Our patients expect their medical care from us (providers), to be timely, of the highest quality, and value. With the digitalization of the patient chart with electronic medical records (EMR), tremendous progress has been made, and now with two decades of EMR use and a decade of incentivizing providers to make it used meaningfully with the federal ARRA act of 2009, there still remain gaps that require fulfillment to achieve our patients’ expectations. Health information exchange (HIE) is a platform to share & interoperate patient’s medical data between provider systems. It serves as one step closer to achievement. Along with the Cures act in 2016, the CMS was motivated to rebrand the meaningful use (of EMR) program to Promoting Interoperability program, which incentivizes providers to share data.

Need for HIE and the role of emerging technologies

Electronically access and share patients’ vital medical history, no matter where they have received care. With the HIE platform, we can view and exchange patient data from connected sources ranging from health care venues such as state and national registries, PACS systems for image viewing, other regional HIEs, and CommonWell Health Alliance®, regardless of EHR.

HIE capabilities also provide the functionality and standard formatting to share Immunization records, Allergies, CCDs, PDFs, HL7®messages, images, scanned documents, H&Ps, discharge summaries, and clinical notes, which can help provide safer, more effective care tailored to patients’ unique medical needs. It also minimizes gaps and errors in patient history with comprehensive medical information from multiple care settings. Shared patient information in a timelier manner, can lead to more informed decision-making.

Ongoing regulatory changes require adoption to increase accessibility to patient data.

HIE cannot be efficiently done without digital technologies, emerging technology solutions like identity management using master patient index (MPI), FHIR interface technologies for information exchange, and 3^rd party vendor system that uses AI/ML to identify the patient accurately and improve the quality of the data that is being exchanged.

Having an HIE system in place does not mean that the accessed data is usable; patient care and safety cannot be supported if the data shared are useless.

Most pressing data integration and interoperability challenges

The need for a complete set of medical information that our clinicians can assess to provide the best care for our patients. We want to make sure that the right patients are not only matched and enrolled, but also that they are seamlessly accessible to our clinical care teams.

Having an HIE system in place does not mean that the accessed data is usable; patient care and safety cannot be supported if the data shared are useless. In our organization, more than 50% of the data received through HIE is unusable without going through a data cleaning process. This may be due to incompatible data formats, incomplete data, misidentification/loss of data categorizations and labeling, and data duplication.

We have engaged clinical and technical teams that assist us to ensure that robust MPI tools and reporting are being used for patient matching and enrollment. This includes record locator and record exchange services based on accurate patient matching.

For accessibility and user adoption, we have embedded HIE access via specialized screens & pages within our EMR system. Additionally, our HIE supports federated (distributed), centralized hybrid data models to ensure data connections are established as a foundation to enable better & cleaner data exchange. In addition, the EMR and other 3^rd party vendors are releasing products that interface between the HIE and the EMR to do the cleaning, creating context and appropriate matching processes for member matching, and leveraging AI/ML for the data cleaning.

How to build a successful data integration strategy?

The following are the key pillars for the data integration Strategy

1. Organizational Business Strategy
2. Care delivery processes
3. Data Governance
4. Data Privacy & Regulatory Compliance

Beyond the federal incentive program for interoperability, improving the care and providing value for the patients is a core of our healthcare providers’ business strategy. The data integration strategy should be infused into this business strategy to successfully achieve it.

Understanding the care delivery processes, people involved, and the data generated & used by it provides answers to the questions to address in the data integration strategy.

Implementing data governance to govern data through its entire life cycle from when it is created, managed, used, and archived. The governance facets should also include the data quality, data security controls, and the data architecture for seamless integration across the systems.  

When consent for data sharing, patients should feel confident that their data privacy is maintained to the federally mandated Regulatory & compliance rules. The strategy should include automation of these regulatory and compliance processes and audit records to track the data usage.

These key pillars along with the appropriate digital technologies road map should help the organization build a strong strategy.

Once the strategy is built, the proper execution of the strategy is also vital to reap the benefits of the data integration. We found it is more successful when the strategy is broken into multiple programs and projects that can provide quick wins to show the value of the integration.

With the right integration strategy, data governance processes & using emerging technologies, we all benefit from HIE, and it is a bridge to better care for our patients.

