By Robert Palmer, Chief Innovation Officer, HCB Health
Point of care interactions between patients and healthcare professionals are undergoing significant changes. Whether in the doctor’s office, hospital or pharmacy, new care models are being established that are designed to bring fundamental change to the doctor-patient relationship. At a time when new drug product innovation has slowed down considerably, digital technologies and behavioral shifts are seen as an efficient and effective way to create patient-centric improvements. Observing and understanding the macro-trends in major point of care destinations tells us a lot about the potential for improved patient outcomes.
Mike Collette, CEO of PatientPoint, and Nanette Oddo, VP of Phreesia, are co-chairs of the Point of Care Communication Council (www.PoC3.org), an organization that advocates for the effective use of point of care channels to advance healthcare outcomes. “The single biggest change is how we have to redefine what point of care is,” Collette says. “Historically patient care has been within the four walls of a doctor’s office or hospital. Today, the point of care extends well beyond the four walls.”
Oddo sees another big change in what she calls the “shift of risk.” She points out that because today’s patients are more aware of medication side effects, for example, point of care conversations have shifted from one-way communication from the doctor to a more give-and-take collaboration. Patients are also more educated about – and wary of – the cost of drugs, co-pays, and insurance coverage considerations. “Once the patient is ready for a discussion, both the patient and the doctor have to be better prepared for a richer, deeper, easier to understand exchange of information.” She emphasizes that the discussion can’t just be about a specific brand or treatment. “The question is, what can brands do to think through the entire disease state discussion?”
The doctor’s office – not what it used to be
Tools and resources designed to have more productive conversations at the point of care can play a pivotal role in improving health outcomes. Research published in the American Journal of Managed Care found that the average office visit is 87 minutes, with only 20 minutes spent with a healthcare professional. That’s a lot of unproductive time. To make the situation even more critical, long and unproductive wait times in the doctor’s office tend to affect those patients most in need of care. Lower-income patients, for example, are often paid by the hour and simply can’t afford to be away from work; these same patients are more likely to be in poor health. And older, cognitively impaired patients are particularly affected by the lack of opportunity to have a comprehensive conversation.
Over the past several years the trend has been that patients spend more time waiting in the exam room than they do in the waiting room. Consultants figured out that moving patients to the exam room as quickly as possible leads the patient to believe they are receiving care rather than merely wasting time. Often the reality is that the patient is simply wasting time in a “more medical” environment. But an isolated environment can also be more conducive to receiving non-personal information by watching videos or reading pamphlets that are specific to their condition. When available, these informational tools can increase the value of the patient’s limited time when he or she is actually talking to the doctor.
There are several game-changing trends that are designed to reduce the inefficiencies of the office setting. Addressing the challenges of a growing primary care physician shortage, especially in rural settings, while at the same time reducing cost, telehealth technologies are changing the very concept of point of care intervention. Vidyo’s telehealth solution, for example, provides real-time video interactions to deliver in-home, ambulatory, and acute care services. The adoption of telehealth solutions will accelerate as new generations of patients intuitively understand the seamless interoperability of connected digital devices. There is also the growing trend of doctors making house calls. As people are living longer and opting to age in place, house calls keep patients out of the hospital while still allowing for a number of on-site digital interactions – e-prescribing and EHR usage, for example. Medicare and Medicaid are actively encouraging house calls as a solution for delivering better care at lower cost.
EHR technology is undergoing changes that can have a dramatic impact on point of care interactions. Adoption of patient portals has been slow, but the benefits can be enormous. “Patient portals will soon be much more important, as usefulness improves,” Collette says. Although patients have been slow to adopt improved EHR offerings, the ability to provide patient education or financial services within the healthcare professional’s work stream is very valuable.
And the benefits aren’t confined to the patient. For a medical practice, “increased patient portal adoption impacts business results, including higher average patient pay yield, an increase in patient accounts receivable and reduced accounts sent to collections,” according to Josh Gray, VP of Athena Health’s research division.
