealth companies, payers, and retail giants like Amazon.
And that means expanding the playing field.
Houston Methodist already has a Center for Innovation Technology based in its flagship hospital, Texas Medical Center. Now the health system is partnering with The Ion, a 16-acre innovation district hosted by Rice University that's home to a wide range of industries.
"We are advancing the evolution of the hospital's role in healthcare through digital transformation," Stansbury said in an August press release announcing the partnership. "Having a footprint at the Ion will not only provide the Ion's network and Houston community with a window into what we are doing for patients, consumers and providers, but also gives the Ion community and rising innovators an opportunity to bring its own ingenuity and ideas to life with ours."
Stansbury says this new endeavor expands the healthcare innovation sandbox to include people, ideas, and industries that may not have been considered in the past. She points out the Center for Innovation Technology, which opened in 2018, is an ideal location for new ideas within the healthcare setting, while the space in The Ion will pull in concepts that might be new to healthcare.
"We need to tap into the talent that's out there," she says. "There's a lot of hope in what we want to have happen in that space. Some of it will be new to us."
Michelle Stansbury, vice president of innovation and IT applications, Houston Methodist. Photo courtesy Houston Methodist.
Stansbury joined Houston Methodist almost 30 years ago, after holding leadership roles at Compaq Computers and Amoco Oil. Among the many projects she shepherded through the years was the move in 2016 to the Epic electronic health record platform, followed by the opening of the Center for Innovation in 2018.
To Stansbury, integration is a linchpin to fostering innovation. The Center for Innovation, she says, was created with an eye toward breaking down the barriers between innovation, operations, and clinical, and involved executives from each department who took on multiple roles across the board. The goal was to get each department actively involved in discussing new ideas.
The center is designed as an innovation lab within the hospital environment, and it became a hotspot for critical thinking during the pandemic, with digital health and telehealth platforms and tools taking center stage. A lot of the thinking focused on the smart hospital and telemedicine processes that could be applied to inpatient services.
"You're still going to need the physical space," she points out. "You're never going to get rid of it. You're seeing a combination of the physical and digital – the 'phygital' space."
At the same time, she notes, the pandemic showed the industry that healthcare could be moved out of the hospital and into the home. But for that to work, healthcare needed to start looking at other industries that had already perfected online and home-based services.
Hence, the partnership with The Ion.
"We're talking about not only the hospital of the future, but the hospital room of the future, the clinic of the future, and the home of the future," she says. "There's a lot of ideas out there that we need to look into when we plan this."
At The Ion, Stansbury expects to see a wide range of ideas tested out, including wearables and biosensors, machine learning and AI, voice-enabled technology, and healthcare applications in smart home technology like TVs. She also sees a lot of interest in technologies and strategies that improve and reduce workflows for clinicians, especially nurses.
"In many cases they're the champions now" of new ideas and technology, she says of the nurses, one of many groups affected not only by staffing shortages, but high levels of stress and burnout. "They're coming up with some nice ideas in care redesign."
These projects and partnerships have positioned Houston Methodist as a leader in healthcare innovation, and Stansbury says other health systems have taken notice and sought advice. And while the health system is certainly open to advising and collaborating, she notes that innovation is often specific to the challenges, cultures, populations, and workflows of each hospital.
"They have to be very careful doing just what Houston Methodist is doing," she says.
In other words, there might not be a right way and a wrong way to do things, she says, just a different way. That's what thinking outside the box—or the hospital—is all about.
The innovation arm of Henry Ford Health is going national with DromosPTM, a tech platform designed to improve specialty pharmacy operations.
Henry Ford Health's innovation arm is going national with technology designed to improve specialty pharmacy operations.
Henry Ford Innovations has announced that the DromosPTM patient therapy management platform is now being used in seven health systems and specialty pharmacies across the country, and others are planning to integrate the technology in the months ahead.
“These partnerships allow increased functionality and provide patients across the country a better experience and care,” Lisa Prasad, the health system's chief innovation officer and leader of Henry Ford Innovations, said in a press release.
