How the "Most Perfect" of the Health Homes will use Technology

In my last blog submission, I promised I would explain how the "perfect" health home, the one with the best outcomes, will disrupt conventional health care systems (and thinkers) and use as many telehealth tools as possible.

An information universe

So what does this mean?

I will break this down into two areas:  medical information sharing, and service provision.  The smart thinkers designing health homes have already figured out the first one (well most of it!), but the second area (service provision) will need to be designed by the service providers and local health home leaders - and in my opinion will be the one factor that sets apart the success of one health home, vs the relative mediocrity or failure of another.

1. Medical Information Sharing
One way health homes will use technology differently from the case management systems they are replacing is by utilizing a medical information technology sharing platform.  This regional platform in my region of New York State (Capital Region) will by administered by HIXNY and all of our regional health homes and downstream providers must document their cases and service in one of many software platforms that is compliant with HIXNY.  HIXNY will then grab data from these local platforms, and combine it with real time data from medical providers so that all medical information is accessible by the health home case manager at any point in time.  Furthermore, the case manager will be able to receive "alerts" when client, "Nancy," has entered the hospital.  The care coordinator will have medical information at hand, all the time.

Obviously this is transformative, and I believe in a very positive direction.

Challenges in implementing this approach are not only found in the mammoth task of ensuring platforms can speak to each other (the task at hand now), but also are found at the micro level with the care coordinators.  Now care coordinators need to be able to access this info all the time.  And how do they do this, what types of laptops, tablets or smart phone platforms should they use?  Questions of after-hours care also soon come into play:  who monitors this information 24/7, and who responds to an urgent situation emerging with a client on a Sunday morning, now that we know this situation is happening in real time?

2.  Service Provision

Essential tools of a Care Coordinator (and their clients!)

Next, with all this new information, how is the case manager supposed to respond to each piece of information?  Medication was changed by the doctor on Dec 1 but is still not filled two weeks later?  A family crisis causes homelessness and basic needs are suddenly a challenge threatening medical stability?

With an average of eighty clients each, the care managers will not only need to deal with these clients expediently and effectively (using telephone, email and text to coordinate with providers and the client) but also will need to have the information for helping at their fingertips (an online 2-1-1 database) and also be given clear policy and procedure by supervisors about how to manage  each situation.

Will enhanced Medical Information Sharing help provide better health outcomes for high-end utilizers of health care, YES!  Will health home administrators have to completely re-think what "case mangement" is, YES, and it will be no easy task.

But keeping in mind the core concept - the need for MORE connections - and how to maximize these connections between each medically vulnerable person and their care coordinator and medical providers - will be key to success.  If we think in traditional, face-to-face/appointment centered care, we will trip ourselves up.  Thinking about effective high-touch, low cost solutions will be the only road to success.

photo credit: GustavoG via photopin cc

photo credit: Yagan Kiely via photopin cc