The Path Forward: A Better Normal
By Anish Mahajan, MD, MS, MPH
Chief Medical Officer at Harbor-UCLA Medical Center and LANES Chair of the Board
We’re all well aware of the unprecedented historical significance of the global public health situation managing the coronavirus pandemic. Approximately 21.2 million cases are confirmed globally, and of those, 5.4 million cases are present in the United States at the time of this writing, with many states reaching new seven-day rolling average highs for newly reported cases.
We’ve all had to shift our behaviors in how we do things ─ including changing the way we live and work.
However, until sufficient evidenced-based treatments have undergone the legit vetting processes coupled with a commercially safe coronavirus vaccine for COVID-19 endorsed by the medical scientific community, we will face the harsh reality of fighting daily the transmission of the respiratory illness.
Our collective path forward is not only a new normal, but hopefully we can work together to make it a better normal.
What I see today (and it’s not good)
Telehealth is increasing for outpatient care. This virtual service is reasonably good care for those without an active issue and I’m pleased to see telehealth increasing in use for select patients. As a practicing primary care physician (PCP), I can verify that a percentage of my patients require significant hands-on evaluation and care. We cannot rely on telemedicine alone to treat our populations.
Unprecedented unemployment and other unforeseen conditions will lead to a reduction in healthcare coverage. Before COVID-19, one in three Californians relied on Medi-Cal, California’s Medicaid program. That ratio will only increase.
Lastly, people are deferring care, which is troubling considering the consequences. Survey data from the Kaiser Family Foundation illustrates that 48 percent of Americans have postponed or skipped medical care. As a result, we in the medical community are witnessing pent-up needs that must be addressed. Budgets are slashed at a time when ramping up care is the solution to curbing the growing backlog of cases in anticipation of potential surges.
Interoperability is critical
I believe the pandemic has compelled the healthcare industry to realize the power and medical necessity of an health information exchange. For a PCP to truly quarterback care, effective care of patients requires managing health holistically. This means taking into account the specialists treating the patient’s specific conditions, the safe transitions from inpatient to outpatient or vice versa, and the actions taken during clinical follow-up to ensure discharge is handled properly. Throughout the inpatient to post-care process, the quality, safety and effectiveness of care coordination relies on timely access to real-time data 24/7 to monitor the patient’s response to treatment and adherence to recommendations over a period of time.
With COVID-19, this is even more important! We are discouraging patients from visiting in person with their providers. Providers absolutely need to know what happened to their patients admitted to hospitals or seen at other care sites. They must proactively reach out through telehealth in order to manage care from afar.
A population health management platform like LANES that aggregates and synthesizes information in one place and uses good logic to move up those patients requiring emergent attention is critical.
Fragmentation of care persists
Fragmentation between primary care and acute care persists. My dual roles as chief medical officer and primary care physician allow me to demonstrate the need for good data exchange from both points of view.
As a PCP with one-half day of clinic per week, I am responsible for the primary care of approximately 200 patients. Many of my patients have come to me for primary care for more than two years. Like all patients, my patients are also followed by specialists and sometimes end up in hospital ERs and wards that are out-of-network. With LANES, I have access to data from the Department of Mental Health for psychiatric care previously unattainable. Key medical details are available at my fingertips when, before, I could only get that information by having a direct conversation with my patient. My team of nurses also must be kept apprised. For example, between patient encounters with me, I previously could not verify whether my patient was keeping up with mental health appointments until a line of sight into that data was made technically possible through LANES.
In the hospital, I see the reverse side of the coin as we care for patients who are assigned to many different primary care networks in the region. Naturally, PCPs in the community who are providing primary care to inpatients in our hospital but who are not on our electronic health record system need to have access to the data we generate in the hospital. What did the MRI done in the ER for the headache show? What do the inpatient rheumatology consult service notes recommend?
We all need smartly created data exchange for access to rich, relevant and timely patient data. HIEs like LANES normalize the transmission and flow of data to providers in a logical, structured and easily accessible way.
The path forward: data acceleration
Lot of unknowns are on the horizon, but we’re taking note of the positives coming out of the pandemic. Dr. Hal Yee, the chief medical officer for L.A. County Health Department Health Services, recently labeled this watershed moment the “better normal” and I agree.
While there is no shortage of data, the challenge of having actionable, up-to-date data at the point of care endures. Doctors and nurses want the data delivered in such a way that is not only timely but also doesn’t require them to sift through volumes of unnecessary information. As an industry, we must radically reimagine the way data is delivered. If the technology doesn’t make the process easy for providers to access data quickly and triage it to prioritize protocols, then the tool is not solving the problem. Clinicians need toolsets that deliver actionable insights informing their diagnosis in real time minus the headaches of wasted effort and time.
We’re increasingly seeing other industry sectors reimagining work performance. Moving data information around wherever people are to get the job done is required for remote working. Healthcare historically lags behind in technology innovation and it can no longer afford to be in last place.
LANES solves important use cases
I see HIEs such as LANES solving many important use cases as we move forward embracing a better normal in healthcare.
One is providing real-time data for patient encounters.
When a physician or nurse lacks a relationship with a patient while caring for an acute condition, the provider can retrieve data from the LANES HIE ─ which integrates with different electronic health record systems. Such data including doctors’ notes fills in the gaps when patients are unable to recall or answer questions about their previous medical care.
But, the most powerful use case is the consolidated view of data on populations.
A PCP is responsible for the care of a population of patients who may receive specialty care from other physicians (locally or not) and who move in and out of hospitals and in and out of networks. Nurses, medical assistants, care managers and many other providers of care also need access to that population’s medical history. The ability to coordinate care and manage a population hinges on the ability to access a consolidated view of the patient’s longitudinal information. Making that data available and actionable to all to truly manage population health is the whole game.
Healthcare’s “new normal” in the aftermath of the virus must support an analytics-driven patient ecosystem. The good news is, we already have a regional interoperable health data system that connect all providers, hospitals, nursing homes, long-term care facilities, payers, state and local governments, public health entities, and patients with a holistic view of a patient’s medical history in a longitudinal patient record. It’s called a health information exchange and our future depends on it.