Developed in 2013 to help Henry Ford Health's own specialty pharmacy, Pharmacy Advantage, DromosPTM "fills a long-existing gap in the specialty pharmacy industry by offering efficient patient-focused care and service," officials said in the press release. It includes tools to help pharmacies take advantage of patient portals, find financial assistance for expensive prescriptions, improve medication monitoring, and identify best practices.
The licensing agreement for the technology is one of more than 30 that Henry Ford Innovations has enacted since its launch in 2011, representing more than $100 million in potential revenues for the health system.
Health systems and payers are forging partnerships with paramedics and other community health providers in mobile integrated health programs that bring home-based care to high-risk, high-expense patients.
The growing value of healthcare in the home is creating some interesting new partnerships for health systems and redefining the house call.
Sometimes called mobile integrated health (MIH) or community paramedicine, these programs give health systems and payers an opportunity to address gaps in care and reduce ER traffic by sending specially trained paramedics to the homes of selected patients—most often those identified as high-risk or who often call 911 or their doctor. Hospitals or health plans can partner with local fire or EMS departments to offer the service, train their own paramedics or contract with a vendor.
"It allows us to create an integrated system of care," says Patrick Mobley, president of Bright HealthCare, a six-year-old payer operating in 14 states, which launched a partnership in 2021 with MedArrive, a San Francisco-based startup offering MIH services. "We were looking for an in-home solution that provides more proactive care."
While each program is unique, most begin with a provider or payer identifying a population in need of home-based care – most often high-risk patients with chronic care needs who aren't following doctor's orders at home or so-called "frequent flyers," who often call 911 for non-urgent care needs and treat the ER as their primary care provider.
Once that population has been identified, a plan is drafted to send specially trained paramedics and/or home health aides to the home. These providers can perform primary care services and wellness checks, coordinate more specialized care, screen for social determinants of health, even just sit down and chat for a while with someone who's lonely.
"We're the glue between the patient, the provider and the payer," says Dan Trigub, who co-founded MedArrive in 2020. "Healthcare is a lot more than just acute care treatment. The continuity of care is absolutely critical."
Critics of these programs say the cost outweighs the benefits, and the challenge does lie in identifying the ROI and proving sustainability. Aside from patient engagement and improved health and wellness, payers and providers are balancing the cost of these programs against expenses tied to hospital and ED visits, as well as reduced hospitalizations.
In a 2021 study published in the Journal of the American Medical Association (JAMA), researchers at Canada's McMaster University analyzed some 1,740 calls by an MIH program operated by Niagara EMS (NEMS) of Ontario in 2018, and found the program reduced ED transports by roughly 50% (compared to emergency transports in 2016 and 2017) and slashed the mean total cost per 1,000 calls from roughly $297,000 to about $122,000.
"This economic evaluation’s findings suggest that MIH delivered by NEMS was associated with reduced ED transport and saved substantial savings of EMS staff time and resources compared with ambulance for the matched emergency calls," the study concluded. "This service model could be a promising and viable solution to meeting urgent healthcare needs in the community, while substantially improving the use of scarce health care resources."
California-based payer Molina Healthcare launched an MIH service earlier this year in Texas, also partnering with MedArrive.
"The mobile integrated health program will provide more efficient in-home care to members by bridging the gap between the hospital and primary care services, assisting in authorizations, ensuring medication reconciliation, and identifying social disparities that may affect care," Chris Coffey, plan president for Molina Healthcare of Texas, said in an e-mail to HealthLeaders. "Molina members currently have access to services that provide referral to in-home healthcare services; this program goes the extra mile in offering Molina members special after-hour access to Mobile Integrative Health (MIH) caregivers."
Coffey says the program helps Molina by reducing and preventing unnecessary ED visits and hospitalizations and ensuring that resources are directed to members who need them the most. It also allows members to be treated in the comfort of their own home, rather than travelling to a doctor or hospital.
Eventually, he says, the program will expand to other states, and could be broadened to address other populations, such as the elderly, and offer such services as remote patient monitoring, behavioral health and substance abuse care, and hospice care.
"The business model can be used for implementation of a variety of change management projects," Coffey says. "Mobile integrated health services are meant to challenge current systems that underserve populations, specifically elderly patients, and can be used to close quality gaps, provide non-emergency in-home assessments, vaccinations, education, and overall care."
