Most health system executives understand that significant changes are necessary in healthcare to adapt to the preferences of today's consumers while cutting costs and delivering quality care. A recent article quoted an executive of the Cleveland Clinic about three major trends that are shaping the health systems for the future (see: Why Today’s Hospitals and Health Systems Need to Be More Patient-Centric to Fight Rising Costs). Below is an excerpt from it:
“A central challenge for the United States is that between 18 to 20 percent of GDP is going to healthcare, and it’s on track to go higher,” says Edmund Sabanegh,... President of the main campus hospital of the Cleveland Clinic....“This explosive growth in expense is not sustainable and we cannot afford it as a country.” He discussed three trends that are emerging in response to this challenge and that will shape the hospital systems of the future. All of these trends amount to one thing: making healthcare more patient-friendly.
- [Patient centricity] “The hospitals and health systems of the future will need to be more patient-centric. Patients will not come to health systems- health systems will need to come to patients,” he says....But if there are clear algorithms in place for identifying patients who need much more advanced care, patients may be able to receive very routine kinds of services at much lower cost.”
- Price transparency “Going forward, people are going to be able to shop for healthcare asking very specific questions....And people will be able to compare prices at different institutions. You are going to be able to compare apples to apples.” This kind of price transparency is being advanced by innovative companies offering niche services at lower cost....
- Leveraging the digital revolution...."[G]etting patients to the right doctor in a timely fashion is still a challenge for hospitals.” Online scheduling of patient visits and online consultations with experts for second opinions are the future....[H]ospitals and health systems of the future must leverage technology to allow for remote monitoring so that specialists can intervene during a patient visit without having to be physically present at all locations.
I have blogged extensively about the three major healthcare trends cited by Dr. Sabanegh: (1) patient centricity/consumerism; (2) price transparency accompanied by the need to lower the cost of care; and (3) digital medicine with emphasis on AI. However, as the focus for this note, I want to briefly make reference to Dr. Sabanegh's point about the use of clinical algorithms in paragraph #1. He states that clinical decision support (CDS) algorithms can be used to direct patients who only need basic care to lower cost providers. I came across an article that covers the basic of this process as it applies to telephone triage by nurses at the Mayo Clinic: How Mayo Clinic Uses CDS Algorithms to Standardize Nurse Triage. Here a excerpt from this article:
For almost a decade, Mayo has been working on a different way to deliver clinical decision support for its primary care patients. Starting with a proprietary health IT tool called ExpertRN and moving later to adopt the Curion platform from Applied Pathways, the healthcare system has relied on an algorithmic approach to phone-based triage....The nurse is able to use a guided decision tree based on the symptoms the patient presents. The algorithm leads them through a number of questions, which helps assure that key assessment points are not missed.....It gives our triage nurses a bit more structure than the generalized guidelines currently used across the healthcare industry. He or she will always use clinical judgment and experience in addition to what is on the screen, of course, but it does help to present them with a standardized series of options that lead to a very thorough assessment.
For delivering patient care whether by telephone or in person, I can't think of a more important use for clinical algorithms than triaging patients to the most appropriate provider. Such triaging not only has significant quality implications but, as noted above, it also affects the cost of care.
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