A Five-Part Series
Part IV: Technical Aspect
In our earlier blog entry, we posited that the term “population health” is rather meaningless unless stated in terms of how it is implemented, which involves the application of the clinical, organizational, and technical aspects of population health management. We previously examined the clinical aspect and the organizational aspect; finally, we focus on the technical aspect.
Health information technology provides the foundational support for the workflow and process changes necessary for effective population health management. Those changes ultimately will foster the strong healthcare relationships needed to implement organized systems of care; coordinate care across multidisciplinary teams and settings; enhance access to primary care; centralize resource planning; provide continuous care either in, or outside of, office visits; promote patient self-management education and healthy behavior and lifestyle changes; and facilitate essential communication among providers and patients.
The Agency for Healthcare Research and Quality has identified five domains of health information system functionalities to support population health management:
- Domain 1: Identify subpopulations of patients who require preventive care or tests.
- Domain 2: Examine detailed characteristics of identified subpopulations.
- Domain 3: Create reminders for patients and providers to make information actionable.
- Domain 4: Track performance measures in real time to compare care delivered to national guidelines.
- Domain 5: Make data available in multiple forms (e.g., printed, exported, or graphically displayed).
Presently, there is a significant gap between existing and optimal functionality for population health management. Progress is being made, but the lack of cost-effective health information technology solutions remains a major impediment to fully integrated population health strategies.
Providers are particularly challenged when selecting and implementing technology solutions. Many have adopted EHRs, but that is only the first step. A wide range of other applications will be required to implement the functionalities identified above. Further, systems must be adaptable to a rapidly changing payment and regulatory environment and the light-speed change of technology itself.
The Accelerating Pace of Technological Development. Emerging daily are cutting edge applications that are making the initial iteration of health information exchange obsolete. No longer must providers query raw form records from individual episodes of patient/provider interaction in order to get the actionable data they need for the specific analysis they are conducting. Selective data extraction from multiple patient records and collation of that specific information for more efficient analysis is becoming feasible.
Increasingly, healthcare executives are looking beyond the vendors who supply their core financial and clinical information systems for the IT capabilities needed for population health management. The more specialized, creative technology developers are capturing a larger portion of the population health management space.
As a result of the dynamics inherent in identifying and deploying IT solutions to support population heath management, healthcare executives are understandably moving cautiously – developing their population health strategy, identifying gaps in IT needs to support it, and addressing the urgent IT needs such as automated patient outreach capabilities and patient communication. But they are keeping their options open when considering the more complex analytical applications that will ultimately be required for the development of more comprehensive strategies to address population health needs and effectively manage patient stratification—those actions that truly move the needle in improving population health status.
Impact of Disruptive Technology. The IT space is being further complicated by the proliferation of disruptive technologies that are likely to cause fundamental changes in access to, and delivery of, healthcare. Consider smart phone applications that harness the device’s capabilities—computing power, camera, audio, video, motion sensor, and GPS—in new ways to manage health and wellness. There are fitness and weight control apps, exercise programs and progress monitoring apps, apps to monitor glucose for diabetics, heart rate and blood pressure apps, sleep hygiene apps, and stress reduction apps, just to name a few.
What happens when all the data such devices produce find their way into the medical record? How will data be used productively and applied to benefit the patient? How might that information be used to impact population health management? How will providers cope with the influx of information and effectively deal with it? What apps are being developed daily that could come online virtually overnight and will totally disrupt how healthcare is monitored and delivered?
It’s somewhat terrifying to realize these rhetorical questions are already being answered. Creative digital geniuses can use established technology systems to tinker freely with ideas and develop and market new applications with no investment other than their time. Digital disruption is not only reducing the barriers of entry into the market, it is obliterating them. Development of technological solutions that used to take years from development to market can now be done in days. Large IT investments can be rendered obsolete overnight.
Rapid Change – Challenges and Opportunities. So how do leaders contend with the volatile environment of such a key component of the organization’s population health narrative? First, management must obviously be prudent in making any large investment in IT. Having the ability to meet immediate needs while remaining nimble enough to capitalize on new and emerging technology that dramatically enhances capabilities is a prudent planning strategy, as we noted above.
Second, perhaps the challenge can, and should be, recognized as an opportunity. Digital innovators are having a hard time maximizing the potential that comes from their efforts and creativity. They need some connection to healthcare providers who can channel that power productively. We often encounter digital developers who have a nifty new application, but who have no appreciation of how that application can really be used to impact the healthcare environment.
Those well-meant efforts would be better channeled were there better communication between digital developers and healthcare leaders grappling with the complexity of population health efforts. Grasping that opportunity, healthcare leaders may be able to dramatically cut their IT investment with technology solutions tailored to their specific needs. Really strong solutions could be marketed to others, perhaps creating a whole new source of revenue for the healthcare organization.
The potential benefits from the use of digital technology are illustrated by a recent longitudinal study by the Veteran’s Health Administration (VHA). The VHA has been using a wide variety of technology, including videophones, messaging devices, biometric devices, digital cameras, and telemonitoring devices in its home telehealth program since 2003.
A retrospective analysis of VHA data from 2009 through 2012 found that VHA’s routine use of such digital technology has been successful in coordinating care and more efficiently managing patients with complex chronic conditions. For example, after 12 months of home telehealth (non-institutional care) the mean annual healthcare costs for VHA home telehealth patients fell 4%, while the corresponding costs in a matched cohort group increased 48%.
Without harnessing the power of technology, the reach of population health management will be severely limited, extending only so far as an individual physician’s working knowledge of his or her patients’ medical conditions and social circumstances. Properly aligned with the clinical and organizational aspects, technology is the key to unlock the potential of population health management.
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