by Scott Chesney –
The novel coronavirus and the disease it causes, COVID-19, will change forever the way healthcare is delivered, including when, where, how, and by whom.
Patients will rapidly learn new tools to improve their self-care, knowledge, and enable them to seek care without enduring crowds. Providers will be paying more attention to their facilities’ preparedness and stockpiles and look for ways to deliver care while keeping themselves safe. Facilities will look to aggressively add capabilities around managing patients remotely and managing their supplies and stockpiles.
At RCG, we do web and mobile development, and data integration, analytics, visualization, and modeling. We enable people to connect and work more efficiently and to use data to make good business decisions. But we are not going to be able to manufacture and distribute millions of urgently needed N95 masks, or ventilators, or build thousands of beds of new hospital capacity, or add healthcare workers to our system. Still, there are many critical capabilities we can help with, including care delivery, patient and clinician engagement, and supply chain management initiatives we can start immediately. Several of these we have initiated this month with our partners on the front lines: providers, hospital systems, and even payers and health-tech firms. All of us in technology-related fields have an important part to play during this pandemic.
The following are areas we currently are and will be working with our customers and partners in healthcare to ensure that we are giving them the best shot to increase the capacity to meet the curve.
It does not take a crystal ball to see that the new coronavirus will increase the demand for telemedicine exponentially. Paired with improved mobile capability, telemedicine will play a key role in treating patients while keeping them physically at home. This is not just for people with COVID-19 symptoms but is equally important for any of the other illnesses or injuries that are still occurring.
Telemedicine has been growing rapidly as early adopters discover the visit convenience and efficiency with no drive to the doctor, no check-in process, and no waiting room. The next few months will broaden acceptance and adoption throughout the population. Any provider who does not create or expand their telemedicine presence is at risk for losing patients – or worse, exposing them to coronavirus or other infectious agents unnecessarily.
Beyond traditional telemedicine, tele-mental-health is highly likely to see a significant uptick. With the information broadcast continuously on the news, it would be surprising if the number of people seeking some kind of behavioral support did not rise dramatically. Telemedicine is well suited for this type of short term, possibly short-appointment need. Clinicians in New York and other hard-hit areas are already experiencing severe overwork and burnout and are asking for additional psycho-social support. Aside from patients receiving care, those in quarantine and family members who can’t be with sick loved ones have tremendous needs for emotional support that are not currently being met.
Mobile Patient Apps
As a complementary technology with telemedicine, mobile apps for healthcare consumers will likewise see an abrupt increase in acceptance and usage. Equally important, consumers will look at the mobile leaders and best consumer apps on their phones and apply those expectations to their health encounters. At the very least, every provider should have a single patient app that offers all the following functions.
- Interactive directory with filters on network, location, specialty, language, and availability.
- Dynamic scheduling with accurate and updated provider availability. This should include a real-time waitlist with automated alerts when a provider has an opening.
- Demand management with two-way messaging to ensure patients spend as little time in waiting rooms as possible. This should be paired with in-system location tracking and navigation assistance to ensure people get where they need to go by the safest and most direct route.
- Bot based self-triage with recommendations for common self-care items.
- Full financial management with the ability to make, review, and export co-pays, deductibles including crediting and accounting for claims payments.
- Chart access, including lab results, provider recommendations, prescriptions, and recommended follow-ups and appointments.
- Global and targeted alerts, notifications, and splash-screens for communication in the face of major incidents.
- Integrated population health information and resources. Providers often have best-localized health information and the most pertinent resources for their patients.
- And of course, embedded Telemedicine. The self-triage component might connect seamlessly to either a medical or mental health provider, depending on the patient’s condition and needs.
Telemedicine and patient apps address important parts of the patient experience, but a third leg is a key to ensuring continuity of care. This is remote monitoring, leveraging the millions of devices in patients’ homes and on their bodies. The number of consumer devices that allow for real-time or near-real-time streaming of health data back to an EHR or other central data store is still small. But the careful application of existing technology can accomplish much of the same thing.
For one example, providers could use the scheduling and notification capabilities of the patient app to establish check-ins to remind patients to upload or enter information from smartwatches, or blood-pressure cuffs or thermometers. Of course, privacy and HIPAA compliance is a concern, but security and data encryption in motion and at rest should be core to any patient app architecture. Also, beyond what we think of as typical medical monitoring devices, even most mobile phones now have the audio fidelity and video resolution to provide clinically beneficial snapshots of a patients’ health and disease progression. For instance, this could be the patient taking selfies of their throat or recording their cough and breathing.
Employee and Team-Member Apps
In every health system today, the top priority should be doing anything possible to support the healthcare providers that are interacting face-to-face with COVID-19 patients. That includes many things that technology can’t directly address, like procuring and providing PPE. But there are several things a well-designed employee app can do to help. These include:
- Allowing both administration and clinical staff to quickly adjust schedules as necessary to react to conditions on the ground and personal or family situations.
