In 1997, health information technology and digital health pioneer Warner Slack wrote his bold and prophetic book, Cybermedicine: How Computing Empowers Doctors and Patients for Better Care. Slack argued that “the electronic digital computer, with its capacity to hold large amounts of data and to execute multiple complex instructions and accuracy would…find an important clinical role in both diagnosis and treatment.”
While the digitization of health information has solved many problems in American medicine — particularly, helping to reduce medical errors by enhancing clinical decision support — it has inevitably created many new ones. Clinician-oriented solutions such as electronic health records (EHRs) are contributing to physician burnout instead of facilitating patient care. Many anticipated that health information technology would reduce costs by limiting the duplication of tests and studies, but there is little evidence that it has accomplished this. And while patient-oriented digital solutions have proliferated in number, their clinical impact has been limited. Slack anticipated a world in which patient access to records would enhance "patient power” — yet many patient-oriented solutions have little relevance in the clinical exam room.
Yet there are rays of light, each of which shares a common denominator: a rigorous focus on the specific needs of the end user, be it patient or clinician. When creative health systems consider and engage the end user of the digital technology as the “customer” of that technology, adoption levels are high and so, too, is the impact. Two CareMore Health initiatives serve as examples: One provides patients with non-emergency transportation, and the other is a new secure platform for clinical team communication and collaboration.
Patient-oriented solutions. A focus on simplifying and solving basic patient needs is what drives adoption in health care, not novelty or degree of innovation. Many have suggested ride sharing as a solution to improve access to non-emergency medical transportation. However, simply putting ride-sharing apps on the cell phones of patients will not solve the medical transportation problem, particularly since aging seniors are significant users of health care services and many of them do not have smart phones or the digital literacy to use them.
When CareMore Health, a delivery model that focuses on care for high-cost, high-need Medicare and Medicaid patients, partnered with Lyft to improve access to its care, it did not believe the solution was putting a smartphone application in the hands of more seniors. Instead, CareMore and Lyft worked to rigorously document the challenges patients face in accessing transportation services and built a model that addressed their needs; these challenges include the timeliness of pick-ups and the extent to which drivers were sensitive to the mobility needs of seniors.
The collaboration contributed to the development of a dispatch tool that allowed a central transportation office to request rides on behalf of seniors before and after their appointments were scheduled. Consequently, patients do not have to fumble with an app that many find difficult to use. CareMore was able to improve patient satisfaction with rides, shorten wait times, and lower overall health plan transportation costs by more than $1 million a year.
Clinician-oriented solutions. As a physician-led organization, CareMore’s approach to health IT implementation fully embraces the end user at the outset. Clinicians identify the problems to be solved and collaborate during the testing of solutions to help the information technology team refine the app. Once fully implemented, continual refinement and oversight of the solution is managed collaboratively by physicians and members of a digital implementation team to ensure that the technology is being embraced and effectively utilized so its benefits are fully realized.
An example is TigerText, CareMore’s new secure platform for clinical team communication and collaboration. Inpatient, hospital-based physicians were accustomed to using phone calls, text messages, faxes, and e-mails to communicate with various outpatient physicians such as primary care doctors and specialists, and information was delivered to the members of the clinical team in question in a fragmented and inconsistent way. The new platform required clinicians to move to a single platform for communication.
Clinicians identified the problem that needed to be solved and once versions of the technology were rolled out in a test phase, provided feedback on the use of the technology within their daily workflows and across the enterprise. This continuous clinician input resulted in refinements to the interface that enhanced its usability. While CareMore is in the early stage of implementing the platform, physician satisfaction with it is high.
CareMore’s IT department adopted a similar approach to building its AMAZE app, which integrates into a single interface all of the disparate systems to which CareMore physicians needed to log into — including CareMore’s care-management software, electronic health record, and pharmacy data systems, among others. The proprietary platform integrates lab and clinical data on inpatient admissions, stores status updates on patients, enables medication reconciliation, and transmits data on patients to other clinicians within the system. Physician input helped improve the navigation approach and resulted in a format that users felt supported medical decision making.
When the end user identifies the problem, participates in building in the solution, and continues to engage during its refinement, adoption is inevitable.
The American health care system is in constant need of innovation and digital health has the ability to provide solutions to some of its biggest challenges. As simple as it is, the industry has often failed to engage the end user in building solutions. By placing greater emphasis on the problems of the end user — and less emphasis on the systems themselves — health care systems will perhaps succeed in creating the cybermedicine revolution prophetically envisioned by Dr. Slack.
Omid B. Toloui
Omid B. Toloui is vice president of digital health strategy and alliances at CareMore Health, a division of Anthem, Inc. Twitter: @fiveplusfour.
Zubin J. Eapen, M.D.
Zubin J. Eapen, M.D., is chief medical officer of the CareMore Health System, a division of Anthem, Inc. Follow him on Twitter at @zeapen.
Sachin H. Jain, M.D.
Sachin H. Jain, M.D., is president and CEO of the CareMore Health System, a division of Anthem, Inc. He is also a consulting professor of medicine at the Stanford University School of Medicine. He previously was the chief medical information and innovation officer at Merck. Follow him on Twitter at @sacjai.
This article originally appeared on HBR.org and is being brought to you by Medtronic.