Transforming the Continuum of Care With Technology
Graver: What do you see coming up?
Murphy: When I left Aurora Health Care in 2011, I had been focusing on some aspect of electronic health records for about 20 years. Then at the Office of the National Coordinator for Health Information Technology (ONC), I started to realize that a lot of health IT was evolving outside of the traditional electronic health records—things like mobile apps, analytics, population health management, big data, etc. I became very interested in getting outside of the acute care facilities to really think about health and healthcare, and how we do disease management and preventive care in the home. That’s what took me to IBM; I wanted to stay in health IT, but not work on electronic health records (EHR), per se. The EHR is certainly important; I would call it the foundation of what we do. But I wanted to work on the next big thing in health IT.
In thinking about the future of healthcare technology, the first thing I’d look at is mobility. What can we put on a mobile device that will empower our caregivers and our patients and make a big difference as to how we think about health and healthcare?
The second thing is population health management. I think that’s becoming the new organizing framework—getting out of the acute care focus and really thinking about these four different population segments:
- The healthy well
- The people who are predisposed to disease
- The management of chronic disease
- The very small sliver of the acute care episodes
It’s important to think about how we use health IT in different venues with those different population segments. We need to really think and act on value-based care and maintaining health and wellness, as compared to just managing episodes and diseases. We also need the ability to find patterns and opportunities for improvement by collecting data and analyzing it.
One of the biggest changes will be the government mandates around value-based care. Reimbursement is going to be value-based, not volume-based. You’re going to get reimbursed for maintaining the health of a population and managing chronic disease well, not for itemized episodes of care and services. The government has gone on record saying that by the end of 2018, 50% of payments from Medicare will be bundled payments and value-based.
If you’re not getting paid for every chest x-ray and every lab test that you do, and instead start getting reimbursed for value metrics, such as an 85% mammogram screening rate in primary care, you get a different mindset for how you think about these things.
The industry has consistently maintained that with information comes empowerment, and with empowerment comes better participation of patients in their own care and better outcomes. Getting patients engaged in their own care is being encouraged at all levels—including participation in health and wellness activities, as well as disease management processes. Even in acute care, patient engagement is encouraged, as patients are being given iPads so they can see their own care plan and access their test results. Or they might be presented with a daily itinerary to see what’s going to happen to them during the day. That’s just one more example of how technology is already transforming the whole continuum of care.
Graver: What’s most important as we move ahead?
Murphy: As we continue to strive for the development and adoption of health IT, we have to remember it is the means to an end and not an end unto itself. Health IT should be used wisely and judiciously to support health and healthcare, and to help us move to the transformation we all know we need in our healthcare system. If we are going to improve the industry, all members of the healthcare team need to work together—including the patient—and with nurses helping to lead the way.