Using Connected Health to Improve Care Coordination
Connected Health is a term used to describe the collective of telemedicine technologies
Care coordination is a key strategy that has the potential to improve the quality and efficiency of the American health care system
A disjointed US healthcare system highlighted by deficient communication and collaboration between primary care and specialty care is a barrier to quality care coordination
Care coordination tasks can be reconstructed using digital health tools
May 05, 2020 — Connected Health is a term used to describe the collective of telemedicine technologies: live interactive, asynchronous (a.k.a. store & forward), remote physiological monitoring (RPM) and mobile health (1). This approach can add value to medical services by increasing access to care and expanding physician expertise to large populations — while improving quality and reducing costs.
In primary care uses for connected health may include:
Diagnosis and treatment
Patient education and self-management
Motivation for behavior change
Remote monitoring (wearable or home sensors)
Medication management
eReferral and eConsult
Remote Specialty Care
Primary Care and Care Coordination
Care coordination in primary care involves planning patient care activities, and sharing this information between the patient and the care team to achieve safer and efficient care. Challenges to these strategies are the disjointed US healthcare system highlighted by deficient communication and collaboration between primary care and specialty care (2).
Organization that are successful at coordinating care exhibit: 1) accountability for the patient care; 2) they build relationships and agreements among care providers; 3) they support patients during transitions of care; 4) they create connections to support information exchange with care team (3)
Value-Based healthcare is leading the adoption of new strategies, such as the Patient-Centered Medical Home (PCMH) and Accountable Care Organizations (ACOs). However, the inadequate supply of physicians and shortage of time for direct patient care may be a limiting factor in the implementation of these strategies. Incorporating connected health in primary care processes and workflows might be a feasible option to improve care coordination in primary care.
High-need areas for improvement in primary care:
Education and support of individuals with chronic illness to engage them in self-care and behavior change
Efficient referral process
Medication management and reconciliation
How can we use technology to facilitate care coordination and decrease the burden on physicians and the care team? Well, let's look at some of the essential tasks of care coordination and then describe digital tools that could be used to achieve the goals.
Strategies using Patient-Facing Tools
Education and Self Management
Patients with chronic disease can benefit greatly from education, support for self-management and motivation for behavior change. Digital tools are excellent for this because the patient can access the information from anywhere and at any time.
These tools can be used for:
Reminders of healthy lifestyle choices
Increasing the number of contacts between the care team and the patient via digital tools
Providing easy access to quality information in apps and mobile devices
Examples of these tools include: mobile health apps, HIPAA compliant text messaging, and online therapies.
Medication Management
Medication non-compliance is a pervasive problem, which costs our society an estimated in the billions. Many factors play into the problem: patient low health literacy, limited education, medical errors, and the high cost of medications
These tools can be used for:
Reminders to take medication as instructed
Regular survey and reconciliation of medications
Monitoring of medication usage and compliance
Examples of these tools include: mobile apps, digestible chip within tablets, WiFi pill-cap alerts, pharmacy packages with dated blisters.
Remote Monitoring
Patients with chronic illness benefit from frequent monitoring of biomarkers to control their disease; such as body weight, blood pressure, heart rate and rhythm, glucose level, oxygen saturation. Deficient disease management often ends in repeated hospital admissions and poor outcomes.
These tools can be used for:
Chronic disease management
Preventing hospitalizations and re-admissions
Enabling providers to respond to problems at the time of need
Examples of these tools include: mobile apps, remote monitoring programs, home sensors and motion detectors
Strategies to Increase the Capacity to Provide Integrated Care
eReferral/eConsult
Traditionally, access to specialty care requires moving the patient toward the expertise. This process can be inefficient resulting in poor quality of care and requiring repeated visits to both the primary care and specialty clinics. Connected health technology can improve this process by moving the expertise to the primary care clinic (4).
eReferral is a digital approach in which the primary care physician can exchange electronic referral templates and messages with the specialist, using HIPAA compliant tools within the electronic health record.
These tools can be used for:
Decreasing wait times for specialty care
Allowing specialists to provide clinical guidance to primary care physicians when appropriate
Reducing the number of specialty visits
Improving preparation of patients for specialty visits.
Project Echo/Telementoring
Telementoring and distance education can enhance the knowledge and skills of physicians to practice at the top of their license. Often, patients in remote areas are referred to tertiary centers due to limited local expertise. Project ECHO is a form of telementoring and distance education where physicians meet frequently as groups for virtual group consultations and case-based learning.
These tools can be used for:
Allowing physicians to operate with increasing skill and self-efficacy at the top of their license
Virtual Visits with Specialists
Limited access to specialty care can be a barrier to efficient care coordination. This could be due to limited local expertise or long wait times for visits. Specialty remote tele-hubs are tertiary centers with the resources to provide a range of virtual services, including remote specialty care (5). Remote-hubs expand physician expertise remotely to the point of care.
These specialty hubs can be used for:
eReferrals/eConsults
Patient Registry Reviews
Virtual Consults
Some examples include:
Improving care coordination is a strategy that has the potential to improve the quality and efficiency of the American healthcare system. There are strategies in place to address this problem such as PCMHs and ACOs, but an inadequate physician workforce, limited time for patient care and the cost of implementation makes these difficult to deploy.
Leveraging connected health technologies may allow primary care providers to deploy more effective and efficient care coordination.
If you have any questions about this content, feel free to contact me.
References
Kvedar J, Coye MJ, Everett W. Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Affairs. 2014;33(2):194-199.
AHRQ. Care Coordination. Agency for Healthcare Research and Quality. https://www.ahrq.gov/ncepcr/care/coordination.html Published August 2018. Accessed November 2019.
Wagner EH, Sandhu N, Coleman K, Phillips KE, Sugarman JR. Improving care coordination in primary care. Med Care. 2014;52(11 Suppl 4):S33-38.
Young HM, Nesbitt TS. Increasing the Capacity of Primary Care Through Enabling Technology. J Gen Intern Med. 2017;32(4):398-403.
Raney L, Bergman D, Torous J, Hasselberg M. Digitally Driven Integrated Primary Care and Behavioral Health: How Technology Can Expand Access to Effective Treatment. Current psychiatry reports. 2017;19(11):86.