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For the past decade, interoperability has been a keystone to digital transformation within healthcare. Most, if not all, healthcare organizations have matured in their use of electronic health records and network-connected medical devices in providing care for their patients, and these disparate systems collect a multitude of valuable information about a patient’s treatment and response to care. Facilitating the safe and secure exchange of patient information between disparate systems and devices can yield great value in improving quality of care, patient safety, clinician efficiency and patient satisfaction. When patients experience transitions of care such as:

• Admission from home to hospital
• Discharge from hospital to home with follow-up ambulatory care
• Presenting for urgent or emergent care
• Transfer between healthcare organizations (tertiary, Post Acute Rehab, SNF)

These transitions often leave care providers with a fragmented view of care across the continuum and that can yield a risk of missing critical allergies, medication interactions or lead to duplicative diagnostic testing.

Of course, most recently, the COVID-19 pandemic has demonstrated to all the critical need for a robust national interoperability structure for improving the availability of patient data. Translating patient data between health information systems has been an arduous task, but recent federal efforts coupled with the challenges of the public health crisis have served as a catalyst for rapid improvement in strengthening these connections.

One critical item currently missing from the push for interoperability, is a formalized plan to address patient matching challenges.

In 2009 with the enactment of the American Reinvestment and Recovery Act (ARRA), the federal government established incentive payments to healthcare organizations that demonstrated meaningful use of their electronic health records. This legislation served as an effective stimulus for the digitization of healthcare, and as time passed, it became apparent that further work was necessary to facilitate patient access to data and the exchange of data between providers and patients. As a result, in 2016, the 21^st Century Cures Act (Cures Act) was passed in an effort to accelerate innovation and support of delivering efficient access to better patient information for both patients and clinicians. Following that, in 2018, the Centers for Medicare and Medicaid Services (CMS) rebranded the “Meaningful Use” program to “Promoting Interoperability”, but it was clearly much more than a rebranding effort as it shifted its incentives and penalties specifically toward patient information exchange. 

All of these federal initiatives have come together to drive progress, but in April 2021, the Cures Act compliance deadline changed the game and will continue to do so as we move toward further expansion in October 2022 with the next compliance deadline. While the Cures Act has already spurred some app development, it is projected to open up a network that will enable patients and clinicians alike to engage with healthcare through apps on mobile devices and electronic record systems. The evolution of this technology is creating a healthcare ecosystem that is very different from anything we have experienced in the past and is poised to create a cultural shift in the healthcare experience within the United States, but a barrier remains.

One critical item currently missing from the push for interoperability, is a formalized plan to address patient matching challenges. As noted previously, the U.S. has recognized tremendous improvement in defining standards and vehicles for interoperability, but we continue to face challenges in patient matching as a patient transitions across medical facilities. While organizations utilizing the same EHR vendor do not experience the same complexity in matching barriers, there are many systems nationwide on disparate systems that create significant risk around matching mistakes that compromise patient safety as well as quality and efficiency of care. There are even greater concerns about these risks in the medically underserved populations due to the frequent change of address, telephone and insurer that impact effective matching protocols.

While Congress voted in July 2020 to repeal a ban on the use of federal funds to develop a national patient identifier (NPI) for interoperability, the Senate quickly voted against its approval. Privacy, security and cost remain the primary reasons for opposition to such a measure. In a current landscape fraught with cybersecurity threats in healthcare, many are concerned that if a patient’s identifier were compromised then a patient’s entire health record would be easily accessible. While the concern is valid, the reality is that the risk around the breach of a health data identifier is not as significant as that carried with a social security number. While SSN breaches carry risk of a bad actor accessing banking and other financial information, that is not the case with a NPI; however, there are valid concerns around fraud related to medical identity theft and gaining access to prescription medications.

The cost associated with creating a secure framework for a NPI system will require a significant investment for development. Many argue that it would be so significant that cost could outweigh the value. A point for consideration though is that the cumulative cost (from the perspective of both patient and provider) associated with understanding the care provided to patients with our current fragmentation can be as great and likely more so and would hence offset the expense. Finally, the cost incurred (both financial and in human lives) during the current pandemic is clear evidence that we must take immediate steps to improve the reliable exchange data between the federal government and local health authorities. This effort would sure up nationwide efforts in early identification, tracing, and vaccinations.

