Healthcare is often referred to as a “system,” but frequently it’s anything but. A patient being discharged from emergency services might not have the details of their condition shared with a primary care physician, and that patient frequently won’t speak with a provider until their condition has taken a severe turn for the worse.
Humana SVP and Chief Medical Officer Dr. Roy Beveridge highlighted these gaps in care and communication during his time on stage at the HIMSS19 Patient Engagement and Experience Summit on Monday. He said that the healthcare industry needs to better leverage technology so that it can connect its disparate services, anticipate the needs of the patient, and provide an all-around more convenient product.
Doing so will hardly be simple, he noted, but there is certainly a precedent that systems and plans can look to for guidance.
“You know, when smart devices were introduced a number of years ago, clinicians just said ‘What a dumb piece of technology. It just tells people whether someone walked 5,000 steps or 8,000 steps,’” Beveridge said during the session.
“But the retail sector was very smart. They took the data from steps and they combined it with purchase history. And all of a sudden there was an explosion of understanding. … You could see from someone’s purchase that they bought a pair of shoes. And then six months later, they had walked 1.5 million steps. Anyone on the retail side would say ‘those shoes are broken and you need a new pair of shoes.’ They would advertise for that, and that’s beginning to think about things in a very, very different way. … How can we take a consumer-centric approach in healthcare? And, how we get information into systems so we’re anticipating people’s needs before they need them?"
To illustrate his point, Beveridge painted the picture of Gino, a hypothetical 75-year-old patient with diabetes and congestive heart failure. With just these conditions alone, Gino would already be a candidate for 30-day readmission following discharge.
“But what data systems don’t flow in right now is that he’s a widower and he’s socially isolated,” Beveridge said. “That might not seem like a lot to you, but what happens if I told you people who are socially isolated have a 30 percent higher mortality rate because of it, compared to people who are not socially isolated? Is that something that’s important for an algorithm to understand in terms of how to take care of you? I think so.”
Even beyond incorporating his social determinants, Gino’s case still has several potential scenarios in which it could break down, Beveridge continued. He could be having difficulty managing and administering his own medications, but be too uncomfortable to reach out to a provider or family caretaker for assistance. He could develop an ulcer during his time at the hospital and require prompt follow-up from his doctor, but never see an adjustment in his care plan because the primary care physician wasn’t informed.
These failures and others could be addressed within a system that automatically collects, analyzes and communicates patient data between stakeholders, Beveridge said.
“Think about who has data on Gino — physicians, pharmacy, the hospital has a ton, the health plan has got a lot, the daughter has some,” he said. “So, everyone has so much data, and you think about the retail world. What did the retail world do with all of this? They linked all the data together, right? They began understanding from an analytics standpoint how they were going to take care of the issue — and the issue in this case is Gino.”
In some respects, the culture shift required to close these gaps has already begun, Beveridge said. Even if many systems have not yet deployed a comprehensive system to support their patients’ care, providers are steadily becoming more understanding of the hurdles some patients are facing.
“I have a confession to make,” he said. “When I was in practice and someone was discharged from hospital and they didn’t show up a week later, I got irritated. Doctors at that point would use the expression ‘the patient was non-compliant with medical orders.’ That’s a shocking statement. If you start thinking about it from the patient’s perspective, Gino is going to have trouble getting to my office. Gino’s got a whole bunch of problems, and it’s not that he’s not compliant, he’s got issues in terms of how to get there.”
Equally encouraging is that, by and large, the technology needed to connect healthcare services and guide the patient through their care has already arrived, he continued. Gino’s numerous risk factors could be flagged by an automated system that would trigger telephonic interventions from a staffed care coordinator. That coordinator could also schedule food deliveries or stress the importance of eating to a family caregiver, or a home care nurse could be deployed to monitor his recovery using a mobile clinical workstation — otherwise known as an iPad.
“Every part of what I just talked about are things that actually occur at this point. There’s nothing there that we don’t actually have the ability to do. We have glucometers that are attached by Bluetooth, we have scales that measure someone’s weight in terms of their congestive heart failure risk. We have all of these things — they’re just not coordinated,” Beveridge said. “When you compare it all to the retail world, it’s all the same story. We’re just 10 to 20 years behind.”