Intel Healthcare IT

4 Posts authored by: jlemieux

There’s essentially a 1-in-5 chance that a Medicare patient will be readmitted within 30 days of being discharged from a hospital.

 

The U.S. government estimates $17 billion USD a year could be saved by preventing unnecessary readmissions through better care coordination, not to mention the improved quality of life and lowered infection risk for patients who don’t have to go back to the hospital.

 

Under new federal rules, hospitals with readmission rates considered too high now carry risk of having portions their Medicare reimbursements withheld.

 

The hospital discharge summary is an important document to aid communication that can prevent unnecessary returns to the hospital. If incorporated into an effective workflow, it helps open a window of opportunity for patients and their normal care teams to get on the same page with the hospital on next steps, such as making follow-up appointments, monitoring to prevent complications, managing a new medication regimen, etc.

 

So, if each hospital creates a better discharge process, we will tackle the readmission problem, right?

 

Not entirely.

 

The problem, especially in metropolitan areas, is that patients go to several providers, and a few different hospitals. Therefore, the needed care coordination cannot be confined to one hospital alone. It needs to be spread across the community, including the patient, the patient’s primary care provider, specialists, and in some cases, non-traditional health workers. And to do that efficiently, communities need to standardize the discharge document as well as some targeted post-discharge interventions.

 

That’s the fundamental premise behind an important project that a small Intel team joined in the metropolitan area of Portland, Ore.  We were honored to work with a team led by Melinda Muller, MD, of Legacy Health, who directs a pilot to standardize the discharge summary and process.

 

We describe the project and its initial lessons in a new whitepaper: Developing Community-Based, Standardized Hospital-Discharge Summaries.

 

There are other efforts all over the world to improve the discharge summary process. We’re interested in your thoughts.

 

What’s happening in your community?

It’s vividly educational to pitch in on the front lines of a grand challenge like the Oregon Experiment, sometimes described as “ACOs on steroids.”

 

• How do you take a financially strapped program (i.e., Medicaid), nearly double its size, control its per capita cost growth, and deliver better care and service to its patients?

 

• How do you create more cost-effective clinical workflows across organizational boundaries among traditional competitors?

 

• And how do you use IT to support the program’s lofty goals?

 

Observers of the movement toward accountable care organizations (ACOs) will look to Oregon for evidence of success or failure. To be fair, it will take a few years to defensibly answer these fundamental questions.

 

What we can say definitively now is that the journey is as necessary as it is fascinating. We describe it in a new white paper, ACOs on Steroids: Why the Oregon Experiment Matters.

 

Health Share of Oregon is a lean startup organization that administers a Medicaid transformation project involving several healthcare providers and public agencies in metropolitan Portland.  Health Share of Oregon’s broad ambitions, as well as its birthing pains, demonstrate the opportunities and barriers to healthcare transformation efforts that go beyond tinkering at the edges.

 

I’d like to recognize the great work of Intel colleagues Stephanie Wilson and Prashant Shah, who dug in with Health Share of Oregon’s IT team for about nine months to help get the project started under very tight deadlines. We learned a lot and felt honored to work together with the Portland area health IT community.

 

In healthcare, it’s the long haul that matters. Although the startup phase may perhaps be the most exciting, the ultimate success of the project will be determined through the ongoing hard work to continuously improve. It will take the whole community of Medicaid providers, IT professionals and health data experts to answer the grand questions of the Oregon Experiment.

 

Our thanks go out to the whole Health Share of Oregon community for their efforts to create a safer, higher-quality and financially sustainable system for people with lower incomes and barriers to healthcare access.

 

Because of the Medicaid expansion under the Affordable Care Act, the federal-state program is in need of healthcare leaders and IT professionals willing to innovate.

 

Do you see innovations happening in your community? What’s working and what’s not working?

To provoke some thinking about what the future holds for healthcare IT professionals—as well as all of us as individuals—there’s  a new TED talk I highly recommend.

 

Intel fellow Eric Dishman, GM for healthcare at Intel, distills his difficult and confusing journey through the healthcare system – and how technology can improve such journeys for future patients. You can see the video here.

 

This talk is inspiring on at least two different levels. It’s inspiring to see how computing innovation can help solve big problems, and make our lives safer and more convenient. And it’s an inspiring story of how human compassion from a stranger saved Eric’s life, giving him the kidney that he needed.

 

In the presentation, Eric demonstrates an example of how patients will be more involved in their own care, something that he has worked on for more than a decade at Intel. He conducts a live online conversation with his nephrologist while, using a handheld device, projecting a live ultrasound image of his newly transplanted kidney for the audience.

 

The talk weaves together three themes of “personal health” aided by new technology and emerging models of care:

 

Care anywhere – the infusion of mobile devices and communications technologies that let clinicians and patients stay on track – beyond wires and organizational walls.

 

Care networking – the shift from solo-based practice to true team-based care. He says, “We have got to go beyond this paradigm of isolated specialists doing parts care to multi-disciplinary teams doing person care.” Eric contrasts the efficient and comprehensive care he received from the kidney transplant team with the scattered and unconnected care he received for many years when no one knew precisely how to treat him.

 

“The sacred and somewhat over-romanticized doctor-patient 1-on-1 is a relic of the past. The future of healthcare is smart teams – and you better be on that team for yourself,” he says.

 

Care customization – the development of a care plan for the individual, taking into account everything from one’s needs and personal wishes to one’s unique genomic variations. He tells the audience how he is living proof that we are living at the cusp of a revolution in personalized medicine. He challenges the medical research community to “experiment on my avatar in software, not my body in suffering,” he says.

 

But he saves the best for last. You need to see how his 15-minute TED talk ties it all together at the end. It’s a tribute to people who make a difference, and an inspiring call to action.

 

What questions do you have?

For patients with complex needs, it’s a big task to coordinate care within the walls of one clinic and hospital. But to truly meet the individual’s needs – as well as the societal demands to improve healthcare quality and access at a sustainable cost – care coordination requires a community approach.


The role of primary care is critical. Yet it’s been often overlooked or under-invested in fee-for-service healthcare. Many communities are working hard to change that now, some with a “hotspot” model of incorporating community-based services and care plans for people who need the highest levels of care coordination. Intel has ethnographers, project managers, and IT architects working with a small set of these communities.


Based on our observations so far, Intel has produced a new white paper, A Global Imperative to Design the Nucleus of Care, which explores four pillars of community-based primary care models such as the primary care medical home.

 

Read the paper and let us know what questions you have.


Coordinated care will also be a main topic of discussion during the Intel webcast series on Oct. 23. I encourage you to register for the webcasts today and join us for the health IT panel discussions. Register here.

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