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Connected health has been a target without focus for more than twenty years, that is up until two years ago. The COVID-19 pandemic has accelerated connected health adoption around five years, but the 21^st Century Cures Act came into place, payers adopted reimbursement strategies that embrace connected health. As a result, we are seeing development in technology solutions that are more refined and user-friendly.  

Pre-COVID, Luminis Health was piloting video telemedicine visits. Our goal then was to have greater than 100 video telemedicine visits in a month. Two of the problems faced at that time were structuring a telemedicine program that ensured reimbursement for telemedicine encounters and finding ways to encourage providers to change their business approach when things were working just fine.  

Luminis Health was also piloting take-home wearables for expectant mothers that would automatically populate the patient’s chart. The appeal of this program was to control pre-eclampsia in expectant mothers. The barrier here was finding blood pressure cuffs that our development team could integrate with. Many of the cuffs used proprietary protocols or had limited ways to integrate their data.  

Looking toward the horizon, connected health technologies are here to stay and each healthcare organization will have to maintain and expand their footprint in these spaces.

After the emergence of COVID-19 in the United States, our telemedicine adoption numbers raced past what just a month earlier was a lofty goal. Instead of discussing how the team could drum up support for 100 video telemedicine visits per month, we were looking to scale our support and architecture to support 13,000+ video telemedicine visits in a month.  

Our remote patient monitoring program also grew dramatically. In May of 2020, we were awarded an

Federal Communications Commission (FCC) telemedicine grant that allowed us to procure single-use low acuity monitors. These monitors were distributed to two groups of patients. The first group was returning home after an inpatient hospitalization for COVID-19 and met a specific set of criteria. The second group was referred to the program by their primary care provider with the goal of preventing emergency department admissions. Patients would then use their personal smartphone, or one that we provided, to integrate to the monitoring device and transmit the data to our clinical care coordination teams and primary care providers. Using this solution, we were able to have 549 patients either recover from COVID-19 at home or monitor patients that were at risk of needing emergency services and proactively provide care before the need for the emergency department presented.  

What changed? In that brief period of time, we found payers remove barriers to reimbursement, we were fortunate enough to receive a grant to help shoulder the cost of the single-use low acuity monitors, a market had been established for cost-effective connected health devices, and perhaps most importantly, patients and clinicians have embraced this shift in care delivery and saw the value to care it provided.  

Pre-COVID, numerous concerns were elevated around patient hesitancy or access to technology, and to a lesser degree, the level of trust for data not captured in the exam room. Now, most will agree that patients have less of a technology barrier as we once thought, and that wearable data or remote patient monitoring is reliable data that can positively impact patient care.  

Luminis Health was better positioned to respond to all of these changes due to active deployment of controlled pilots such as telemedicine and remote patient monitoring. Several years earlier, we made the active decision to have a dedicated software development team that we could leverage to accelerate changes to software systems. We also have executive support from the CEO down to run these pilots in a risk-controlled and patient-centric way. These factors allowed Luminis Health to pilot the operationalization of connected health technologies. Once conditions were right, we were able to rapidly scale both the technology and operationalization footprints.  

Looking toward the horizon, connected health technologies are here to stay and each healthcare organization will have to maintain and expand their footprint in these spaces. The reasons are simple: healthcare organization next door will be, patients are going to continue to expect it, and healthcare disruptors will be capitalizing in this area. 21^st Century Cures Act mandates data exchange, which will empower patient choice. Consequently, healthcare disruptors that offer such healthcare products have significant room to grow. 

At Luminis Health, we are tackling many of these strategies with our new digital front door experience that prioritizes patient access while minimizing the need for staff access. For example, we are focusing on expanding and allowing patients to schedule a broader number of types of visits directly on the provider’s schedule without having to place calls or wait for callbacks. We are also investing in technologies that allow for more seamless sharing of information and data from the patient to the provider and the provider to the patient. Lastly, we are exploring how we can leverage our technologies and operational experience to provide telemedicine visits on-demand without having to wait for a scheduled slot with a caregiver.  

Wearables, telemedicine, remote patient monitoring, and other connected health technologies are truly exciting, but this also presents a new way of operating. The sheer amount of data and expectation for immediacy is causing transformation. These technologies create new and different workloads for our caregivers at a point in time when we are at crisis levels in terms of provider and nurse satisfaction. All of this data needs to be assessed by the care teams, and actions will need to be taken. This is where I personally hope to see more technology focus. Advanced surveillance algorithms and mechanisms are needed for the next evolution of connected health.  

