What we're thinking about


Image: photo by K. Xu; "The Dance" by Regina Holliday

Last week, I joined thousands of people who gathered in Orlando, FL for the Institute for Healthcare Improvement’s 2015 National Forum, in which healthcare professionals from around the world, including inspirational leaders as Don Berwick and Magic Johnson, brainstormed on how to achieve the quadruple aim (including workforce joy). Three main themes that I found were reiterated throughout the conference were:

1. Value-based care and co-designing around the patient:

As healthcare moves from a volume-based care model to a value-based care model, healthcare leaders are struggling to define what “value” would mean to the patient versus the provider.

Anna Roth, CEO of Contra Costa Health System, a safety net hospital system, shared that underserved patients tended to be less concerned about their own health, than about meeting ‘basic needs’ such as having secure housing or food for their children. “Meeting the patient where they are at” has become the mantra for providers — to build a partnership revolving around the patient’s personal priorities and preferences. Southcentral Foundation Nuka System of Care is an example of a best practice that has successfully been able to implement a care model that addresses and cares for the “whole” patient.

Key Takeaway: Healthcare organizations should consider human-centered design in co-designing care together with the patients, through

a) addressing social determinants

b) using digital health to provide care everywhere, and

c) personalizing care for all patients

2. Capitalizing on technology for data capture and deriving meaning from that data

With the acceleration of technology in health care, the ability to capture data about patients has provided much value to providers in not only being able to better track patients’ progress through digital health tools, but also being able to make better evidence-based clinical decisions.

The challenges in the current system are:

a) interoperability of data and patient records

b) avoiding information overload and deriving meaning from the data to support clinical decisions

One of the best practices shared was CRISP Health Information Exchange (HIE) in Maryland, in which all patient records are kept within one system throughout the state and information could enter the HIE from other EHRs and be extracted. Johns Hopkins Medical Center was able to use the admit/discharge information in the HIE to better address the gap in care they were seeing in transitions of care from inpatient to outpatient, improving patient care coordination and follow-ups, and ultimately improving quality and outcomes.

Key Takeaway: Collecting data is helpful, but the true value is in making data available to all providers and making that data meaningful.

 3) ‘Quality Improvement’ versus ‘innovation’

Health care organizations have started to be more proactive in launching quality improvement initiatives, and even encouraging residents and medical students to lead projects. As compared to last year’s conference, I noticed a much stronger emphasis on ‘innovation’ beyond quality improvement. But what’s the difference?

Chris Trimble, adjunct professor of Business Administration at Dartmouth and author of “How Physicians can Fix Healthcare”, describes it in the simplest way. Quality improvement involves a much smaller scale process in which one area or measure can be improved through analyzing current processes and removing waste. By contrast, the shift moves towards innovation when a completely new process or product is introduced to the current system. Trimble mentions that the only way that innovation can effectively be executed is through having a small full time team dedicated to a single initiative. This small team must be also able to execute this project themselves, which makes them more reliably available.

One example Trimble mentions is at Primary Children’s Hospital in Salt Lake City, in which a small full-time team formed with an MD, NP, nurse and MA. The team was able to completely redesign their clinical workflow and their schedules so that each of them had 1/3 of their time set aside per week for care coordination and follow-ups with patients/families. Overall results showed an achievement of the triple aim.

Key Takeaway: Trimble concludes that by rebuilding a care team from scratch, the team is able to practice ‘clean-slate team design’ without breaking anything in the care flow. 

In our current health care ecosystem, we have struggled with the inefficiencies and the slow transition to value-based care models. However, this conference was an eye-opening and valuable experience that allowed health care professionals from around the world to share their struggles and experiences and also learn from best practices that have found success.

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On Saturday, October 31st, Klio's co-founder and CEO Jacqueline Thong will speak on a panel discussion about digital health and entrepreneurship during the Boston Young Healthcare Professionals Digital Health and Innovation Conference. The panel, moderated by Mandira Singh of athenahealth, will also include Boston-based health tech entrepreneurs Gil Addo of RubiconMD, TJ Parker of PillPack, and Julie Yoo of Kyruus

The event, which will be held at Microsoft's NERD Center facility in Cambridge, is BYHP's first healthcare conference. The objective of the conference is to gather leaders from across different ares of healthcare to discuss the current state of digital health and innovation as well as future trends. Tickets for the event can be purchased in advance here

Boston Young Healthcare Professionals (BYHP) is a non-profit organization that creates opportunities for young healthcare professionals to reach outside of their respective silos and gain exposure to the larger healthcare landscape by connecting with healthcare professionals in various fields, including: clinical, provider, payer, health care administration, pharmaceutical/life sciences, medical devices, public health, legal, policy/advocacy, government, consulting, research, and IT.

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patient questionnaire

In early October, the National Coordinator for Health IT Karen DeSalvo announced that the ONC (Office of the National Coordinator) will develop a policy framework for identifying best practices, gaps, and opportunities for the use of patient-generated health data (PGHD) in research and care delivery. Then, last week at the Health 2.0 conference and at events surrounding National Health IT Week and Boston HUBWeek, there was more excitement and discussion about the wonderful world of patient-generated health data, which includes data coming from patient self-tracking applications as well as passively-collected information from wearable devices and sensors. So why all the fuss?

