Hidden Insights Revealed From the Pandemic: Where Do We Go From Here?
by Sanaz Cordes, MD
coauthor: Matthew Stein
Original source: LINK
The COVID-19 pandemic has taught healthcare a hard lesson: the future is here, and we must move quickly to keep up. Its arrival has fundamentally changed how we think about care delivery. Health system initiatives around telehealth, patient engagement, remote workforce, and virtual care can no longer fall into multi-year rollout plans. On the flip side, the pandemic has demonstrated that when the health and safety of patients and staff are at risk, healthcare organizations are capable of moving infinitely more quickly than they ever thought possible.
Many of our healthcare partners are still implementing immediate response solutions to the surge of COVID-19 services. Other clients are seeing a decline in the demand for COVID-19 care and are now focusing on converting short term solutions into sustainable and scalable long-term strategies. And other healthcare partners are optimizing long-term strategies that were already underway and have been accelerated by the crisis.
So, where do we go from here?
Conversations have been heavily focused on technologies such as telehealth and remote care tools to support the surge of patients seeking services. Discussions are now expanding to include future state of care delivery. Taking it one step further, any care models we develop must also incorporate hidden insights revealed by the pandemic.
Social Determinants of Health
The COVID-19 crisis shined a spotlight on the importance of incorporating social determinants of health into patient care plans. For example, minorities saw a vastly higher mortality rate, per capita then as compared to whites. A recent CDC analysis identified that white patients experience a death rate of 45.2 per 100,000 as compared to 92.3 and 74.3 among blacks and Hispanics, respectively. · While this is a national statistic, in many cities the disparity was even higher. We learned that high density living conditions hinder the ability to socially distance. Lack of insurance and low-income status makes access to telehealth cost prohibitive. Areas with high air pollution increase adverse outcomes for infected patients. Food insecurity due to lost income and decreased availability of government sponsored programs like WIC trigger fear and anxiety that escalate the mental toll of quarantine.
The future state of care delivery must identify at-risk populations and reveal these insights at the right time and place in order to personalize care plans to improve outcomes. Insights that drive patient-specific questions, care transitions, discharge planning, remote engagement, and financial assistance are examples of data-driven strategies that are crucial for a pandemic/post-pandemic world. Data mining, predictive analytics, and delivery of personalized patient data in real-time will be a crucial component of any care model moving forward. Even the most basic of pulling discrete data from the EHR is solid a starting point for identifying social risk factors. But considering that 80% of the data in the medical record is narrative and non-discrete, AI and machine learning elements will deliver the most value to organizations and drive positive outcomes for patients.
Vulnerable post-acute populations
Organizations delivering direct care and support to patients and staff in post-acute care settings including skilled nursing facilities and long-term care centers have clearly been identified as hot spots for COVID-19 and potentially for future infection pandemics. Public health departments, parent health systems, and the staff at these facilities found themselves underprepared and, in many cases, under supported, to handle the unique challenges of managing vulnerable populations along with their families and visitors.
The future state of care delivery must include specific protocols, processes, and resources for post-acute care facilities that house patients who are at the highest risk of adverse outcomes from an infectious pandemic. These facilities need support from health systems and public health organizations. Implementing immediate access to higher level of care via remote and virtual care solutions (including equipment, network, and providers) is crucial to support staff and patients. Access to continuously updated content from public health officials must be in place, and technologies that automate curation and distribution of this information is essential for scalability. Better workflows and protocols for engaging outside emergency responders for care transitions are also needed, which should leverage pre-deployed, on-demand virtual and remote care solutions to provide the most comprehensive care possible with the least risk to caregivers and patients.
Patient engagement and triage
Few healthcare organizations, including outpatient providers, hospitals, and public health departments, were prepared for the surge of inbound queries from the public. Traditional triage models that ranged from calling a provider’s office to more sophisticated patient call centers could not scale fast enough to absorb the increased demand. Even health systems that had already deployed some automated patient engagement capabilities like portals and secure messaging could not scale the human element that was still necessary to respond to queries.
