5 Ways Technology Will Enable Value-Based Care in 2020 and Beyond

If your first thought while reading that statement was, “I’ve heard that before – and nothing actually ever changes,” your skepticism is well founded, as industry experts have been purporting significant transformation for at least a decade. However, I truly believe we’ve reached a tipping point, and that consumers will see real healthcare change in the near future. It’s a bold statement to make, but there are a few forces at work that I believe will make it true — namely, the intersection of value-based care and technological innovation. 

1. Digital Therapeutics: Engaging With Patients During Recovery 
2. Promoting Patient Wellness With Wearables 
3. Price Transparency: What’s The Cost Of My Care?
4. Healthcare, Personalized: Precision Medicine and Genetics
5. Dr. A.I. Will See You Now

The full Forbes article can be viewed at this link.  

“Patient Journeys”: improving care by patient involvement

“I will not be ashamed to say ‘I don’t know’, nor will I fail to call in my colleagues…”. For centuries this quotation from the Hippocratic oath, has been taken by medical doctors. But what if there are no other healthcare professionals to call in, and the person with the most experience of the disease is sitting right in front of you: ‘your patient’.

This scenario is uncomfortably common for patients living with a rare disease when seeking out health care. They are fraught by many hurdles along their health care pathway. From diagnosis to treatment and follow-up, their healthcare pathway is defined by a fog of uncertainties, lack of effective treatments and a multitude of dead-ends. This is the prevailing situation for many because for rare diseases expertise is limited and knowledge is scarce. Currently different initiatives to involve patients in developing clinical guidelines have been taken, however there is no common method that successfully integrates their experience and needs of living with a rare disease into development of healthcare services.

The full article can be downloaded below.  

Validation of use of billing codes for identifying telemedicine encounters in administrative data

Telemedicine is the use of telecommunication technology to remotely provide healthcare services. Evaluation of telemedicine use often relies on administrative data, but the validity of identifying telemedicine encounters in administrative data is not known. The objective of this study was to assess the accuracy of billing codes for identifying telemedicine use.

In this retrospective study of encounters within a large integrated health system from January 2016 to December 2017, we examined the accuracy of billing codes for identifying live-interactive and store-and-forward telemedicine encounters compared to manual chart review. To further examine external validity, we applied these codes and assessed patient and visit characteristics for identified live-interactive telemedicine encounters and storeand-forward telemedicine encounters in a second data set.

In manual review of 390 encounters, 75 encounters were live-interactive telemedicine and 158 were storeand-forward telemedicine. In weighted analysis, the presence of the GT modifier in the absence of the GQ modifier or CPT code 99444 yielded 100% sensitivity and 99.99% specificity for identification of live-interactive telemedicine encounters. The presence of either the GQ modifier or the CPT code 99444 had 100% sensitivity and 100% specificity for identification of store-and-forward telemedicine encounters. Applying these algorithms to a second data set (n = 5,917,555) identified telemedicine encounters with expected patient and visit characteristics.

These findings provide support for use of CPT codes to perform telemedicine research in administrative data, aiding ongoing work to understand the role of non-face-to-face care in optimizing health care delivery.

The full article can be downloaded below.  

Citizen science to further precision medicine: from vision to implementation

The active involvement of citizen scientists in setting research agendas, partnering with academic investigators to conduct research, analyzing and disseminating results, and implementing learnings from research can improve both processes and outcomes. Adopting a citizen science approach to the practice of precision medicine in clinical care and research will require healthcare providers, researchers, and institutions to address a number of technical, organizational, and citizen scientist collaboration issues. Some changes can be made with relative ease, while others will necessitate cultural shifts, redistribution of power, recommitment to shared goals, and improved communication. This perspective, based on a workshop held at the 2018 AMIA Annual Symposium, identifies current barriers and needed changes to facilitate broad adoption of a citizen science-based approach in healthcare.

The full article can be downloaded below.  

As Healthcare Goes Digital, Social Care Lags Behind

Since 2009, federal legislation has awarded billions of dollars to physicians and hospitals that make health information technology part of their practice. While many highlighted the downsides of digitization, the providers who unlock its full potential know very well that it benefits clinical care immensely.

Most social care organizations, however, were left untouched by this outpouring of funds—not for lack of necessity, but their inability to qualify. Although their exclusion was no doubt a missed opportunity, digital tools and data solutions have emerged over the past decade that can more than make up for lost time.

The reasons for digitizing social care are as numerous as the challenges that come with it. Here are a few of each.

The full Forbes article can be viewed at this link.  

WHO HEALTH AND CLIMATE CHANGE SURVEY REPORT

This report presents global findings from the 2017/2018 WHO Health and Climate Change Survey completed by national health services. Regular updates on key health and climate change indicators empower policy makers to make more informed choices to: assess the implementation of policies and plans, identify gaps in evidence, and better understand the barriers to achieving health adaptation and mitigation priorities. This report provides a vital snapshot of the overall progress that governments have made in the field of health and climate change to date, as well as insight into what work remains in order to protect their populations from the most devastating health impacts of climate change.

The full report can be downloaded below.

Top 8 Predictions That Will Disrupt Healthcare in 2020

Every year, our team of futurists, analysts, and consultants at Frost & Sullivan's Transformational Healthcare Group comes together to brainstorm and predict the themes, technologies, and global forces that will define the next 12 to 18 months for the healthcare industry. We also retrospect how we did each year, and each year we are becoming more accurate in the predictions we make. For the 2019 predictions that were released in November 2018, six out of eight predictions realized as anticipated, while the two remaining predictions have not panned out exactly the way we thought.

