The following is a guest post by Dr. Gary Ferguson. Gary Ferguson has a strong background in starting, leading, and turning around healthcare IT organizations. Dr. Ferguson earned his doctorate in pharmacy and pharmacology at the Los Angeles County and University of Southern California Health Network, and gained clinical experience working in a trauma center.
While healthcare often cites a host of somewhat sketchy reasons why they’re different, there is one particular way in which they are: Preventing repeat business is increasingly a good thing.
In this line of work, repeat business for a healthcare facility is known as readmissions, and there is a great deal of focus on this topic at the moment. The Centers for Medicare & Medicaid Services (CMS) decided to penalize hospitals that show consistent, high rates of repeat business for the same medical problem.
Taking a look at what causes preventable readmission brings up some very easy targets:
Inconsistency
Healthcare struggles with having consistent care paths without gaps and poor handoffs.
For starters, evidence-based medicine guidelines are entrusted to doctors memories, which we can expect to be imperfect. If a doctor has more than half of the care guidelines in their head, they’re doing well. And no two doctors will remember the same things.
Take a step back and consider the inconsistencies across the spectrum of healthcare operations, and the opportunity for standardization and measurement is staring us in the face. Business process management in a nutshell.
Disconnects
There are two disconnects at work here…a disconnect between multiple caregivers like nurses, doctors and pharmacists and a disconnect between caregivers and the patient and their support community. Both of these problems should be addressed through better collaboration and open communication, two strengths of social media.
It doesn’t help that written instructions are too often given by busy doctors to busy staff, then delivered to woozy patients more focused on getting home than anything else. This can be improved by better process management, training and communication, also strengths of business-facing BPM.
Deafness
A Dartmouth Atlas Project found that only 42.9 percent of patients visited their doctor within two weeks of hospital discharge. It is well known in the community that this is a significant factor in readmission. When things go wrong or right, we need to be listening. Event technology has been applied nearly everywhere else with great success for decades.
It will take time and investment to turn around the problem of repeat business, but with CMS estimating the cost of preventable readmissions to be $17B annually and penalties for those who don’t show progress, there is plenty of reason to believe the investment will be made.
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Chris: You’ve laid out a great issue: readmissions, and then asserted multiple times that BPM, social media, and event technology can help. Can you provide more elaboration on how those technologies could help? I’m not acquainted with event technology.
Brad, good question. Event technology involves looking for or ‘listening’ for a specific occurrence of a single piece of data or a combination of data. Risk scenarios often include multiple simultaneous occurrences to indicate a larger problem, like an unfilled prescription and a skipped physical therapy appointment in combination. By designing systems to watch for events (or non-events), we can find problems sooner before crisis hits. The problem with simple systems that simply store data is that a busy, understaffed medical community has a hard time sorting through data to see what happened and didn’t and making determinations where to put their efforts. Systems built on event intelligence significantly improve the ability to manage a population by resolving situations before problems become bigger and more expensive.
Brad, thanks for your question. I’ll give an example of each of the three areas:
BPM - Business processes in healthcare are often actually transactions. The big EMR systems in use refer to business processes but are actually screens and transaction flows as patients and data move through stages of care. Taking the time to understand what healthcare workers actually do, where there are handoffs, where there are compliance and safety requirements isn’t a luxury, it is necessary.
Social Media - Social media allows much faster flow of information between care professionals, departments, facilities, etc. A historical record of an issue or a particular patient is created that gives evidence to support decision making in ongoing care. Not everyone can get on a phone call at the same time, and email is point-to-point, but social media is one talking to many and many talking to one.
Events - Software has become good at sorting through data and finding patterns. In the case of sepsis, one of the deadliest of healthcare problems, spotting an elevated temperature, elevated white blood cell count and rapid heart rate in someone NOT admitted for those causes. Finding things in combination is harder s patients are treated by multiple people who may not compare notes. Secondly, if a patient is discharged and fails to pick up a required prescription, their risk of readmission goes up. A system watching for non-events would trigger a notice to care professionals so that someone can intervene.
Chris,
Great points. One significant repeat event that we should encourage are those preventative events. Chris, I think this is one of the areas that healthcare wants to focus to ensure events do reoccur as scheduled.