A letter from the guest editor highlights the important work that remains for provider organizations to integrate digital advancement as a key strategy to address some of the most pressing challenges transforming the healthcare landscape.
Am J Manage care. 2022;28(1):9-10
When The American Journal of Managed Care® published its first special issue on health information technology in 2012, the healthcare sector was on the verge of widespread digitization. The following decade saw a dramatic increase in the adoption of Electronic Health Records (EHRs) and the attestation of use of defined documentation practices and features that are essential to realizing the value of data-based healthcare. technology. Targeted policy-driven efforts, combined with market forces, have resulted in great progress. And yet, despite the many challenges encountered and described by researchers and practitioners along the way, we realized that digitization was the easy part. True digital transformation – the reinvention of healthcare to leverage technology seamlessly in the pursuit of safer, more accessible and higher value care – remains ambitious. Significant work remains to be done for provider organizations to embrace digital advancement as a key strategy to address some of the most pressing challenges transforming the healthcare landscape. These include prioritizing performance within a value-based contract, committing to a new understanding of patient care as a whole, and finding a sustainable organizational approach to engagement. virtual patient.
Performance under value-based contracts
Accountable Care Organizations (ACOs) and other value-based payment redesigns rely on a data infrastructure that supports more efficient care coordination and advanced analytics to address cost and quality issues unsustainable. Apathy et al demonstrate in their work that hospitals do indeed expand their health information exchange efforts after joining an ACO, but the response is delayed and has less effect in markets where ACO penetration is low. weak. This finding underscores the interdependent nature of organizational investments in data sharing and highlights the need for continued policy efforts to more directly incentivize, support and regulate interoperability in the context of value-based payment agreements. Perloff et al’s investigative work describes a different but related ACO challenge emerging from continuous data silos. Their work demonstrates, on average, a high number of different EHR development products used concurrently within a given ACO and the distinct challenges of integrating, managing and analyzing this data to generate performance data. . These issues, if left unaddressed, hamper the advanced performance monitoring necessary for organizational learning and improvement.
Commit to a new understanding of holistic patient care
The information that providers use to make decisions about patient care and that informs more structural investment in population health is changing rapidly. Organizations must have the ability to identify and act on patients’ social needs and risk factors, such as food or housing insecurity, that critically shape their well-being and interactions with the system health care. Given the challenges of collecting this data, Vest et al convened a group of experts to identify and assess the quality of routinely collected structured data that could be used to impute and characterize social risk. The authors highlight the data elements that can be most useful in today’s data environment, and they also outline plans for the continued development of methods and approaches that mitigate the current limitations and biases with which these data is often recorded. Walker et al also focus on tackling social risk, analyzing a regional effort to promote the referral of patients from the health system to community-based services when food insecure. The results illustrate the challenges of implementing the data sharing that is necessary to support cross-sectoral partnership. The authors offer key insights into how we might address the technical capabilities and resource limitations, as well as the characteristics of the regulatory environment, that impede these critical efforts.
As we examine advances in data-driven healthcare decision-making, the use of predictive analytics is also a priority for healthcare systems. The exponential acceleration in the volume and types of data available for advanced analytics, and the sophisticated methods for doing so, far exceed our knowledge of how to integrate predictive insights into supplier decision-making. Nong et al use user-centered design to determine the information providers need to evaluate these tools and incorporate them into care decisions. Given growing concerns about caregiving biases that are reflected and amplified in the design and use of these tools, the authors highlight key ways to integrate equity considerations into the development of models and in communicating the results of predictive tools to end-user clinicians.
Finding a Sustainable Organizational Approach to Virtual Patient Engagement
The ongoing COVID-19 pandemic has disrupted and accelerated health system planning around virtual care offerings. The data suggests that telehealth services have plateaued at levels significantly lower than spring 2020, but still well above pre-pandemic volumes. As a result, provider organizations continue to grapple with how to implement and sustain more strategic hybrid care delivery models. This includes, first, the offer of telehealth visits. Friedman et al suggest in their work that telehealth holds great promise for reaching patients with mental health and chronic disease management needs, including in older, more racially diverse neighborhoods. The work presented by Tan-McGrory et al offers policy recommendations for advancing virtual care services for equity, including improving access to technology, addressing immigrant patient concerns about privacy, and improving the integration of interpretation services.
Organizational efforts must also consider how best to integrate and support the use of online communication tools to increase patient engagement and provider access. Work by Fareed et al suggests that patients who use patient portals have higher satisfaction scores. However, Escribe et al offer insight into the organizational challenges of managing the communication that flows through a practice through these online access points. The authors use a new detection approach to categorize the types of tasks that providers handle through their email inbox and find a high variation in clinical as well as administrative demands. These methods could have future application to help provider organizations develop clear expectations and team workflows for how virtual communication should be used to best meet overall patient needs.
Digital advancement is not the end goal, but rather a strategic approach to organizational learning, optimizing care processes, and improving data-driven outcomes. The areas of research targeted in this special issue and the specific insights offered by the authors’ analyzes help us chart a course towards integrating and leveraging our ongoing commitment to digital healthcare.