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Healthcare has never been considered an industry easy to disrupt or willing to embrace innovation. It took a global pandemic to change healthcare as we know it today and I am certain that we are only at the beginning of this change process curve, putting one disruption point behind us and a few more to come. We have been working hard over the last few decades, moving past what once was a ‘Sick Care’ and truly focusing on ‘Healthcare’, which promotes our communities’health and well-being. Yet, we failed to prepare adequately to face this pandemic and gave a response that one would consider less than optimal for the most expensive healthcare system in the world. Without a doubt, resilience and dedication to providing quality care have allowed us to get to where we are today despite all adversities we faced.

By virtualizing care and delivering innovations at home, we are building bridges which no health system can build physically.

What needs to change moving forward?

All of us will have many different ideas and perspectives around how to navigate a path forward, but one thing is clear that ‘Status Quo’ is now less desirable than ever. I am not saying that almost all care will need to be virtual & delivered to the patient’s home, but why not aim for it? It is only when we seek dreams we are able to create tomorrow’s success today. We all know that highly complex and advanced care will always require hospitals and medical facilities where patients will have to travel, but can’t we at least work on making HealthCare a little more ‘Caring’ and ‘Healthy’? Self-care equals better patient care and bedside standard of care saves more lives than any other medical interventions. Hospitality in the context of a hospital aims to make the patient’s experience positive. By virtualizing care and delivering innovations at home, we are building bridges which no health system can build physically.

Today, I am able to coordinate a video visit with a daughter in Florida and an elderly parent in my home state Massachusetts where I practice primary care, to go over End-of-Life Planning discussion and help assess medication compliance and home environment which might  prevent next fall &/or ER visit. My care team is able to engage with patients virtually in realtime at the most vulnerable points in their care, such as post-hospital discharge through TCM (Transition Care Management) program, monitoring and preventing the adverse outcome of chronic disease through RPM (Remote Physiological Monitoring) program, & engaging patients, post Emergency Room visit to improve access to care, address gaps in care or prevent further downstream utilization thus reducing total cost of care.

Compass Medical, where I practice as a primary care physician and function as Chief Medical Information Officer, is a physician-owned and led medical organization serving over eighty thousand patients across Southeastern Massachusetts. Just like many other healthcare organizations, we also faced the crisis head-on with a steep decline in office visits, rapid deployment of Telemedicine, and process disruptions around every aspect of care delivery given new safety and infection control measures needed to implement. Patients were avoiding essential in-person care and providers were beyond overwhelmed trying to manage clinical and operational volatility.

Crisis breeds Opportunities and Success breeds Complacency.

A group of our leadership team members and clinicians came together to seek new opportunities amid this crisis and we came out with what we call today ‘Connected Care Services Model’. We doubled down on CCM (Chronic Care Management) we implemented as a centralized service since 2016 and expanded by incorporating TCM (Transition Care Management) program enabled through real-time ADT (Admission Discharge Transfer) feeds. We recruited a pool of clinical staff and providers rapidly to deploy RPM (Remote Patient Monitoring) program and post Emergency Room discharge Telehealth follow-up the program. We increased our TCM utilization by 500% and created a new services model while our peers were either doing 100% virtual care or waiting for this pandemic to be over to go back to “Old Normal”.  

Our patients started embracing these new care delivery models rapidly. They appreciated working outside the box of medical buildings we so get hyperfocused on as our sole means to provide excellent quality care. Now the care was in patients’ hands or reaching out to them in times of their most vulnerable. Remote care is not just limited to providing necessary means to take care of patients in their homes, but also should enable every care team member to provide the highest efficiency of care possible. Remote work from home enabled us to continue many essential clinical and operational processes without major gaps in the workforce due to exposure or other such needed measures. We have a set of providers currently utilizing remote scribing services, including myself which allows for greater flexibility and efficiency by reducing EMR documentation burden.

Remote care or Telemedicine is not the next big thing. I firmly believe that remote care is an opportunity, but at the core, it is just another part of a comprehensive care delivery which we need to continue to enable through data and technology. We cannot wait for the crisis to be over to pave the path forward as our most high risk and vulnerable populations need us in healthcare today more than ever to provide new ways to handle old problems and work together to find solutions to new challenges we all face together.

