Wednesday, March 2, 2011

Another Role for Disease Management: Systems Integrator

When the Disease Management Care Blog gives one of its many presentations, lectures, grand rounds or sitzfleisch sermons on the topic of team-based disease and care management, it frequently turns to anecdotes from the aviation industry. Much of the autopilot work of passenger jets, says it, occurs with little human interaction and many of the tasks are handled by non-pilots. Yet, pilots are necessary because there are exceptions and emergencies that require human intervention. So it can be in health care: there is much than be automated, teams increase efficiency and the roles of doctors are to recognize when guidelines don't make sense and to take care of really sick patients. Such are some of the elements of a "systems" approach.

An even more insightful view of airlines and systems is why the DMCB likes this just-published JAMA commentary "The Need for Systems Integration in Health Care," written by Simon Mathews and and Peter Pronovost of the Johns Hopkins School of Medicine. This interesting article also draws from the aviation industry, but goes one step further than the DMCB. Using the example of an airline company that wants to add aircraft for its fleet, the authors note that there is a company called "Boeing" that acts as an "systems integrator."

Boeing's role can be contrasted to how health care is assembled today, where hospitals and doctors fabricate their own ICUs, emergency departments, operating room suites and provider networks, all from the ground up. Clinicians and administrators - with little experience in technology or engineering - are the ones who are cobbling things together one thing at a time on a piecemeal basis. Little wonder, then, why equipment isn't compatible, data systems don't communicate and work gets either duplicated or dropped between the cracks. And as these pseudo-systems grow in complexity, they become less safe and more expensive.

The authors recommend that a "health care systems integrator" is necessary. That would involve 'learning labs' that figure out how to best coordinate health care "components" to maximize usability, coordination, effectiveness and integration. In other words, assemble the best technologies in a working whole at the lowest cost that can be "dropped" into a hospital, much like Boeing delivers planes to United.

What an interesting idea, says the DMCB.

While this article focuses on entities like operating and emergency rooms, the DMCB wonders if there aren't some important parallels for population care management. As health care systems and Accountable Care Organizations strive for greater "accountability" and "gainsharing," their temptation will be to cobble their providers together, retrofit their electronic records to include some sort of care management documentation and change the job descriptions of some nurses to include patient education.

In contrast, there are some "Boeing-like" vendors who really serve as "systems integrators" that construct and deliver total care management solutions. Examples of this integration include hiring the right nurses that who can take full advantage of optimized case management work flows that also come with state-of-the-art documentation software (that's compatible with every electronic health record out there). Those nurses will know which patients are at greatest risk because they're not only working with and making things easier for their doctors (who are struggling with other systems issues involving other "airports"), but have the results of health risk assessments and access to predictive modeling generated patient lists. And best of all, it all comes packaged and can be dropped in. It works as a unified whole, in which the information moves easily, providers can message each other seamlessly and everyone understands their role in getting patients to the right level and type of care at the right place at the right time.

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