By Fauzia Khan, MD, FCAP
The mandate to embrace technology has been driven by federal government regulations, as well as disruption of the traditional fee-for-service model. Although we have started to embrace this model in the clinical world, what if these technology platforms could also be effectively used across the entire continuum of care, from the hospital to the home?
Over the past decade, technology innovations have continually pushed the boundaries in the healthcare industry. According to a CDC report (figure 1) in February 2015, it shows a dramatic increase in EHR adoption. This is due, in part, to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, which provided incentive payments to eligible hospitals and providers that demonstrate the meaningful use of a certified electronic health record (EHR) system, but it also shows the pent up demand and the inevitable paradigm shift that is coming to the healthcare industry that patient data needs to be accessible, available and actionable.
Figure 1. Hospital emergency departments with an EHR system: United States, 2006–2011
NOTES: All trends were significant (p < 0.05). EHR is electronic health record. “Any EHR system” is a medical or health record system that is either all or partially electronic. Emergency department estimates are based on a question indicating the department “uses” an EHR. Estimates for a basic system prior to 2007 were not included, as not all data elements were collected. A basic system had all of the following functionalities: patient history and demographics, patient problem lists, physician clinical notes, comprehensive list of patients’ medications and allergies, computerized orders for prescriptions, and ability to view laboratory and imaging results electronically. SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2006–2011. Adoption of a basic EHR system by hospital EDs increased from 19% in 2007 to 54% in 2011.
Significant challenges remain with aggregation, data capture and normalization capabilities in the hospital and ambulatory settings, however we are beginning to see some improvements, this finally allows for better care coordination across the continuum of care. The addition of clinical decision support (CDS) and real-time analytics becomes even more critical, thus enabling clinicians to develop the best treatment plans for each patient, using intelligent and actionable information. Another driving force to deliver better care coordination and communication is actually coming from the consumer market. Recent technologies such as wearables have allowed patients to take a more active role in their own care, empowering them to make better, healthier decisions. The FDA estimates that 500 million people worldwide will use a health app by 2015, and estimates predict that by 2017, the global mobile health and wellness app market will be worth $26 billion. Most of the revenue, about 84 percent, will come from related services and products like wearables, such as Fitbit and Jawbone, and also future technologies like the new Apple Watch.
Data at the point-of-care, whether in the home, in-patient or ambulatory setting should be actionable, comprehensive, and increasingly accessible to all key stakeholders including patients, physicians, and payers. Whether that data is delivered through an HIE, EHR, or a smart device. In time, once we move treatment closer to the individual, this will close crucial care gaps, provide greater visibility, and accelerate decisions that lead to better outcomes.
If the last decade was focused on inpatient, outpatient, and ambulatory data integration and interoperability, the next several years should focus on creating the Connected Healthcare System, which includes the home. With mobile technologies, ubiquitous Internet, and smart devices, the boundaries between home, hospital, and ambulatory and long-term care facilities will blur.
With patient-specific and real-time information accessible at the point-of-care (the definition of which will also change), physicians could better manage common chronic conditions and patient populations. In addition to clinical decision support (CDS), another necessary layer to develop would be around analytics. CDS would empower clinicians to make more informed, evidence-based decisions, while real-time analytics would allow clinicians to view and analyze at-risk populations from both a preventative and interventional perspective. Analyzing patient populations and outcomes provides vital information for physicians that can significantly impact patients by triggering earlier interventions, reducing avoidable errors, and improving overall health outcomes.
A fully realized Connected Healthcare System is still in development, but it is certainly within our reach. As we move toward more integrated technologies across hospitals and lab systems, we need to also spend our resources on developing a home network that can provide evidence-based data and real-time alerts to providers, patients, physicians, and even network managers. Once this integration takes place, the healthcare industry can focus its attention where it belongs—on better managing patients and populations.
Fauzia Khan, MD, FCAP is chief medical officer and co-founder of Alere Analytics.