The future state of care delivery must include intelligent technology to automate early-state triage workflows to allow medical staff to work top of license and scale the organization to meet a surge in demand. Deploying cost-effective, digital engagement tools that automate a significant portion of the triage process provides strong ROI by freeing up staff to provide direct care only for patients that meet criteria for immediate care. These tools can be simple web and/or mobile applications with branching logic that walk the patient through a series of questions to stratify them into no-risk, low-risk, at-risk, or immediate-care-required tiers. More advanced tools like chatbots are highly effective in delivering customized, interactive communication to patients by leveraging conversational artificial intelligence (AI) technology to direct them to the appropriate level of response. That same AI technology can be used on the reverse side to allow care providers faced with a large number of incoming calls to prioritize the response queue.
Care expansion readiness
Probably the most consistent challenge across all healthcare organizations, regardless of size, is the ability to physically scale to meet the surge in demand. Staff shortages, lack of supplies such as PPEs and testing equipment, and the lack of physical locations for care delivery are some of the overwhelming challenges faced by healthcare providers and staff during this pandemic. Demonstrating tremendous innovation and determination, organizations stood up temporary facilities in tents, arenas, and other remote locations - sometimes in a matter of days. Other organizations rapidly converted portions of the hospital that were not designed for infectious disease surveillance and treatment into isolation rooms leveraging cameras, mobile remote monitoring equipment, and other telehealth tools.
The future state must have a surge-readiness model in place that includes the ability to add physical space, technology infrastructure, tech security, and new technologies that can rapidly be deployed outside the walls of the hospital. Portable technical capabilities for patient, staff, and family communication are essential in crisis scenarios. Pre-deployment of wireless bridges that can extend network outside hospital facilities, network kits for wired and wireless capabilities to temporary locations, procuring equipment like preconfigured phones and digital signage to share up-to the minute procedures and information to patients, and cameras to allow for remote patient monitoring are all ways that health systems can prepare themselves for ongoing and future pandemics. For the foreseeable future having an emergency PPE supply might not be immediately accessible given supply shortages, thus technology changes are needed to make up for shortage of those critical supplies.
Sustainable and scalable screening programs
The surge of patients requesting and requiring COVID-19 screening exposed that our healthcare system is significantly unprepared for disaster readiness. Medical staff are placed in high exposure situations due to inadequate protocols and technologies to handle mass disease screening. As of the beginning of April, over 9,200 healthcare providers were confirmed to have contracted COVID-19, and there are strong indicators that that number will rise as more health providers are able to get tested. Noninfected patients requiring hospital-based services like obstetrics, oncology, and dialysis and visitors to these facilities are similarly at risk by proximity. Organizations are left with no alternative but to prohibit family and friends from being present in many cases, which results in unimaginable scenarios regarding critical and end-of-life care.
The future state for healthcare organizations must incorporate a mechanism for mass screening of populations that reduce infection risk for patients, providers, and medical staff. Populations and staff entering healthcare facilities must be screened early and often. Many of our healthcare partners are implementing mass screening devices, such as heat detection cameras, that function autonomously with adaptive ambient temperature adjustment, video recording, and data analytics. These smart devices use algorithms to accurately identify people with elevated temperature in order to flag them for manual screening.
Dual care delivery models
The pandemic state has forced health systems to quickly implement policy changes to protect patients and staff. Most facilities stopped providing elective and non-urgent care in order to reduce exposure. These changes have significantly affected the financial health of hospitals and provider groups, as most were already struggling with shrinking margins. Additionally, consumer behavior had grave economic impact on these organizations, as the number of patients seeking care at outpatient, emergency, and urgent care facilities rapidly declined due to fear of exposure. A recent survey by the Primary Care Collaborative reports that 20% of primary care practices predict possible closure within a month. These financial, operational, and human costs will permanently change the way we deliver care in the U.S.
A dual model of care delivery to support crisis care and non-crisis care is crucial. Health systems must implement the processes, technology, and infrastructure necessary to rapidly scale in response to current and future pandemic situations while still delivering routine care. The drop off in outpatient appointments highlights the importance of regaining patient confidence so that they feel safe seeking and receiving care. It is clear that running simultaneous systems of care with specialized pathways for infection containment will be a requirement for any future state of care delivery.
Each of these challenges and solutions are uniquely different for each healthcare organization, and there is no one-size-fits-all roadmap. We would like to hear from you and learn about your organization’s experience, challenges and goals.