In New York, the Arc of Rensselaer County, a residential support program for people with developmental disabilities, has launched an MIH service to give its target population access to primary care services at home. The organization is partnering with UCM Digital Health, which offers "a digital front door platform with a 24/7 emergency medicine treat, triage, and navigation telehealth service."
Don Mullin, the Arc's CEO, notes that the 150 or so patients they serve "have the same healthcare issues that we have," yet a trip to the doctor's office, clinic or hospital is much more challenging.
"We would be paying [ambulance or EMS services] to bring them to the ER, where they might spend five or six hours, and then they'd bring them back, and Medicaid would be charged for the entire visit," he says. "This reduces a lot of that time and effort and stress. We can see $300,000 a year in Medicaid savings alone."
In addition, he says, "a lot of the individuals we support have high anxiety. Going out into the community is a real challenge for them. And a phone call [with a doctor] isn't always great for folks who can't always communicate that way."
Mullin says the service, which sees about 150-175 visits a year, is coordinated with each patient's primary care provider.
"We've probably reduced primary care visits as well," he says. "That's another savings we haven't considered just yet. These savings are coming out of different pockets."
The Pip Care app, developed by a company spun out of the Pittsburgh-based health system, improves care management for patients before and after surgery.
Three UPMC hospitals will be testing out a new digital health app designed to improve care management for at-risk patients before and after surgery.
The app was designed by Pip Care, a new company spun out of the partnership between UPMC Enterprises, the innovation arm of the Pittsburgh-based health system, and Redesign Health. It uses what's called Enhanced Recovery After Surgery (ERAS) processes, workflows, and protocols to help patients prepare for surgery and manage their recovery at home after the procedure.
“Surgery can be incredibly difficult on a patient’s body; in some cases, it can have the same toll as running a marathon,” Aman Mahajan, MD, chair of anesthesiology and perioperative medicine at the University of Pittsburgh and executive director of UPMC Perioperative Services, said in a press release. “If we can help patients make healthier decisions – like losing weight or quitting smoking — before they have their procedure, then we can lessen their time in the hospital and speed up their recovery."
The app will be tested at UPMC's three Centers for Perioperative Care (CPCs), located at UPMC Shadyside and UPMC Presbyterian in Pittsburgh and UPMC Horizon in Greenville. The CDCs, which use multidisciplinary teams to help high-risk patients, such as those with chronic diseases, improve their health and wellness before surgery, account for some 10% of the health system's surgeries with inpatient stays.
The digital health platform could be a model for most pre- and post-surgery care plans, as it helps patients access resources, communicate with and share health data with their care teams, while allowing those care teams to better monitor patients after hospital discharge.
"It is a service that all patients could benefit from, not just those who are at a higher risk for complications," Mahajan said.
“While patients understand a planned surgery can reduce pain, improve mobility, and change their quality of life, questions and fears about surgical procedures can lead to delays or even no-shows," added Kathy Kaluhiokalani, founder and chief executive officer of Pip Care. "Having a personal health coach to guide you along each step of your journey is key to ensuring patients complete surgery with confidence and have a smooth recovery.”
Research by Brigham and Women's finds that more time spent on the EHR can improve primary care quality outcomes, but there's a fine line between the right amount and too much.
New research out of Brigham and Women's finds that more time spent on the electronic health record platform can improve quality outcomes in primary care, though providers still need to make sure they're not overdoing it.
As reported in the Journal of the American Medical Association (JAMA), researchers at the Boston-based health system tracked ambulatory quality measures for 291 primary care physicians affiliated with either B&W or Massachusetts General Hospital in 2021. They reported "significant associations between EHR time and panel-level achievement of hemoglobin A1c control, hypertension control, and breast cancer screening targets."
The research team, led by Lisa Rotenstein, MD, MBA, and Michael Healey, MD, both of Brigham and Women's and Harvard Medical School, and A. Jay Holmgren, PhD, of the University of California at San Francisco (UCSF), noted that they tracked EHR time not only during the day, but also after hours and during what is called "pajama time" (evenings and weekends). They also separated and tracked time spent on clinical matters and "in-basket" tasks.
