In the recent book-turned-movie Moneyball, Oakland A’s General Manager Billy Beane and his analytic sidekick bury themselves in lists of player statistics. The challenge was translating all that data into meaningful action – using that information to win.
Baseball is a great example of information overload, and like baseball, the healthcare sector is suffering from information overload. Fortunately, healthcare providers and organisations can learn from the sport that is known as America’s Pastime.
What is the shared objective?
In baseball, statistics help identify the best players and inform how they can combine into the strongest team. Player performance is quantified in everything from basic counts of singles, doubles, and triples to the more detailed “ground ball fly ball ratio” or “on-base plus slugging.” In a gross oversimplification, the strongest team scores the most runs while keeping its opponent from doing the same. Scoring is the shared objective.
In healthcare, improving patient outcomes is the shared objective. Depending on specific players, that objective comes with additional caveats – such as containing cost to treat or maximising the use of a particular therapy. However, the common thread across payers, providers, caregivers, suppliers and patients is the patient.
By reorienting our perspective to that of the patient, we can find clarity in an age of information overload.
From a technology standpoint, the technical infrastructure associated with healthcare has never been so advanced. Healthcare technologies range from highly adapted devices for people with only the most basic IT skills, through highly interactive services linking wireless medical devices to applications on smart phones.
While the trend is to move toward more interactive services that help to inform patients and encourage adherence to self-care regimes, most systems today are built around the need to collect (and transmit) data from patients.
Underlying many of these technologies is an inherent shift toward increased connectivity. Today, telehealth is empowering different aspects of healthcare delivery through the use of telecommunications.
For example, people can manage their own health and wellness through a wide range of services ranging from text messaging and telephone-based coaching through to remote monitoring of vital signs. Furthermore, remote monitoring will only increase in importance with the aging population and the growing impact of chronic diseases.
From a physician interaction standpoint, one of the best examples of success comes from the U.S. prison system. Risks associated with transporting prisoners compounded with cost pressures necessitated an alternative approach to traditional in-person appointments. With telehealth, prisoners could instead videoconference with physicians.
Today, over half of U.S. states use telehealth in their prisons. The Arizona Department of Corrections estimates telehealth saved $237,000 across nine facilities in 2008.
Given such potential savings, healthcare reform is driving even further investment in connected health, even in an economic downturn.
This shift is not without growing pains, however. For example, take the current debate: Is your iPhone a medical device? There are those who argue that as soon as it starts storing patient data, that answer must be yes. However, that classification results in the regulatory requirements that accompany medical devices, burdening developers.
Multiple data formats
The health information age is in its infancy. Interoperability and consistent data standards are not universal. So not only do we have more data than ever before, we have more data in more formats than ever before.
The variability in formats is not surprising when you consider the sheer number of players involved in healthcare. Healthcare combines the interests of patients, providers, payers, caregivers, suppliers and regulators. Each group has a different perspective on patient data and a different interest in its use, and until recently, sharing information was largely non-existent.
It’s important to recognise that the power is shifting in data ownership. Technology investment by integrated health systems is leading the pack with connecting patients and managing costs.
The incentive is clear to maximise the impact of physician resources. Using a connected patient portal enables that. Patient portals are actually most successful when they serve as a conduit to connect with physicians, nurses or further trusted resources.
This connects back to the growing population of active patients. Information is a button click away with the Internet. For example, patients are self-aggregating through website such as PatientsLikeMe where individuals can compare experiences with those who share their diagnosis. Patients are no longer tied to the traditional brick and mortar physician’s office to gain insights for themselves.
The additional challenge with the sheer volume of data is deciphering the quality of information that you encounter. Mass amount of data are generated through patient-led websites, online resources and even social media. The resulting data quality is suspect. However, by simply ignoring such sources, organisations may miss insights about patients that would never otherwise be possible. In the age of information overload, where is the balance?
Baseball cards of healthcare
As with baseball statistics, it’s that common goal that can provide clarity in an age of information overload. To align across the common goal of improving patient care, we need several important inputs:
- A clear understanding of the patient
- Quality data including clinical and demographic indicators
- Meaningful analytics with the ability to assess by patient segment
- An understanding of the stakeholders in the patient pathway
- The ability to walk ‘in the shoes of the patient’
Electronic medical records are the baseball cards of healthcare. We know what we can expect from a baseball card. However, healthcare has yet to agree standards with that level consistency. Absent that consistency, we need to focus on the data that best defines the needs of and differences across patients.
Patient demographics and epidemiological segmentation provide parameters with which to consider patients. By understanding the impact of therapies (whether medical, behavioural or other) across different patient segments, we can develop the analytical infrastructure today that will be poised to take advantage of the standardisation that will come with the evolution of standardised electronic medical records.
Furthermore, we need to understand all of the stakeholders in the patient pathway. For example, patients become active participants in their own care and receive services designed to focus on their individual needs and preferences, whereas providers are incentivised to use electronic health records in both inpatient and ambulatory medical practices. Payers, on the other hand, are particularly interested in outcomes data and that incentivises them to invest in data solutions that help them better reduce their costs, while policymakers must focus on promoting self-care, largely due to the current economic conditions.
By understanding the perspectives and priorities of the different players, an organisation can better determine (a) where to look for existing data from others, (b) where it makes sense for them to invest for themselves and/or (c) where opportunities may exist to partner for mutual value.
The ability to walk “in the shoes” of patients – recognising their priorities, preferences and behaviours – which extend far beyond a single touch point with a physician or caregiver – provides another valuable lens. That is, what happens at each step along the patient journey?
One example is the use of home/remote monitoring devices that enable self-monitoring of conditions and electronic reporting of results to physicians, or home/remote devices that include prompts and reminders to improve adherence to a health improvement or treatment plans. Such an insight during the management stage could help drive an organisation to provide a service that it did not previously provide.
The patient experience can help make the link between what your patients want and what you need to change about your services.
That being said, reorienting our perspective to that of the patient is not enough by itself. It is also necessary to clearly define one’s strategic priorities. Commercial realities dictate that we do more with less, and clear strategic priorities help inform the depth of detail required across different types of patient data. When incorporating the breadth of information associated with patient pathways, data volumes can quickly become prohibitively large, and clear strategic priorities help avoid that pitfall.
It is an exciting time of increasingly available information, and by adopting a patient-centric approach with the intelligent use of data, we can maximise the potential for innovation.
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