Editor's note: This is the first of a two-part series on new care models and delivery methods, along with the new technologies that enable them. The second part, to run Tuesday, May 31, will take a closer look at the patient's role and responsibilities.
Health care is not a solo effort. It requires a team of individuals who provide care to patients as directed by a care coordinator. In a care team model, the primary care physician plays a central role as coordinator and developer of the care plan, as well as the care provider. Other health care professionals on the team include nurses, dietitians, chronic care coaches, physician assistants and medical assistants. The patient is also a member of the care team, as are the patient's family members. Each team member plays an important role based on his or her level of training.
Technology's Role in Extending the Reach
New technologies not only provide the connectivity for the care team, they also support shifting team roles and responsibilities, provide lower-cost options for care, improve access and increase productivity—all essential for extending the care for health systems.
Care team resource. For this all-encompassing team approach to be successful, the team needs to stay connected so information, problems, questions and progress can be tracked and shared by all. New technologies provide connectivity and communication as well as a suite of customized applications. Together the provider and the patient decide which applications are appropriate and configure them with alerts, reminders, content and social networking services to address the patient's specific needs. As the figure shows, technology not only supports the work of the care team, but it is also a team member.
While no patient solutions are currently in widespread use, a number are in the pilot and early-adoption stages, or are targeting specific patient requirements. For example, WellDoc offers a suite of patient solutions that provide real-time coaching over mobile phones for people with chronic diseases. People with diabetes, for example, can record information about their blood glucose values, carbohydrate intake and diabetes medications. The FDA-cleared software provides immediate feedback on a person's health status. Connectivity to the physician's EHR is in progress.
Another example of new patient solutions is eMedLink, which offers a range of technology-enabled care options including video visits, patient data collected at home via direct entry and through medical devices, and authorized access of the data by the patient's physician with alerts and reminders, based on patient readings.
This level of connection is particularly important for integrated health systems and newly forming accountable care organizations and their patients. For those with such chronic conditions as diabetes, asthma and heart disease, effective care models supported by the right technologies help keep patients out of the hospital and living active lives. For post-acute patients, the daily reminders for patients to enter vital signs and health-status data online alert providers of potential problems so interventions can be made before the patient requires readmission.
Shifting roles and responsibilities. Technology also has allowed the care team to shift roles and responsibilities to meet a growing demand for resources while lowering costs and maintaining quality. For example, at UNITE Health Center in New York, most of the responsibility for patient teaching has shifted to health coaches, patient care assistants who undergo a training program on chronic-disease management. Essential to the project is the center's EHR system, which allows the health coaches to track patients and provides templates to guide interactions.
Lower-cost options. Other cost-lowering technologies in development involve diagnostic tests that can be given by members of the care team other than the physician or nurse practitioner. For example, researchers at the University of California-Davis, have created a lab-on-a-chip for HIV testing that does not require expensive resources and is able to deliver results in seconds. Others are adapting the lab-on-a-chip architecture for testing a wide variety of blood factors for patients at the point of care at an affordable cost.
Improving access and productivity. Online provider-patient consultations (e-visits) can range from e-mails regarding minor ailments and minor changes in health status or medical questions, to webcam online visits, to traveling physician robots. E-visits eliminate the need for face-to-face visits and, more importantly, allow providers to address problems sooner.
Online communications let physicians control their schedule and be more productive. They can work from home, work in the evening or fill an in-office cancellation with an e-visit. This also keeps face-to-face visits open for those who really need to see a physician. At the University of Minnesota Medical Center, Fairview, 36 physicians are beta testing e-visits. Physicians take shifts when they're available for online sessions with patients. E-visit hours are Monday through Friday, 8 a.m. to 8 p.m., and weekends, 9 a.m. to 5 p.m.
For patients requiring more personalized e-visits, mobile robots can be the eyes, ears and voices of physicians who cannot be there in person. Robots developed by such vendors as InTouch Health, Robosoft and Mobile Robots allow physicians to speak directly with a patient, examine the patient's physical features such as facial movements and hand control, and determine the patient's medical problem with the same acuity as if the physician were in the same room.
Technology: Enabling the Care Team
As care moves beyond office visits and inpatient stays and becomes the responsibility of the entire health system, the care team made up of professionals and family members needs to work in concert to address the many facets of attaining and maintaining good health for patients. New technologies support this care team approach by connecting, educating, reminding, alerting and allowing care to be delivered wherever the patient and the care team may be, to address health issues quickly and to monitor progress.
Editor's note: Part 2 of this two-part series will describe a few of these technologies in more detail.
Fran Turisco is a research principal in Healthcare Emerging Practices at CSC, headquartered at Falls Church, Va. Much of the information for this article was taken from her latest research report, "The Future of Healthcare: It's Health, Then Care," available at www.csc.com/lefreports.