Kathy Mazza, RN, senior advisor, population health informatics, clinical digital solutions, at Northwell Health
Photo: Northwell Health
How hospitals and health systems measure success in healthcare is changing, as quality ratings and emerging payment models drive initiatives to reduce days of hospitalization while simultaneously preventing avoidable admissions.
Patients go home quickly following medical and surgical inpatient admissions or emergency department visits and have acute health needs requiring management in the community, explains Kathy Mazza, RN, senior advisor for population health informatics and clinical digital solutions at Northwell Health.
Payment model paradigm shift
Mazza, who holds a Ph.D. in biomedical informatics, has recently been conducting research in the use of chatbots for remote patient monitoring.
"Readmissions have typically been a focus in [value-based care] programs because they are seen as a surrogate measure of the quality of care and they result in increased costs," Mazza explained. "This paradigm shift in payment models rewards health systems that deliver effective and efficient care.
"In tandem, patients are becoming less passive, taking a more proactive role in their care and using personal health apps and wearable devices to track activity and monitor wellness or chronic disease," she continued. "Patients expect the same frictionless access to healthcare via apps on their phone that they have experienced with other industries like retail and banking."
Advances in technology such as app-connected wireless devices, wearables, sensors and chatbots have the potential to help providers remotely monitor patients and understand how their patients are faring when they are outside of facilities.
"Leveraging that data for early identification of patients at emerging risk – perhaps a heart failure patient who has gained weight, a post-op patient with a new onset fever, a senior whose step count is diminishing – can allow us to engage the patient and intervene in a timely manner to prevent an ED visit or hospital admission," Mazza explained. "This concept of patient-generated health data is not completely new."
Workflow challenges
In Northwell Health's early work in the use of remote patient monitoring devices and chatbots for CMS Star patients and COVID patients during the surge in New York, staff learned a lot about the opportunities and challenges of incorporating patient-generated health data into typical workflows.
Mazza offers a variety of advice for peers implementing these technologies:
- Patients express interest and satisfaction with reporting this data – especially when they perceive it is actually used to plan their care.
- CMS has initiated policy changes that incentivize and reimburse providers for reviewing and interpreting patient-generated health data.
- Providers acknowledge patient-generated health data can improve health outcomes, but they have legitimate concerns about both the quality and volume of data from internet-connected devices. Assuring accurate, secure, timely and meaningful data is shared is critical to success.
- Taking an enterprise approach to the collection of patient-generated health data across multiple departments can reduce costs, improve data integrity, streamline workflows, and create efficiencies in dashboard monitoring and management of clinical escalations.
- Many EHRs have limited capacity to capture and display patient-generated health data intuitively. Clinicians and health IT leaders must consider how to integrate this data more seamlessly so clinicians have the insights they need to incorporate it in their medical decision-making while reducing the documentation burden.
- Everyone must consider how to address the ethical concerns associated with disparities in care for those without devices or internet access.
"Patients have long recorded data about health or symptoms in notebooks or logs and shared information with providers at the time of an office visit," said Mazza. "However, the concept of patient-generated health data is evolving, as today we can tap a vast amount of health data available via apps and devices in near real time to improve communication between patients and clinicians to improve health and reduce overall costs of care."
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Healthcare IT News is a HIMSS Media publication.
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