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With the proliferation of smart devices, it’s no surprise that Veterans have begun to turn to consumer products and apps to help monitor their own health using their cellphones and other personal devices such as Fitbits, Apple Watches, and more. The good news is that it provides people with a wealth of data to help manage their health. The not-so-good news is that this personal health data (also known as patient-generated data) often doesn’t make it to their care providers, who could partner with them to improve their health.

The U.S. Department of Veterans Affairs (VA) Office of Connected Care is laser-focused on improving health care through technology as we see a significant opportunity to integrate patient-generated data with the care plans offered by VA health care teams. The information that Veterans gather about their own health habits can be a key tool that providers can use to improve Veterans’ health outcomes, potentially detect health risks sooner and, ultimately, help change the direction of increasing health care costs.  

Recently, we’ve been blending VA telehealth technology with patient-generated health data through our Apple Watch pilot program. A group of Veterans at James A. Haley Veterans’ Hospital in Tampa, Florida, have each received an Apple Watch that can conduct an electrocardiogram (EKG) — a test that monitors the heart’s electrical signal — and save the results in a format that makes them shareable with the Veteran’s VA care team.

This electronic transfer of information often saves Veterans from having to drive to in-person appointments at the VA Medical Center. Once a Veteran is able to transfer the EKG results to the Health app on their iOS device, they can then share it with their provider through one of two VA innovations: during a VA Video Connect appointment, or through Secure Messaging on My HealtheVet, VA’s online patient portal.

In addition to Apple Watches, VA is gathering data from other types of Connected Devices including FitBits and Glucometers. OCC has developed a mobile app called “Sync-My-Health-Data” (SMHD), which allows a Veteran to pair their device with the SMHD app so that the data can flow into VA’s Patient Generated Database for analysis. OCC is conducting an analysis of this data, coupled with data from VA’s Electronic Health Record and Socioeconomic data for two clinical cohorts – Diabetes and Sleep/Stress.  The insights generated from this analysis will be presented back to VA providers and patients.

VA is also innovating in the field of self-care with our Annie app. Named after Lt. Annie G. Fox, the first woman to receive the Purple Heart for combat, Annie is a text messaging platform that promotes self-care for Veterans enrolled in VA health care.

Here’s how it works: When a patient is enrolled in a clinical protocol, such as medication management, the Annie app can be programmed to send personalized, automated text messages to the patient to remind them to take their medications. Annie can also receive text messages from patients. For example, patients who are enrolled in hypertension management can send their blood pressure readings to their clinical care team via a text message.

VA has had over 6,000 patients use Annie for multiple clinical conditions, and the number is steadily growing. And excitement among VA providers about Annie is growing too. Annie lets providers review patient data at any time prior to the patient’s visit, enabling them to proactively adjust the plan of care if necessary.

“VA providers should be wholeheartedly enthusiastic about using Annie. It allows us to reach our patients in ways we couldn’t previously and ultimately improve health outcomes,” said Dr. Lynn Kataria, Chief of Neurology Education Washington, D.C. VA Medical Center in a VA testimonial.

VA’s Office of Connected Care has made significant strides in telehealth and mobile health technologies and the future looks even more promising as we continue to lead from the cutting edge by expanding our capabilities through these efforts and others. Most importantly, our use of patient-generated data to influence major improvements in our Veterans’ health care cannot be overemphasized. To learn more about how the VA Office of Connected Care is using mobile health technology to enhance Veteran care, visit https://connectedcare.va.gov/.

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The Problem. The increasing shortage of healthcare professionals in the U.S. presents a challenge for many healthcare organizations, especially those in rural areas. Approximately 20% of Americans live in rural areas, including 1.9 million people in Northern New England (Maine, New Hampshire and Vermont), yet, only 10% of physicians practice in those regions, leaving many people without adequate access to care. These rural populations tend to be older, have more chronic medical conditions, have lower incomes, and must travel long distances to receive specialty care. To make matters worse, more than 80 rural hospitals have closed in the U.S. since 2010. In many rural areas, including Northern New England, the lack of specialty care in local hospitals, and patient capacity limitations of regional tertiary care referral centers creates significant pressure.

Many of the challenges of rural health care can be mitigated through telemedicine. Telemedicine can increase access to care, decrease workforce disparities, improve outcomes, lower costs for patients and systems, and enhance patient and provider satisfaction.

