“You can’t solve a problem on the same level that it was created. You have to rise above it to the next level.” – Albert Einstein
Author: Saurabh Mathur, Holon Chief Technology Officer
Industry efforts towards digitization, interoperability and satisfying Meaningful Use have resulted in a wide array of technology solutions implemented across healthcare. There were numerous advances achieved in patient care, electronic records and data analytics, but all the “good” came at the cost of rendering the healthcare system into a dizzying array of highly decentralized sectors. Each sector imposed unmanaged administrative work on physicians, taking their time away from providing quality care for patients.
CEMENTING OF SILOS
Additional technology did not help break down the silos. Instead, it cemented them by compartmentalizing care into distinct systems – hospitals, physician offices, home care, skilled nursing facilities, etc. with ineffective and incomplete communication and a general lack of data portability between those settings. And providers, despite of their vested interest in patient care, couldn’t see patient outcomes across the spectrum of care.
If something new were to be devised to help with these challenges, it would have to be:
- One that could be paired with existing systems that providers use.
- One that made providers more efficient.
- One that surfaced the most vital information, in the right time and workflow.
- One that engaged the end user.
- One that was easy to use.
- One that was interoperable.
- One that gave a complete assessment of the patients’ health risks and care considerations.
THE MISSING HUMAN FACTOR – PHYSICIAN BURNOUT!
The silos and extreme lack of visibility, combined with the push towards value-based care have created an environment that’s ripe for transformation. When I speak with technology, clinical, and business leaders, I hear the same thing: the systems of today are not designed to help them make the critical transformation to value-based care and cause more churn for the providers. In this case, technology is not a catalyst for positive change, but a barrier. Here’s what I see:
- Information is not easily understood.
- Patient health is not accurately represented.
- Providers don’t know what they need to do in their EMR to be compliant.
- Healthcare delivery leans towards enabling primary-care models, even while the shortage of these providers is well known.
- Providers have to put in extra hours every day, and maintain additional staff, to help with ACO compliance and data entry, as they navigate disconnected systems.
- Providers are presented with information in an untimely manner, typically in an offline mode at the end of the day or the week, to walk through all the care gaps and the discrepancies in coding and documentation totally outside workflows.
- Interoperability, although possible, is an after-thought for several systems, making it harder to exchange new data points made available for population health management
THE LIGHT BULB MOMENT
The answer hit me in July 2015. I had casually placed an online order for a few books for my five-year-old daughter, but noticed that ads for other books started following me from site to site. They were targeted ads that mirrored my needs and interests at that time. I thought how that might be flagged for privacy concerns, and how that could be totally irrelevant and annoying at times, etc.
But then, a thought came to my mind. What if something like this was not flagged for privacy concerns? What if the concept can be turned on its head and instead of being a liability, it could be converted into an asset? Can the awareness and information about a clinician’s context be made more meaningful?
What if a clinician was looking at a patient’s chart or in a particular workflow in their EMR, and information from systems external to the EMR could be surfaced to them in a non-obtrusive fashion and in relevance to the patient in context? What if the information presented to me is interactive and directly actionable? And a lightbulb came on in my head.
Interoperability and interoperation are not just two semantically different terms. Interoperability describes a capability and interoperation describes an activity. Can the contextual awareness lay the foundation for interoperation across disparate systems, making providers more collaborative around patient care and efficiently manage care of their patient populations?
I regrouped with Robert Connely IV, our Chief Strategy Officer, who was already contemplating technology that could provide insights with a “tap on a provider’s shoulder.” Together, we connected the dots.
But would it solve the problem? We immediately reached out to key HIT thought-leaders and heard “If you can build such a system, it would be the talk of the town.”
For our first prototype, we started with a couple of EMRs that we had access to in a demo environment. We gathered up a list of test patients and prepared a member roster, representing a risk bearing ACO’s population of patients, along with some mocked-up care gaps, coding gaps, and some alerts, and staged those patients across the two EMRs.
We knew that the real value of the solution, while interconnected with a clinician’s EMR, would be best demonstrated via a user interface that is rendered alongside the EMR and presents itself in a fashion that does not interfere with activities in the EMR. The solution would prepare the providers and clinicians to be on top of patient care, managing gaps in care and coding, exchange clinical information about patients to close gaps, hopefully real-time, when the patients arrive for their visits. That sort of solution would also free users from having to login to multiple external portals and such.
As we shared it with key HIT thought-leaders, they saw what we saw: a true market disruption. Interestingly enough, it immediately trigged new use cases, and new ways it could solve old problems.
THE ROAD AHEAD
Innovation in healthcare is going to be the prime focus as the industry goes through another transformation in the near future. We will be focused on creating solutions that are commonsensical and can empower and enable clinicians to make timely decisions for effective patient care, while improving their efficiency. With the advent of newer intelligent systems and standardization of healthcare data distribution, you will witness us implanting more sensory capabilities around different types of data and events across the patient care continuum, enabling more care collaboration workflows.
For me, that’s the thrill of innovation. Creative solutions don’t just solve one problem, they open up thinking around multiple problems. They help innovators see different angles and new perspectives, and create a flurry of creativity around issues. The possibilities become endless. With break-through innovation, we remain dedicated to surfacing insights with the user and physician experience top of mind – not an afterthought.
That’s what drives our technology, and it’s what drives our team. Our mission is simple: liberate the data, and design simple solutions to complex problems. Anything less isn’t good enough.
Saurabh Mathur leads the research, development, architecture and infrastructure activities at Holon. After graduating as an Electrical Engineer from the National Institute of Technology in India, Saurabh started his career at McKessson Provider Technologies, Alpharetta GA, in 2001 as an integration developer, where he built a HL7 interface engine that integrated various disparate applications within a healthcare system. After McKesson, Saurabh joined Novo Innovations, Alpharetta GA in 2006 as the first developer in the startup organization. Saurabh contributed directly to the growth of Novo Innovations to merge into Medicity and later Aetna, by inventing, architecting and building the Novo Grid, iNexx Platform, HISP, and Notify platforms. Prior to coming onboard at Holon, Saurabh served as the Chief Architect at Medicity and was rewarded 4 patents for his work over the 9 years of his journey at Medicity.