"It is notable that among all metrics of EHR time examined, there was the greatest numerical association between daily time on the in-basket and daily time on clinical review and ambulatory quality outcomes," the study noted. "Although time spent on clinical review on the day of a visit can now be accounted and billed for under the 2021 Evaluation and Management coding changes, time spent on the in-basket is typically not compensated. Rather, in-basket work is performed in addition to visit-based, revenue-generating work, often outside of scheduled clinic hours. In addition to substantially increasing since the COVID-19 pandemic, time spent addressing in-basket content has been associated with an increased likelihood of burnout and intent to reduce clinical hours."
That said, Rotenstein and her team pointed out that more time spent on the EHR "may represent a level of thoroughness, attention to detail, or patient and team communication that ultimately enhances certain outcomes."
The challenge, then, is to find a balance between spending meaningful time on the EHR and ensuring it isn't negatively affecting care quality or the caregiver's health.
"These results underscore the need to create team structures, examine PCP and office workflows, and enhance EHR-based technologies and decision support tools in ways that enable high quality of care, while optimizing time spent on the EHR," they concluded.
In addition, Rotenstein and her colleagues wrote, "Future studies should seek to identify the specific work patterns that contribute to the associations we have identified and characterize payment strategies, workflows, and technologies that can facilitate PCPs delivering high-quality ambulatory care while minimizing EHR burden."
The New Orleans-based health system is seeing improved clinical outcomes in a pilot Medicaid program targeted at patients living with hypertension and type 2 diabetes.
Ochsner Health is reporting strong results from a pilot remote patient monitoring program targeting Medicaid patients living with type 2 diabetes and hypertension.
Billed as one of the first in the country, the program, coordinated by Ochsner Digital Medicine, saw nearly half of participating patients dealing with uncontrolled hypertension bring their blood pressure under control within 90 days, a 23% improvement over traditional care management. And almost 60% of those with poorly controlled diabetes were able to improve their blood-glucose readings and A1c levels.
“So meaningfully moving the needle among Medicaid patients with type 2 diabetes and hypertension is unprecedented," Denise Basow, MD, the New Orleans-based health system's first and current chief digital officer, said in a press release. “We are confident this program can be scaled to improve the lives of others across the state and around the country to mitigate the impacts of chronic disease.”
The RPM program was launched in June 2020 at Ochsner LSU Health Shreveport, and has enrolled more than 4,400 patients. Health system officials noted the program addresses a serious gap in chronic care management in Louisiana, where roughly 40% live with hypertension and 14% lives with diabetes.
RPM programs hold great potential in bringing care management out of the hospital, clinic and doctor's office and into the home, where providers can monitor a patient's daily health and habits and adjust care (including medication) accordingly. With digital health technology, they can capture relevant data to identify trends and support treatment plans.
Ochsner is one of the top health systems in the country with regard to digital health strategy, and has been gradually building out several programs on a national platform. Data from the RPM program could be used to support arguments to the Centers for Medicare & Medicaid Services (CMS) to improve Medicare and Medicaid reimbursement.
“As clinicians, we are always working to improve patient outcomes and the overall patient experience, and this program shows that we can use home-based technologies to accomplish both," Lauren Beal, MD, Ochsner's medical director of primary care and community clinics for northwest Louisiana, said in the press release.
One of the keys to a sustainable RPM program is sustainable clinical outcomes, and Ochsner officials noted that those living with hypertension continued to show positive results after 18 months. In addition, the program was well-received by patients, with a net promoter score greater than 91.
Ochsner officials said they'll continue to work with payers and employers to improve reimbursement, which would allow the health system to expand the program to other parts of the state and, eventually, other parts of the country.
“Over 30,000 patients have benefited from Ochsner’s Digital Medicine chronic disease programs,” Richard Milani, MD, Ochsner's chief clinical transformation officer and vice-chairman of the Department of Cardiology, said in the press release. “We're offering patients compassionate human care combined with the power of technology, and we’ll continue to expand these programs to help more patient populations.”
