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Gopal K. Chopra, M.D.

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Health Care Organizations Kludge Networks

Posted: 11/07/2013 1:22 pm

Health care is going through a process of re-grounding itself in patient-centric care. All rhetoric aside, we have to enable multidisciplinary teams with sophisticated but easy-to-use technology to encourage rational care-centric behavior. If we continue down the path of administrative care and continue to be accountable under the meaningful use checklists, we will have successfully divorced the care provider from the patient. Too many network breaks are occurring as a result of misaligned accountability and poor tech interfaces. Technology should be a boon with the capability to clarify our motives with payment transparency, reduce uncertainty by providing clear, easy real-time outcomes data, and create value by utilizing data to make care choices and optimize process. We can leapfrog the infrastructure by securing the BYOD mobile market to make care connections seamless.

Health care is not easy to navigate, and unfortunately it is also not easy to change. Change will occur and can only occur through a series of traumatic transformations. With all the uncertainty of change, everyone is very mindful that there should be no interruption to care. Accountable care organizations that are informing their patients, engaging care providers, and thus empowering better decision making understand that technology is a powerful tool to support their community through this digital and care model transformation. Many, however, are kludging networks, and patients are suffering from reduced access to care.

We know that we need to reduce the burden of administrative tasks care providers are faced with to improve productivity and quality of care. The consequence of these burdens is a lack of communication among health care providers, something central to the broken health care paradigm. The mandates of the current care act only further strain doctors and care providers. We are held to a model that complicates the technology design and have become committed to a care process built on misaligned judgment, beginning with billings all the way through to the current "2-midnight" rule. The current administration has suffered from many contradictions and health care as a result has suffered several serious jolts. We need health care leadership to drive quality care. Quality care doesn't come from using punitive techniques to gain compliance, and it doesn't come from the deployment of legacy EMR technology. It comes from supporting innovation and from using positive vs. punitive solutions. The mismatch of standards is creating severely misaligned behavior by care provider networks. To untangle us from the absurd processes of accountability, we need simple solutions, and easy collaboration through innovative technology can help.

Accountability measures should focus on collaboration and outcomes. Teams create quality care, better decision processes and, ultimately, efficiency. They enable multidisciplinary approaches and better resource management. The process improvement of efficient, effective and clearly understood communication is the crux of cost reduction and care quality improvement. Whether we are planning a patient's discharge, or we are confirming a medical transfer, even organizing staff responsibilities for pre-operative assessments, a collaborative group communication is the vital first step. Being available when the decision needs to be made enables preemptive care. Many of our communication systems fail in this regard because of their checklist framework. Engaged and collaborative care teams enable better access. Paging fails because it requires call back and instructions are almost never documented. Phone calls fail because there is latency and phone-tag and no clear written transcription. Emails fail because of security, complexity and lack of notification flexibility. Electronic medical records are databases and communication systems with a burdensome funnel of permissions and requests. There needs to be an easier way to enable dialogue with pertinent care team members and involve the patient.

Dr. Michael D. Klein, AI Philippart Chair, Pediatric Surgical Research of Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit says, "Patients have a lot of experience with how hard it is to get in touch with their physician. They are delighted to have a way to do this without being intrusive. Asking them to text you, gives them trust in you. We need secure communication solutions."

A cost-conscious health care system with a penalty oriented affordable care act that forces compliance is a sure way to create change, but is it the change we want? We're discovering many pain points in an effort to be more patient-centric, but, thankfully, innovation has sprouted to address these issues. Adoption of these innovations should be the focus of care delivery as opposed to the check box mentality that is currently rife. It's time to embrace the BYOD revolution and enable better, simplified collaborative care that also involves the patient. Better access to care starts with making communication easy and accessible throughout the entire health care network.

 
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