Providers, plans intersect with consumer-driven, evidence-based medicine

This article was first published on Most Wired Online

The stakes are high but the rewards are higher as we play to the end-game of evidence-based medicine (EBM)—something that happens only about 55 percent of the time in the United States, according to a recent study by the Rand Corporation. This same study estimates that the United States can reduce its healthcare spending by 30 percent if patients receive EBM routinely. With annual healthcare expenditures in the United States now at $1.8 trillion US, the savings could be nearly $600 billion US per year.

Interoperable electronic medical records (EMRs) are seen as the ultimate conduit for realizing the benefits of evidence-based medicine. However, the growing movement toward consumer-driven care (and the corresponding consciousness of the financial and health-driven implications) make it unlikely that the population is willing to wait for interoperable EMRs to be deployed.

As a lead-in to interoperable EMRs, consumer health management tools can substantially improve the odds that evidence-based care is delivered throughout healthcare. Unlike interoperable EMRs, many consumer health management technologies are already available to facilitate data-driven care. With consumers at the reins and the support of stakeholders across the healthcare system, EBM real-time benefits are well within reach.

Health plans as enablers

Consumer-driven EBM stands to benefit stakeholders across the healthcare ecosystem. Through their roles in managing at-risk and chronically ill populations, public and commercial health plans and self-insured employers are better positioned than other stakeholders to enable consumer-driven EBM. By putting consumer health management tools in the hands of providers and consumers, they can engage populations to become or stay healthy. Also, these tools can inform patients of evidence-based practices that are most relevant to their personal health and the health of their families.

Most patients with chronic diseases require care from 6 to 12 providers across dozens of facilities, and they must undergo multiple episodes of care. Given this, it's no surprise that patients receive evidence-based care only slightly more than 50 percent of the time. To help ensure that both the consumers and their teams of often-independent providers have the most current care plans and core clinical information available, many health plans are proactively pushing out a common care plan, an electronic clinical summary, and corresponding EBM guidelines that precede the patient's arrival to the next care setting.

By additionally offering clinical summaries accessible in an electronic XML document format within a secure virtual workspace, health plans can enable providers to access and share relevant clinical documents with the care management team and other providers without requiring a continuous Internet connection. Virtual collaborative workspaces offer several other benefits to providers and health plans: The health plan and the entire care team have a common work area to keep everyone up to date, and they can effortlessly share files, coordinate and manage tasks, and even upload contextual information (such as current demographic, eligibility, benefit information, prescription history, lab data, and care management progress notes) into clinical systems.

Health plans can jump-start consumer-driven EBM by supporting high-risk populations with health management tools that follow patients across the continuum of care. These tools can deliver information to desktop and laptop computers, mobile phones, and wireless personal digital assistants. To help ensure maximum adoption of health management tools, health plans will need to build and integrate consumer health management functions and customer service and support around the emerging digital lifestyles of consumers.

Telephone-based technologies will still be needed to promote adherence to care plans long after the patient leaves the provider facility. For example, personal and interactive telephonic reminders proven to improve dietary habits of high-risk patients with high cholesterol can now be widely deployed through commodity speech recognition and telephony software that provides the consumer with a tailored, interactive experience.

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A day in the life of the patient care scenario

A scenario that typifies evidence-based medicine might play out like this.

Concerned about his high blood pressure, a patient goes to the Web to find more information. Instead of wading through ad-supported search results, the patient conducts a search through an authoritative search window from his health plan that's built into his e-mail and default home pages. Without needing to leave the search window, the patient schedules a consultation with his primary care physician.

During the appointment, the primary care physician determines that the patient has a slightly enlarged heart and refers him to a cardiologist. His physician has an electronic medical record system in place so the patient can leave his appointment with a digital copy of his updated health record and post-visit instructions. Even though the cardiologist does not have an EMR, she is able to instantly view all records from the primary care physician because the patient has invited her to a virtual collaborative workspace that enables her to view and download the records.

The cardiologist concludes that the patient's heart size is due to untreated high blood pressure and prescribes medication, weight loss, regular aerobic exercise, and a low-cholesterol diet. The cardiologist drops the consultation note and echocardiogram report in the virtual collaborative workspace, making it instantly available to the referring primary care physician.

At home, the patient uploads this information to his health management tool. He uses it to track his eating habits, weight, exercise, and blood pressure and to remind him to follow up with his primary care physician in two months. It conveniently displays a health scorecard that provides visual, daily feedback about the patient's health status. To help ensure that he reaches his goal, which is to lose 10 pounds and eliminate the need for medication in 6 months, his health management tool sends him periodic encouraging reminders and coaching when he's on his computer at work and at home and through his mobile Smartphone. It senses and records readings from his Bluetooth-enabled bathroom scale and blood pressure cuff and automatically uploads the data to update his scorecard. The health management tool also provides care guidelines for treatment of hypertension and use of the medication his doctor has prescribed for him.

The patient can elect to have data sent to a spouse, adult child, or other health coach who is helping the patient follow treatment guidelines. For example, as a fail-safe measure to help ensure he meets his personal health goals, the patient can elect to have the tool report inactivity and non-compliance to his spouse, personal physician, or health plan coach.

The virtual collaborative workspace and consumer health management tools described in this article are available for implementation today to maximize the adoption of evidence-based medicine. If consumers prove that health management tools can drive EBM in advance of the nationwide roll-out of interoperable EMRs, this can be good medicine for consumers, population health, and the economy.

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