Technology. Telehealth technology varies by the type of medical service being provided, as well as patient location, both geographically and whether in a hospital, clinic, doctor’s office or home. Regardless, reliable, high-speed internet service is essential. For high acuity services such as TeleEmergency and TeleICU, private data networks are built to provide maximum reliability.  Where private networks are impractical, service is provided over the public internet. When providing services to patients at home, reliable, broadband internet service is vital, but lack of broadband availability poses significant challenges in some rural areas of northern New England. 

A common technology approach for TeleEmergency and TeleICU services is to hard-wire hospital rooms with dedicated phone lines, and wall- or ceiling-mounted microphones, monitors, and cameras that communicate directly with a dedicated, multi-station telehealth hub. This allows the bedside care providers to remain actively engaged in direct patient care for seriously ill patients while interacting with the remote telemedicine team.

Specially designed telemedicine carts are sometimes used for TeleEmergency or TeleICU consultations, but more commonly this option is deployed for emergency and inpatient TeleNeurology and TelePsychiatry services, and for outpatient specialty telemedicine appointments for patients in their primary care provider’s office or another clinical location nearby their homes.  The cart may be stocked with Bluetooth peripheral devices that can be used by a Telepresenter to assist the remote provider with some components of a physical exam. Other services, either requiring less physical exam, such as counseling-dominated visits, or where space is limited, such as TeleICN, where many clinicians may need to participate in the care of a very small patient, may rely on tablets on mobile stands.  In all these cases, the telemedicine provider may be connected via laptop computer, tablet, or smartphone. For outpatient virtual visits to patients in their own homes, patients and providers can connect virtually from a laptop, tablet, or smartphone.

In all of these hardware applications, real-time, two-way video connections via HIPAA-compliant software ensures and protects patient privacy. And regardless of the telemedicine location, hardware, software, or service line, 24/7 technical support is essential to its success and sustainability.   

Adoption and Impact. The ubiquity of personal technology, regardless of patient age and rural connectivity challenges, has paved the way for increased patient interest in receiving care via telehealth. Typically, once people have had the opportunity to try telehealth – either as patient or provider – they’re sold on the concept and seek-out more opportunities to use it. Ensuring the technology is easy to use is therefore essential.  As is generally reported in the industry, at Dartmouth-Hitchcock Connected Care we have validated high patient satisfaction for outpatient virtual visits, including the technology experience.  More than 92% of these patients found the telemedicine connection process uncomplicated and efficient; 100% of these patients would recommend a telemedicine appointment to others. 

Dartmouth-Hitchcock (D-H) Connected Care and its Center for Telehealth was founded in 2012 with a primary objective of delivering outstanding health care to patients throughout northern New England regardless of their location. The D-H telehealth services were designed and implemented with an emphasis on strong collaboration with community health care teams to allow more patients in the region to receive the right care at the right time at the right place, which is often close to home.

TheD-H Center for Telehealth currently provides TeleEmergency, TeleNeurology, TeleICU, TelePsychiatry, TelePharmacy, TeleICN, TeleUrgent Care and outpatient Virtual visits.

The growth of D-H’s telemedicine program over the past seven years has given our team the opportunity to experience first-hand the benefits and value of telemedicine. We have seen TeleICU patient mortality rates improve and patients discharged from the ICU more quickly. TeleNeurology patients are transferred from their local hospitals only 5% of the time. Two-thirds of deliveries with TeleICN stay local. Thirty percent of TelePsychiatry patients are discharged to home after a consultation instead of spending hours and sometimes days boarding in the Emergency Department.  Rural Emergency Department nurses and providers have back-up and support during surges, during times of tight staffing, and when presented with unusual cases. Collaborative care via telemedicine increases staff and provider satisfaction reduces the sense of professional isolation that may occur in rural locations and has become a powerful tool for recruiting new physicians at some of our partner hospitals. 

Telemedicine can play a critical role in transforming health care in the U.S.; but while advances in technology and connectivity enable the delivery of care to patients at the right place at the right time, the priority and focus must always be on patient care. 

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The rise of interoperability and interconnected technologies is fundamentally changing how we care for, communicate and engage with our patients, providers and clinicians. Health IT has helped integrate systems, connect caregivers and patients, and improve our ability to access longitudinal patient data—information about the patient, as seen over time—that helps enhance care delivery. Connected Health is an emerging model of health care delivery that leverages technology to collect and analyze such data by connecting patients and providers, resulting in improved patient outcomes, increased access and reduced costs.

