Understanding Healthcare Evolution


By Creagh Milford, DO, MPH, CMO,  Healthcare Highways


The Democratization of Medicine

Physicians, like other professionals in this Era of Amazon reviews, are finding themselves inundated with questions generated by the wealth of information available to patients via internet searches, wearables, and self-diagnosis applications, losing control of an age-old process to discover a patient’s diagnosis. Doctors will experience more patients presenting them with self-diagnosis, setting appointments for confirmation or rebuttal of their own data-driven conclusions; and doctors will not always maintain control over initiating the “art” of diagnosis. Increasingly, they find themselves in the middle of a process that once began in their office.

Smart technology, wearable health monitoring devices, and the software connecting them—the Internet of Things—has established greater expectations of personalization, customization, and timeliness in healthcare treatment. The current care model is slow to embrace the patient as partner in his or her health management.

Embracing these technologies will bring the Industry closer to the quality of consumer experiences set by the exponential growth of remote, internet-based services automating, regulating—even gamifying—increasingly intimate aspects of everyday life. Everything from the purchase of food and diet programs (HelloFresh) to our emotional health can be ordered, scheduled, and delivered to our door.


Wearables and The Patient-Partner

More than trendy lifestyle badges, wearable health monitoring devices (Fitbit; Leaf) provide patients with the ability to monitor, document, and analyze their health data before entering a waiting room. Tracking and analyzing health data now occurs autonomously across an endless variety of customizable smartphone applications.

These devices offer an incredible opportunity for the early detection–and possible prevention—of diseases when integrated into incentive programs like employer wellness programs. These programs utilize remote monitoring technology and applications that collect and integrate personal health data. As care management applications become more ubiquitous and integrated into patient’s lives, a new world of automated data monitoring, collection, and analysis possibilities will open. Over time, care teams will use this data to manage larger populations (panel sizes), through management by exception rule-based logic and artificial intelligence.


Redefining Quality in Healthcare

Since 2010, the term “healthcare value” has been defined as quality delivered, divided by the cost required to deliver the unit of care. Since then the progression of population health management tactics has taken hold, coupled with more informed and consumer-driven patients, requiring a re-evaluation of our definition of healthcare value. Consumer experience has become a critical element in patients’ perception of high value healthcare. In addition, experts now acknowledge that to reduce utilization, we must also hold providers accountable for the appropriateness of tests, labs, and procedures they perform.

Amazon overcame several long-standing industry giants by its singular focus on and commitment to providing high-quality customer experiences. Healthcare, is not immune to the “Amazon Effect,” wherein companies must adapt, abandon, or strengthen their current operating models or become obsolete (Toys R Us). Amazon’s “one touch purchase” experience has become the default customer experience standard to measure against.

Likewise, if patient experience becomes the metric by which hospitals, staff, service providers, and insurers measure the quality of their care—the value and experience it provides to patients—then reduction of inappropriate care and procedures and the targeted application of procedures most likely to produce positive results take top priority.

Eliminating the current barriers between specialists, hospitals, and primary care doctors; managing the coordination of data collection, analysis, and execution; and establishing a framework of accountability, while initially difficult, is possible due to the wide array of new incentive structures as well as new technology like wireless health devices and tele-services.

Rating systems, cost transparency, online social forums, and condition-specific social media communities now make it easier for current and future patients to reward providers who make the necessary care evolutions with their business—and avoid those who don’t, armed with the ability to publicly post their care experiences.

A patient outcome-focused approach will also require Healthcare to replicate the most influential detail of Amazon’s disruptive business model: bringing the desired outcome to the customer’s front door.


Tele-Care and Concierge Patient Care

Telehealth’s most exciting offering is the ability to deliver care when—and where—the patient needs it. Some telehealth companies combine wearable data collection with a convenient doctor-on-demand model. Soon, enhanced data collection from wearables, clinical informatics, and a patient experience-centered service framework will provide care in the convenience and privacy of one’s own living room—at cost savings for the patient and the health system.

While teleheath cannot replace an in-person visit in all circumstances, the ease of access and overall savings in transportation, time, difficulty, and paperwork cannot be dismissed. Various diagnosis can be accurately rendered through tele-visits, particularly when accompanied by data gathered by the EHR portal as well as other clinical reporting and analysis software that can do what a primary care provider traditionally cannot do: document and analyze everything relevant to patient care that occurs between visits.

Telehealth can reduce treatment redundancies, delays, readmissions, and improve care transitions. Preliminary trials are yielding positive results: telehealth increases and maintains the frequency and productivity of provider visits. Additionally, home-based care supported by wearable technology and monitoring services can save time, money, and increase personalization of care.


Interim Monitoring and Diagnosis

The software and infrastructure giving voice to Alexa and domicile-omnipresence to Nest can expand the reach of a care team, ensuring that patient populations are managed by exception by monitoring the ongoing results of each treatment in-between visits, virtual or otherwise. This information passed through a dedicated network, can be analyzed by “augmented intelligence”—software capable of providing analytical support.

Extended to evaluate a patient’s progress healing over time, or in pill boxes to monitor medication adherence, this technology provides new key insights into patient behavior. Remote glucometers can notify nurses, family, or other caretakers of dangerous hyperglycemic or hypoglycemic states and document the occurrence. In the future, they may be able to simultaneously order the necessary equipment and medicines required for treatment—based on the microsecond analysis of billions of data points, shared globally through centralized servers.

Additional software will ensure this information is securely stored and easily accessed by doctors and care teams for quick, documentation-free review.


Patient-Provider Relationship 2.0

The future of these technologies working in concert to improve patient experience converges at the point at which algorithms will transition to AI or Artificial Intelligence. When technology handles the collection, analysis, diagnosis, and reporting of a patient’s current condition, based on their individual behavior, genealogy, and health data cross-referenced with all known medical information in existence—what does that mean for physicians and their patients? Superhuman performance. This level of superhuman performance will allow physicians to get back to the business of being care givers and spend more time with their patients.

AI can exponentially enhance care team performance: cures, treatment, and prevention of diseases will be maximized when health professionals are able to devote their entire focus to patient care, rather than the maintenance of systems, documents, reports, information gathering, transitions, and all else required by our current healthcare model.

Properly incentivized providers -working with patients in partnership- can be expected to increase patient satisfaction while decreasing the amount of unnecessary procedures, tests, and misdiagnoses.


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