Healthcare is changing. In fact, healthcare has been changing for decades and our health systems have continued to grow, change and evolve alongside it. In today’s market of ever expanding health systems comprised of both horizontal and vertical integrations we’re continually evolving our focus from within the “four walls” of the health system to the geographic region and the patients within it. We’re exploring new models of bundled, capitated and global budget reimbursement and refining those we’ve used since the 80’s. What this means for those of us in pharmacy informatics, is that our focus of how we organize our work needs to change. The boundaries of whom we consider to be our patient is evolving from those physically present in our facilities to those who we have a responsibility toward as a member of our ACO/CCO, our insurance groups, our high-cost frequent fliers and many other patients that aren’t physically within our sight.
We’ve largely passed through the difficult times of Electronic Health Record (EHR) installations, yes we have conversions here and there, we’re merging new health systems with our own and picking up new primary and secondary care offices, but largely the US has adopted the EHR as its primary means of documentation and organization of data. Many of us have chosen large companies to provide our EHRs, and these do an incredible job at providing the tools we need to enable complex care in increasingly large quaternary health systems. While these systems perform greatly at scale, keep us up with regulations, provide tools for mass scale efficiency in operations as well as coding and billing that is necessary in health care today, they don’t always contain the ability to focus on the individual patient. The need to be nimble and respond to each individual patient with their own plan, their own support system, and tailoring medicine to the person’s needs just aren’t there and I doubt they’ll be there any time in the near future. We simply have too many unmet needs at a large scale for these companies to focus on such small scale investments.
The rising trends in healthcare consumerism speak to the need for us to engage our customers and patients in meeting their health care needs where they want them and in the manner in which they choose. For health systems to maintain a competitive advantage this means we need to look outside our EHRs for the individualization our customers and patients desire. The recent growth in digital health (mobile health apps, wearable sensors, tele-pharmacy and other developments) speaks to not only our customer’s longing for this but to the potential benefit that health systems are seeing in utilizing these tools. Digital health applications have grown from a marketplace containing 66,713 options for consumers in 2013 to 165,169 in 2015 and more recently 318,572 in 2017.1 In addition to this, the quantity and quality of research in this space is increasing. In 2017 alone there were over 130 articles published on digital health efficacy, many of which displayed results suggesting their benefit in inclusion within standard of care regimens.1 This is only likely to increase as more companies, start-ups and health systems continue to develop applications in this space. The benefits of these applications/tools offer the ability to reach patients in locations and at times they desire as well as bringing additional and previously unseen data into the healthcare ecosystem for newly advanced analytics.
If we as informaticists desire to meet the needs of our customers and achieve good clinical outcomes we are increasingly faced with the need to provide these applications and tools to our patients to use. First, with hundreds of thousands of applications available it is pertinent for our health systems to cultivate those which have true benefits. Without that we are less likely to see any true results as applications can linger on for years without updates and devices can fall out of maintenance with companies as they move on to better and better tools. Second, we need to help our providers understand when each of these applications has been shown to provide benefit. They must understand and be able to communicate to patients how to use the applications to derive benefit, what these require of them as a customer and what they require of us as a provider. Same as with complex medication therapies, if the patient is not compliant the results often do not come. Third, we must understand how to utilize and make sense of this data when brought back into our health systems. With thousands of data points being generated by our patients and customers daily it is increasingly complex for our providers to separate the signal from the noise. Pharmacists, especially informatics pharmacists, are exceptionally good at parsing through this data, at building tools to sift it and to organize it and especially utilize it to provide the right information to the right provider at the right time. We are at the apex of this change and within the next few years (if you aren’t already) we will be expected to understand how these tools benefit our patients and how to incorporate these new data into models of care for patients outside the traditional “four walls” of our health system.
Our healthcare system is changing, our patients are no longer closely within sight and yet they are within reach. We have the capability to provide care for more patients at any one time today than we ever have in the past. I urge you to begin to study, test, and begin to practice incorporating new data sources into your EHR. Begin to think of new ways you can help and assist patients from afar. Begin to think of how we can use the tools available today to provide care to our patients and what tools we need for the future. These changes bring opportunity, and our responsibility is to see that this opportunity brings forth a better tomorrow.
Seth W. Hartman, PharmD, MBA
Director-at-Large, Section of Pharmacy Informatics and Technology
Director of Pharmacy Informatics
UChicago Medicine
Reference:
- Aitken M, Clancy B, Nass D. (2017) The Growing Value of Digital Health: Evidence and Impact on Human Health and the Healthcare System. IQVIA Institute for Human Data Science. pp 1-72. Retrieved on October 2, 2018 from https://www.iqvia.com/institute/reports/the-growing-value-of-digital-health.