From a technologist’s point of
view, there are three ecosystems in HealthCare – point of care, transition of
care, and patient centered medical home. All three ecosystems are defined by
facility type, level of connectivity access, level of data integration for
treatment, and level of access to clinical care. All three ecosystems
should have seamless integration of technology to measure, monitor, and manage
clinician to patient interaction for best outcomes. However, this is
still a work in progress.
Point of care is defined as networked environments within large complex
facilities focused on an acute event – hospital and healthcare systems,
physician offices, etc. that are associated and utilize a ubiquitous
network. This is the over simplified objective of meaningful use and
accountable care. From a technologist point of view, this should be a
wide federated network encompassing all the disparate systems within the
accountable care organization – from hospital environment through to primary
care physician offices and establishing connectivity with transition of care.
The level of connectivity access should be best in class for structural
connectivity – fiber optics to the door, multi-level wireless access with both
open (guest), and secured, encrypted access. The level of data
integration for treatment should follow the unique identifier of the patient
and all courses of treatment and interaction within Point of Care should be
readily accessible and readable by clinician, patient and caregivers through
consent-driven access to electronic medical records and patient portals. Point of Care is the premier level of access to clinical care. Here, the
patient has chosen to physically be available for diagnostics, treatment and
care follow-up for an acute event.
Transition of Care is defined as
segregated patient treatment facilities focused on episode of care – hospice,
skilled nursing, palliative care, assisted living, long-term care, etc. These facilities are erected for the treatment of patients who otherwise cannot
function within their own residence on an independent basis. Transition
of Care may be episodic based on an acute event (i.e. surgery and post-surgery
recovery) or it may be for the mortality of the patient. The level of
connectivity access should establish direct data exchanges and data transport
methodologies between segregated transition of care systems to the point of
care EMRs, again by patient unique identifier. The level of connectivity
access for clinical providers in transition of care should be cellular enabled
work force management tools that support visibility of daily rounds, daily
medication dosage, and daily treatment paths by patient and disease
state. Paper medication compliance records, paper charting, paper
activity tracking, etc. provide no means of clinical collaboration outside of
the segregated patient treatment facility. The level of access to
clinical care is dependent on the resource, budget and accessibility of each
Transition of Care facility. Technology is capable of establishing
virtual consult, telehealth, remote patient monitoring, etc., but it requires
resource training, capital funding, and a strong network of established Point of
Care collaborators to extend the human knowledge base virtually.
Patient Centered Medical Home is
defined as the patient’s physical and virtual interaction within their home to
multiple providers and vendors – managed care providers, home health
organizations, durable medical equipment providers, social workers, etc. These organizations are providing direct physical home based care and treatment
to patients. To be most efficient in the work force management and effective in
managing the growing patient volume, these organizations must look to full
mobile workforce access tools. The level of connectivity needed is
comprehensive cellular and wifi access. The key barrier to US healthcare mobility
and virtualization is a lack of total cellular and/or broadband coverage. Strong cellular connectivity for a mobile clinical workforce promotes
treatment accuracy, data automation, and change management visibility. Strong
connected access for a patient encourages careplan compliance inclusive of
medication compliance, patient engagement, and better outcomes.
Self-reporting through connected tools - remote patient monitoring
through in-home devices, telehealth through smartphone applications, home care kiosks
in the form of chronic disease management kits, etc. support better
self-management and self-awareness. The level of data integration between
biometrics/vitals, medication compliance, etc. should be seamless and
integrated into the patient health record and integrated back to transition of
care and point of care organizations engaged in treating and supporting the
patient. The level of PCMH clinical access to care is limited by
geography today – the limitation of provider and vendor access to patient in
the home is based on mileage, number of outreach resources, etc.
From a technology perspective,
if we can expand connectivity coverage, better execute data integration, data
flow, and data access, then we can link access to clinical care for the most
needy and underserved. It’s not just a healthcare question, it is an
exercise in community, connectivity, and collaboration.
-Sunny Lu Williams
General Manager
Medical Solutions - Telamon Corporation