Connected Health achieves more information-driven, efficient, and less costly patient care, particularly in patients with chronic conditions.

At Fresenius Medical Care (FMC), Connected Health thinking is a core part of our technology agenda that is focused around the needs of our patients and providers and revolves around three main areas: growing connected health offerings by integrating and connecting clinical care systems and applications; enhancing data collection during treatment by reimagining our medical devices as sensing platforms; and growing our global analytics capabilities to drive personalization and precision in patient care. Our vision is that connected health technology can play an integral role in addressing the needs and goals of chronic disease patient populations relative to managing their condition.

FMC’s suite of Connected Health technologies and applications enable care at home and beyond, provide tools that offer real-time connectivity between patients and their care teams; improve access to healthcare in remote areas; and provide clinical decision support and guidance to avoid potentially negative healthcare events by proactive management and intervention. Our company is also exploring biosensing wearables–such as digital blood pressure monitors and glucose sensors—to empower patients to become more active and engaged participants in their care.

Managing patient populations, particularly with chronic kidney disease, End Stage Kidney Disease (ESKD) and underlying comorbidities like diabetes, hypertension, and congestive heart failure require coordinated and proactive participation by various supporting clinical and nonclinical staff and several different types of care providers and physicians. We are in the midst of a rapid “paradigm shift” from a world of provider-centered, fragmented health information that often leaves the patient out, to one of empowered consumers using powerful digital health apps and services to access and share their own health information when, where, and how they want, to support better health and better care at lower costs for all.

Technology can empower patients to collect, visualize, and distribute personal health care data, including patient-reported outcomes and patient-reported experiences. Connected Health technologies improve communication among patients, providers, and caregivers through connected devices and systems. Connected Health achieves more information-driven, efficient, and less costly patient care, particularly in patients with chronic conditions. Its “Anytime, Anywhere” mode of care delivery brings the right information, at the right time, to the right place and the right person to maximize the efficacy of treatment.

Clinician access to real-time patient data is key in driving healthcare quality. Clinicians at Fresenius Kidney Care (FKC) use the Clinician Portal to see data from home-based and remote patient dialysis treatments collected by devices such as the Liberty Cycler. Staying connected to their patients’ treatments, regardless of location, allows real-time intervention to prevent adverse health events. Through the Patient Portal, patients at FKC are connected to their care team via daily submissions of treatment data and secure messaging. They also have self-service access to their pertinent medical record data and logistical support such as supply ordering and delivery notifications.

To maximize the benefit of Connected Health, there are several number of technology needs. The obvious is the device: usually a smartphone or tablet, decreasingly a computer. Additionally, internet connectivity (Wi-Fi or cellular) is also required to enable Connected Health. Some patients may have cellular but do not use it for medical purposes due to limited data plans. Some geographies do not have adequate bandwidth to support Connected Health even if the patient does have internet access.

Before getting patients engaged with Connected Health, the clinical teams must be believers, champions, and proponents. Few patients are self-driven in managing their care while most patients respond to the guidance they receive from the clinical care team. The challenge is to prioritize Connected Health initiatives to a care team who is already busy with many competing priorities. Therefore, a key ingredient for success is to align the objectives from the top down. (Note, the solution development must include the care team – it’s the broad launch and readiness that must be top-down).

Getting through the clutter of all the other activities, care teams are involved in requires training and effective communication. Examples are hands-on training on how to use the connected health data and tools and best practices for helping clinicians fit the new patient management workflow into their daily routines.

The Connected Health technology must also fit into the patient’s therapy workflow and their “life flow”. The solution must ease the burden of therapy rather than add to it and guide them through the process, reduce the effort to learn, and ultimately reward them with closed-loop feedback. Access to technology can be a barrier from a financial standpoint to some segments. One option to address this is by providing/loaning a device to those segments – IT teams should be engaged for management of such devices.

Today, patient health data is siloed by the provider. The patient is forced to be the middleman communicating between the two providers. They can do this via use of each provider’s separate portal and manually share the data with the other provider. One example of how this can be addressed is via Health Information Exchanges. When patients are seen outside clinics, by their PCP, or experience a hospitalization, FMC as the dialysis provider may not get a timely record of their care outside of our ecosystem; the same is true for these providers that access to dialysis facility care data, such as labs treatments etc. FMC partners with two national frameworks for HIEs– Commonwealth Health Alliance and the Sequoia Project along with some regional players–allowing real-time sharing of patient data to help create a longitudinal view of patient care.

