Clinical Outcomes

If you have wondered why data algorithms on your smart phone anticipate so many of your needs, but your hospital and doctor struggle to leverage technology in effective ways, you are not alone. Some might say there are too many variables in a human’s body and behaviors, or constraints within the healthcare industry, to gain the same benefit other businesses have garnered from advanced technology. On the contrary, success is possible but depends on how well we develop the right technology, integrate it in a way clinicians can trust, and change outdated processes to leverage technology and deliver patient-centered care. Many devices and applications enable monitoring and data analysis with the promise to improve outcomes. At the individual patient level, this can mean smart watches, glasses, clothing, medical wearables, or biosensors to manage care using frequent data points under “every day” living conditions. It is reasonable to assume this ability to monitor will translate into more effective management of behaviors and medical intervention. For example, early identification of fluid overload via the use of smart scales and connected blood pressure cuffs should reduce a heart failure patient’s need for hospitalization, while respecting her autonomy and preference to be cared for at home. However, the potential is only realized when the patient buys into the value of participating, and the care team adopts a 21st century approach to utilizing the data. When coordinated well, we can identify deterioration and offer the right care at the right time and in the most appropriate setting. This may require significant recruitment and enablement of patients and their care givers. It also requires healthcare to redesign how we operate, rather than making small incremental concessions to how we’ve always done things before these innovative technologies existed. Remote Patient Monitoring (RPM) is most effective when matched with knowledgeable clinicians and integrated into an overall plan of care that matches a patient’s health goals. Tech can allow us to monitor a diabetic person’s status daily or even hourly, watching for early signs of acute distress. Trends overtime can predict long term outcomes such as organ failure. Hurdles to overcome include the diabetic patient who does not have internet, or highly values a food culture that does not align with controlled blood sugars. Barriers also include a healthcare delivery system hesitant to rethink traditional roles and redesign antiquated processes. These challenges are accentuated under the strain of postpandemic staffing shortages and outdated reimbursement models.

Technology cannot take the place of clinical acumen, reliable processes and engaging each patient as part of their care team. The key to success is a triad: People, Process and Technology

In the best scenario, these challenges are overcome to pair pragmatic technology with innovative care delivery. Virtual visits with physicians, nurses, care coordinators, behavioral health specialists and others can enable timely & tailored intervention or health coaching. Offering options respects a patient’s time and personal choice, shifting the expectation to travel distances and conform to “office hours”. By leveraging the expertise of varied healthcare disciplines and expanding access to all hours and vast locations, disease prevention and chronic condition management becomes more tailored and manageable. Patients gain choice and convenience, while ED visits, hospitalizations and dire outcomes are mitigated. However, this eutopia comes with some caveats. Inequities of access to reliable technology and connectivity must be addressed to avoid accentuating health disparities. And some in health delivery may be slow to jump on board. As patients can seek virtual care anywhere - across the country at centers of excellence or with a disruptor in the industry – community-based providers may perceive a threat; a new kind of competition for systems and providers who historically felt secure in their market share or niche. Evolved organizations will seize the opportunity. Virtual visits and companion technology may allow differentiation. Or the ability for fewer physicians and their extenders to manage larger panels of patients. Distant providers can deliver care in underserved areas where clinicians are not physically present in sufficient numbers. Researchers will benefit by enrolling a more diverse population in studies by including patients who previously did not have the means to travel to an academic medical center, thereby reducing bias. Virtual work also serves a purpose in today’s environment of healthcare workforce shortages. Clinicians and other team members will benefit from improved flexibility in how, where and when we work – one approach to addressing burnout and the great resignation. On a larger scale, Artificial Intelligence enhances safety and quality on a population level when we leverage ‘big data’ coming from sources such as Electronic Medical Records, radiologic films, echocardiograms, lab results and biosensors. Using biometric data and relevant risk factors, AI improves risk assessment for breast cancer. Natural Language Processing assists in flagging lung nodules mentioned incidentally in radiology reports. Algorithms pinpoint the exact dose and location for radiation of tumors, improving accuracy and reducing risk of treatment complications. Machine learning algorithms identify pulmonary hypertension 6-18 months earlier than traditional diagnostic methods. We can leverage this data technology to understand and anticipate who will get sick or experience disease progression based on their genetic makeup or constellation of symptoms and risk factors. Increasingly AI can predict how an individual will respond to specific treatment regimens with precision. The rate of development in health-related technology is astounding. But adoption is slow, and many of the promised benefits are still limited on a population level. The types of technology described in this editorial serve us ubiquitously in aspects of daily life - how we shop, what we watch, who we connect with. Technology alone will not make the dramatic changes in health that are often promised by innovative companies promoting the next generation of biomedical engineering or AI powered algorithms. Technology cannot take the place of clinical acumen, reliable processes and engaging each patient as part of their care team. The key to success is a triad: People, Process and Technology. When Tech companies sufficiently engage healthcare experts and patients in the development of their innovations, and the healthcare delivery system broadly adopts improved, tech-compatible processes vastly different than the past, technology can enable higher quality, safer outcomes, efficiencies for providers, and a patient-centric approach to care.