User experience flaws have been one obstacle to patient portal usage, but a more critical problem is the lack of transparency found within most patient portals. Relatively few healthcare systems provide solutions that actively encourage physicians to share detailed health information directly with their patients to make sequential point of care discussions more detailed and useful. One somewhat limited system, called MyChart, is found on many EHRs, representing a step in the right direction. MyChart allows patients to see lab results, appointment schedules, and messages from providers that include a brief review of the patient’s condition, a list of medications, and billing information. But what is often referred to as “clinic notes” are almost never included, denying the patient access to the provider’s true assessment and analysis of the visit. In general, the argument can be made that the more information a patient sees, the higher the trust – which leads to a higher adoption rate.
Technology effectiveness in hospital settings
According to the CDC, hospitals represent about 33 percent of total healthcare expenditures. To put that in perspective, physician and clinical expenditures represent 20 percent, with the cost of prescription drugs representing only 10 percent of cost. But while hospitals represent the biggest opportunity for improvement, technological advancement at this crucial point of care has been challenging. According to a PricewaterhouseCoopers Health Research Institute report, “in the New Health Economy, digitally enabled care is no longer a nice to-have, but rather a fundamental business imperative.” This imperative is proving to be easier said than done.
An Accenture study found that 66 percent of the 100 largest hospitals in the country offer mobile apps to patients, but only 2 percent of patients use them – even though almost 60 percent of patients see the need for such apps. Poor user experience and inept functionality are often at the root of low usage, but, even worse, only 11 percent of hospital-designed apps have the top three features patients want the most: access to electronic medical records; the ability to book, change, or cancel appointments; and the ability to make prescription refill requests.
One of the most basic point of care needs would seem to be the simplest to implement: so-called “wayfinding apps” that allow patients to navigate through hospitals. Yet adoption of these apps remains very low because of a combination of poor promotion of the product and a dismal user experience.
The effective integration of digital solutions also present a problem, especially within larger hospital systems. Technology is most effective when it is part of an integrated solution – and that is yet to be the case in many instances. Today’s point of care ecosystem consists of an array of high-potential medical technology that is riddled with integration barriers. A recent research paper published by Healthcare Informatics challenges the medical community to “imagine a team of healthcare providers taking full advantage of a patient’s genetic makeup, body imagery, EHRs, wearable devices, and real-time medical research and population health data.”
This vision has existed before, the study says, but “by 2030, predictive analytics and artificial intelligence will genuinely support this vision, bringing more accurate, timely identification and management for a range of health concerns.” While 2030 may be a long way off, incremental changes in point of care technology – aided by cloud-based solutions – are under way, aimed at interconnectivity and increased access to both patients and providers.
Interesting trends are taking place at the pharmacy
Oddo believes that changes in the pharmacy business model will have a great impact on point of care decisions. Many patients rely on the pharmacist to dispense drug treatment information along with prescriptions. According to the CDC, one-half of Americans have a chronic condition, and one in four have multiple chronic conditions; 90 percent of Americans take at least one prescription medication, and two-thirds over the age of 65 take five-to-nine medications. That makes pharmacies a prime candidate for point of care interventions.
But even as pharmacies are expanding their in-store clinics, there is a trend to make core pharmacy offerings “a click away” for patients. Capsule Pharmacy (capsulecares.com) is a New York City-based “virtual pharmacy” that offers online prescription fulfillment and free same-day delivery, bypassing the pharmacist as a point-of-care resource. This approach in an urban setting is one thing, but Amazon – the ultimate business disrupter for retailers of all stripes – strikes fear in the hearts of pharmacists everywhere. Mobile applications such as Truveris have already made inroads by helping consumers find drugs at the lowest prices, but Amazon has the tools to take the technology to a much higher level. Pharmacy giant CVS is reportedly interested in buying Aetna in order to continue its march into point of care services and blunt the looming threat posed by Amazon. CVS already acts as a pharmacy benefits manager (PBM) that negotiates drug prices. The CVS MinuteClinics offer walk-in services, supplemented by CVS at-home services such as infusion. Adding Aetna to the mix could push millions of Aetna clients into CVS’s pharmacies.
Point of care will continue to change
As Intel founder Gordon Moore famously said, change has never happened this fast before, and it will never be this slow again. Point of care is undergoing an evolution that will lead to revolutionary changes not only in how patients receive care, but where and when they receive it. Technology will be the prime driver.