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People are living longer than ever, and as the baby boomers age, providing care to an exponentially larger, complex population will place a strain on the healthcare system. Nurses are at the forefront of eldercare, and now faced with overwhelming numbers of adults managing multiple chronic illnesses, medications, and transitions in care points, healthcare organizations are exploring new evidence-based strategies to optimize their role in interdisciplinary teams. The concept is simple but vitally important: Nurses are the foundation of healthcare delivery. How can care organizations best utilize nursing professionals in the most impactful, cost-effective and efficient manner? And how can new technologies and the integration of digital health information advance patient outcomes? The answer is analytics.

Comprehensive analytics also provides the nurse with a 360^o view of the member

Top of the Licensure Strategies to Optimize Time for Critical Thinking

Whether it is an advanced practice nurse, a registered nurse in a facility, a licensed practical nurse in a provider clinic, or certified case manager in a care delivery setting, “top of the licensure assignments” (i.e., offloading less complex work from the next level above) is an increasingly popular strategy among organizations across the care continuum. Top of the licensure goals involves continual evaluation of processes to identify tasks that can be completed by other allied health professionals to help free up more time for what nurses do best: perform critical cognitive thought, assess for and identify needs, and deliver holistic care to more patients.

Harnessing Technology to Optimize Nursing Resources and Make Smarter, Safer Care Decisions

Technology adoption is a pillar to “top of the licensure” strategies. After all, technology at its core is designed to empower human performance to the fullest extent of training and capability. With an eye on improving quality and value-based care, harnessing the benefits of rapidly developing technologies is a “must do” for care facilities and organizations.

Electronic Health Records (EHR) are nearly ubiquitous in every healthcare setting across the United States and have become essential tools to promote patient safety and automate processes. EHR technologies enable efficient and secure sharing of health information across interdisciplinary teams and care facilities to prevent errors, avoid duplication of documentation, and provide greater coordination of care.

While it’s clear that EHR technology has transformed the way care is delivered, it presents significant limitations in care management workflow and in optimizing the nurse’s role in detecting physical and/or deteriorating changes in the patient condition. After all, EHR technology is designed to document care–not assess and analyze it.

Enabling the Enabler–Workflow Tools to Supplement the EHR for Care Management Workflow

The guiding principle behind care management is the identification, development, and timely delivery of appropriate interventions to produce positive clinical and financial outcomes within a given population. Utilizing predictive data analysis models in concert with EHR technologies is crucial in identifying at-risk patients – and in leveraging the nurses top of licensure skillsets.

Communication between the EHR and a care management workflow tool can drive efficiency, improve communication between all members of the healthcare team, and alleviate redundancies. It does that by delivering timely and accurate predictive risk scoring through the data gathered by the EHR and other care documentation tools. As a result, nurses and other care manager disciplines can target and engage with at-risk individuals earlier in the condition and/or disease state.

Lacking insight from good analytics, nursing skills are placed on hold as additional legwork is undertaken to identify patients most at risk. Significant time is expended reviewing multiple information sources, including payors, the EHR hospitals, ERs/Urgent care centers, other caregivers, pharmacies, and labs – assuming that that information is accessible at all. This type of administrative work is certainly not top of the license activity for nurses. Comprehensive analytics, such as risk stratification, sorts data based utilization patterns, treatments for chronic conditions, cost, medications, and more to leapfrog over the identification process and speed up nursing engagement for populations members most in need of care management intervention.

Beyond identification, comprehensive analytics also provides the nurse with a 360^o view of the member; including diagnoses, in and out of network utilization, provider/specialty visits, admission/readmission, ER utilization, gaps in care, and medication reconciliation.

All of this information provides the care manager a strong foundation to initiative care protocols. Fingertip access to comprehensive historical details, especially around gaps in care, serves to further support and educate the member on what actions are needed to maintain and improve their health.

Unleashing the power of analytical insight to reduce health risks among patient populations not only drives improved disease management, better health outcomes, and reduces overall costs for a strained healthcare system – it helps nurses function at the top of their license.

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