Behind the hype and likely inflated expectations about the speed and ease of implementation of uptake in the use of patient-generated health data to revolutionize healthcare, here are a few real reasons why PGHD deserves such attention.

1. Earlier detection of issues drives more proactive management. Tools that can process patient-reported or passively collected data from patients and alert care managers to concerning trends when the patient is not in the clinic help providers recognize issues before they escalate. Dr. Mark Groshek of Kaiser Permanente talks about how patient data helps providers in Physicians Practice.

2. Greater involvement of patients. Applications that help patients understand their health data with respect to their treatment plans and their actions can drive engagement of patients in their care, which in turn can improve dialog between patients and providers. Dr. John Halamka wrote in Healthcare IT News about how he has used PGHD to help him manage his own care.

3. Utility of data. As care moves towards further patient-centricity, there is increasing interest in further understanding the patient experience from several angles, e.g., outcomes, satisfaction, quality-of-life, and preferences. This new source of patient data can be used to further investigate comparative effectiveness of therapies as well as refine patient stratification models. Accenture’s Healthcare Technology Vision 2015 report stated that 73% of provider organizations reported positive ROI from the adoption of technologies that supported the collection of patient-generated health data.

With interoperability and workflow integration issues impeding the speed at which provider organizations can deploy and utilize patient-generated health data solutions, EMR providers, patient application developers, wearable manufacturers, and analytics solutions providers will all need to collaborate in a meaningful way so that the promise of PGHD can truly be met.

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Holding Hands

As providers have begun to shift away from focusing purely on clinical outcomes to take a more holistic, patient-centered approach of looking at a patient’s overall quality of life and well-being, the role of the nurse care manager has been gaining significance.

In the past few weeks, I’ve been speaking with care managers to better understand their role in the current care workflow. In my conversations, I found that there are three key ways that care managers improve the overall health of their patients:

1. Patient engagement

The key to providing better overall care is to approach patients in a way that gives them encouragement, empowerment and support. One care manager mentioned that she set small achievable goals with the patient and spoke with patients in a way that encourages them to be proud of their small steps. This allows the patients to gain overall confidence in themselves and take ownership of their own health. In one example, a patient not only started to self-track her own health, but also proactively called the care manager on how to improve. With the patient being engaged in her own health, by the next clinic visit the patient was even able to see slightly improved health outcomes (improved HbA1c levels).

2. Early detection of issues

Care management helps increase the number of touch points with patients. Those touch points allow the care manager to gain a more complete picture of the patient’s progress at home, detect urgent issues earlier, and follow up with any extra support as needed. For example, a care manager described to me a scenario she experienced with an elderly woman who had been discharged. From the EMR clinical notes from the woman’s previous visit, it was hard to tell how the patient was progressing. The care manager called the patient and was able to speak with the patient’s daughter, only to realize that the patient had critical temperature levels and symptoms that called for an urgent visit with her PCP. With early detection of a developing issue, this was one hospital visit avoided.

3. Filling the gaps in care

It has been shown that care provided for patients in transitioning from hospital to home can prevent the most readmissions. Care managers serve the role of being an accessible resource and support system for the patient upon discharge from hospital and in between clinic visits. One of the primary tasks care managers take on involves triaging patients since many of the patient’s issues at home aren’t clinically related and do not require a physician’s expertise. For example, one care manager mentioned that a patient had been missing his upcoming appointments simply because he didn’t have transportation to get to the appointments.

As provider organizations work to integrate care management into their practices, there will be struggles to streamline care workflows; however, even in these early stages, we can see that there is much value to the work of care managers in providing patient-centered care for individual patients and in improving overall population health as well. This growing role of the care manager now calls for tools that can help them more efficiently perform their important work.

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We’re excited to announce the launch of Klio Assessments and Klio Engagement which join our existing Klio CarePlan solution. We have listened to our customers and now provide them with the ability to integrate with one or all three products to work with their existing Electronic Health Record, population health, or care coordination solutions in a truly vendor agnostic manner. Here is a brief overview of our solution set:

Klio CarePlan: generate personalized care plans for patients based on medical record information and quality metrics reporting requirements, such as:
- PQRS (Physician Quality Reporting System) and CMS (Centers for Medicare & Medicaid Services) measures (e.g., for National Quality Strategy domains such as care coordination, patient/family engagement and population/public health)
- ACO (Accountable Care Organization) and HEDIS (Healthcare Effectiveness Data & Information Set) measures (e.g., for diabetes, coronary artery disease, congestive heart failure)

Klio Assessments: easily configure patient diaries and standardized survey assessments which support active patient self-reporting or passive data collection through wearables and third-party apps

Klio Engagement: create rules for pushing alerts, feedback, and educational content to both patients and providers based on the specific needs of a cohort of patients

Interested in learning more? Click here to request a product demo.

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