- It’s now past the time where doctors and nurses should be learning cumbersome workarounds to adapt their work practices to those expected by their EMR system. We have the data and workflow technology and decades of operations research that should mean that clinicians are supported and empowered by our systems instead of being hindered and frustrated.
- Communication and Training. Like with patient apps, never has the need for direct and rapid communication throughout a system been so self-evident. Similarly, as new operational processes and personal protection and treatment protocols are introduced, clinicians should have a secure way to receive and confirm their understanding of the new information.
- And nearly every function of the patient apps mentioned above, adjusted or enhanced for the appropriate employee audience. For instance, a provider directory with additional clinical and schedule information and a one-click option for secure communication.
Employee, volunteer and community support and enablement
Continuing the thought of supporting the people that are treating patients and saving lives, technology can assist in enlisting the broader community. Volunteers should get their version of an employee app, whether they are in-system clinical helpers or people sewing protective masks at home. The training and credentialing functions can help rapidly onboard retired doctors and nurses and former military personnel with clinical experience.
As hospital systems near capacity, even if not overwhelmed and overloaded, community members are also getting creative in other ways to help. Even if this just means donating girl scout cookies to a local nursing home, technology can help identify and publicize the needs and desires of the front-line clinicians. Scheduling and location capabilities can help ensure that no doctor is sidelined because she cannot find someone to watch her child.
Demand and resource management
While operational efficiency is always important in clinical settings, a system at or near capacity must use every tool available to ensure resources of materiel and personnel are allocated in the way that maximizes the clinical benefit offered the patient population. On the other side of the equation, the demand can also be managed to at least some degree, triaging patients and directing them to sites or services where capacity exists.
In some situations, though, the approach to optimization must change. Outpatient settings often trade a long patient wait time to ensure that the patient is present and prepped as soon as the provider is ready. Of course, provider time is the critical resource to optimize, but there is now the counter consideration that extending the time a patient is in the facility increases the risk that the patient will either contract or transmit a contagious pathogen. An algorithm may move away from the standard first-come model to minimize both patient and provider wait times.
This thinking also applies in the unbearable scenario now playing out in Italy where care capability is insufficient, and not all patients can receive full treatment. Health systems and technology must work to remove the burden and guilt from the caregiver, making triage choices. Clear guidelines documented and distributed, and straightforward matching algorithms can provide clinicians with information and context such that the final decision is still theirs, but the necessity and importance of terminating care mitigate the trauma of choice.
Inventory and supply chain management
Presumably, every provider or health system has some kind of inventory and supply chain management system already. But now may be the time to re-evaluate and enhance it. The CDC is not the only organization that’s having trouble tracking down items and ensuring that they are up to date and not expired. Improving capacity in this area may be as simple as including a front-end search functionality in the employee app for those with the appropriate role. Alerts for expiring inventory sent to the right people at the right time can reduce waste and risk.
At the same time, as the federal government is encouraging states to take the lead role in procurement for scarce resources, facilities and systems should be moving to establish peer-to-peer connections to cooperatively allocate and share items with critical shortages. The current crisis is evolving rapidly, but it’s happening at different times and in different places. In the most optimistic scenario, New York’s critical shortage of ventilators in late March may become a surplus by June that can be shared with other states and facilities.
In fact, states are already sharing resources and trying to cooperate despite the lack of federal standards or guidelines. Doctors and nurses are even risking their health and lives by flying from other states and countries to help where help is needed. But how do they know where the need is greatest? Medical suppliers are ramping up the production of critical items but are themselves asking for guidance and information on where their materials can best be put to use. Ideally, this situation will be addressed by the federal government with a nationwide system and set of priorities and criteria. In the meantime, though, we can and must be building decentralized peer to peer systems to allocate critical items according to the best information we can get.
While enacting such a system depends on political and executive decisions, the tools and infrastructure to enable and optimize such sharing is in the technical domain. Solutions may involve optimization and analytics, or more traditional methods like a type of auction or bidding – where one hopes of course that the medium of exchange is not money, but the number of lives potentially saved or enhanced.
The world is different now than it was a month ago.
It will be different still a month or six months or two years from now. We cannot predict with certainty all the changes that will take place, but we already know many ways we can help the global project of fighting the virus. Health systems and providers will need to be using technology to build and enhance their telemedicine, mobile apps, and monitoring, community engagement, and supply chain operations.
RCG is stepping up our engagement with our healthcare clients to provide guidance and skill in these areas, including traditional and cloud infrastructure and architecture, web and mobile app design and development, data integration and exchange, and EHR and health data management and support.