THE POWER OF COMMUNICATION IN THE AGE OF DIGITAL HEALTH

During the past 2 decades I have participated in several innovation projects. The most enduring health innovations embrace communication and community.

All of the commercial EHRs have undeveloped communication tools which intensify existing communication breakdowns and contribute to new problems.

Treating the i-patient: Treating the i-patient occurs when clinicians overvalue the information about their patients from electronic systems. This often reduces time spent on valuable diagnostic activities such as observing patients, talking to patients and families, doing extensive physical exams, and discussing the patients with colleagues. For various reasons, the information available in electronic systems is sightly inaccurate and or not available. Computer order entry also encourages working in isolation from the bedside and nursing units.

It might sound like I am opposed to EHRs in health care. I am not. Community and communication are embraced when we work on patient engagement.

In April [2017], 32 executives, vice presidents, directors and other senior-level healthcare professionals gathered in Chicago to share insights and explore solutions to the industry’s most pressing challenges, including patient engagement, quality improvement, system integration, clinician well being and the relationship between these critical priorities. This live discussion was captured in a graphic recording, pictured below. Source: https://www.beckershospitalreview.com/hospital-management-administration/32-hospital-executives-talk-patient-engagement.html. (accessed 2/10/18)

The most powerful innovation is driven by answering questions WHY, HOW, and WHAT.

The WHY: Some of the original WHYs for electronic health care were to improve diagnostic thinking, prevent medical errors, and support process improvement. The business of health care is the intersection of margin and mission. Today’s EHRs support fee for service profit which does not require communication and quality improvement. Alternative Payment Models (includes ACO, CIN, surgical bundles, etc.) can provide a different motivation where the balance of margin and mission is better served.

The HOW: Looking at the results from Comprehensive Primary Care regions (CPC+) and community networks such as Community Pharmacy Enhanced Service Network (CPESN), we can already see examples of electronic enabled care management which support physicians abilities to diagnose, reduce errors, and participate in process improvement. Health service researchers have routinely demonstrated that a patient’s information and status change rapidly during high risk transitions. Community level innovation reduces these risks

This future is unevenly distributed and will take time to prove and diffuse. This is sometimes referred to as the “science to service gap” which occurs from the time of practical innovation to widespread adoption. It took nearly 60 years for the stethoscope to be widely accepted by physicians — in the age of digital health, we can go faster.

The WHAT: Business and health care leaders have the opportunity to drive communication and community into their electronic solutions. This requires payment innovation and creative use of community resources. Health care inflation continues to reduce US business’s ability to compete in global markets, as result some of the most interesting innovation is happening with on premise health care.

A recent article in Corporate Wellness Magazine makes the case for improving medication adherence for employers. At first glance, medication management might seem like small part of the problem;but, just ask a chief medical officer (CMO) about how critical medication is to disease management. It is essential for self care and can reduce inappropriate emergency and hospital care.

This work sets the stage for additional investments in technology which will accelerate safety and effectiveness. Digital Therapeutics service will leverage these gaps.