The new vision for healthcare for 2020 and beyond will not just focus on access, quality, and affordability but also on predictive, preventive, and outcome-based care models promoting social and financial inclusion. As we are on the verge of entering a new decade of change globally, 2020 will be a reality check for long-pending national healthcare policies and regulatory reforms that must reinvigorate future strategies. China will continue to catch up to the US on some important health metrics as it strives to become the “world’s best and cheapest health system.” 

The top 8 predictions for 2020 are as follows:

1. SDOH analytics platform gains traction during 2020
2. AI develops more use cases and faces more ethical challenges, beginning with radiology
3. Annuity-based model to catapult gene therapy commercialization
4. Continued VC funding mega-rounds make 2020 a banner year for Digital Health Unicorns’ IPO exits
5. Interoperability by pure-play solution vendors will gain ground against standalone systems
6. Telehealth will gain mainstream adoption in the overall mix of healthcare services and will expand beyond the current focus on chronic conditions
7. Precision medicine-led approaches will pave the way for next-gen health data analytics solutions
8. 2020 will be a year of ‘Retailization’ for the healthcare industry, promoting the ‘Comparison Shopping’ consumer mindset

The full Forbes article can be viewed at this link.  

Will Artificial Intelligence Translate Big Data Into Improved Medical Care or Be a Source of Confusing Intrusion? A Discussion Between a Physician Informatician and a Medical Informatics Researcher

Artificial intelligence (AI), the computerized capability of doing tasks, which until recently was thought to be the exclusive domain of human intelligence, has demonstrated great strides in the past decade. The abilities to play games, provide piloting for an automobile, and respond to spoken language are remarkable successes. How are the challenges and opportunities of medicine different from these challenges and how can we best apply these data-driven techniques to patient care and outcomes? A New England Journal of Medicine paper published in 1980 suggested that more well-defined “specialized” tasks of medical care were more amenable to computer assistance, while the breadth of approach required for defining a problem and narrowing down the problem space was less so, and perhaps, unachievable. On the other hand, one can argue that the modern version of AI, which uses data-driven approaches, will be the most useful in tackling tasks such as outcome prediction that are often difficult for clinicians and patients. The ability today to collect large volumes of data about a single individual (eg, through a wearable device) and the accumulation of large datasets about multiple persons receiving medical care has the potential to apply to the care of individuals. As these techniques of analysis, enumeration, aggregation, and presentation are brought to bear in medicine, the question arises as to their utility and applicability in that domain. Early efforts in decision support were found to be helpful; as the systems proliferated, later experiences have shown difficulties such as alert fatigue and physician burnout becoming more prevalent. Will something similar arise from data-driven predictions? Will empowering patients by equipping them with information gained from data analysis help? Patients, providers, technology, and policymakers each have a role to play in the development and utilization of AI in medicine. Some of the challenges, opportunities, and tradeoffs implicit here are presented as a dialog between a clinician (SJN) and an informatician (QZT).

The full article can be downloaded below. 

Challenges of developing a digital scribe to reduce clinical documentation burden

Clinicians spend a large amount of time on clinical documentation of patient encounters, often impacting quality of care and clinician satisfaction, and causing physician burnout. Advances in artificial intelligence (AI) and machine learning (ML) open the possibility of automating clinical documentation with digital scribes, using speech recognition to eliminate manual documentation by clinicians or medical scribes. However, developing a digital scribe is fraught with problems due to the complex nature of clinical environments and clinical conversations. This paper identifies and discusses major challenges associated with developing automated speech-based documentation in clinical settings: recording high-quality audio, converting audio to transcripts using speech recognition, inducing topic structure from conversation data, extracting medical concepts, generating clinically meaningful summaries of conversations, and obtaining clinical data for AI and ML algorithms.

The full article can be downloaded below.  

Resident-led organizational initiatives to reduce burnout and improve wellness

Professional burnout among medical trainees has been identified as a national concern in need of attention. A significant challenge for residency programs is designing and implementing effective strategies to promote resident wellness and reduce burnout. Emerging evidence highlights the importance of developing organizational changes targeting physician burnout.

To address this critical need, Harvard South Shore (HSS) Psychiatry Residency Training Program aimed to assess burnout among residents, identify areas for wellness-related growth, and implement strategies for organizational change to reduce burnout and increase wellness. We aligned closely to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines to systematically approach planning, conducting, and evaluating this quality improvement effort. We developed a wellness action team and assessed burnout using the Copenhagen Burnout Inventory (CBI). We also conducted a survey to investigate high opportunity areas for wellness-related growth and using this data we designed and implemented four organizational initiatives to (i) improve residents’ on-call experience, (ii) increase social activities, (iii) support preventative care, and (iv) promote wellness education. We then re-assessed burnout 1 year after implementation and performed two-sample t-tests to compare CBI scores. We additionally gathered and analyzed feedback from residents on the implemented organizational initiatives’ relevance to wellness and their well-being.

There was an overall clinically meaningful reduction in burnout averaged among all residents that participated. Participants indicated that fitness-oriented activities were most likely to lead to change in wellness habits.

Our implemented wellness program was resident-led and involved continuous feedback from both residents and leadership. Given that there may be multiple factors that affect resident burnout, future studies involving a control group could help reveal whether our intervention contributed to the change in burnout scores we observed.

The full article can be downloaded below.