The Patient Journey: Medicine Without Walls (Part 2 of 2)

Theo Koury, MD, President of Vituity

Theo Koury , MD

President of Vituity

Published December 31, 2015

Welcome to Perspectives final post of 2015. It's certainly been an interesting year for the healthcare industry. But while change can provoke stress and uncertainty, it also opens new possibilities.

In my previous post, we looked at some of the challenges we've overcome in the past 100 years. Medical science and technology have drastically reduced mortality. At the same time, increasing specialization has led to fragmented care delivery.

Today, four converging factors are driving unprecedented change in healthcare:
  • Cost curve. Worrying cost inflation drives changes in regulation toward …
  • Value-based care. This incentivizes integration, which will be supported by …
  • Technology. New platforms facilitate collaboration across the entire healthcare team, including patients. This empowers …
  • Patient readiness. Patients are taking more control of their care, which in turn drives value-based care and integration.

These factors create a tremendous opportunity for the right healthcare organizations to work together. By integrating their services, provider groups and their hospital partners can improve care delivery, maximize quality and decrease costs, creating a win-win for their patients and themselves.

Here's a hypothetical patient story that illustrates what the future of acute care could look like.

Quality Care Anywhere

Mr. and Mrs. Smith are a professional couple in their fifties. One morning, Mr. Smith wakes up feeling crummy. He didn't sleep very well, and he's achy all over. But he's too busy to stay home, so he goes to work anyway.

That morning, his smart watch picks up some abnormal heart rate and temperature fluctuations. It schedules him for a telehealth call with Dr. Caring later that morning. (Dr. Caring is member of Vituity, a multispecialty medical group that works with local partners to provide a full continuum of acute care services.)

During the call (which Mr. Smith conducts from his office), Dr. Caring takes a history and listens to the patient's heart and lung sounds through an app. He determines that Mr. Smith has a viral syndrome.

Based on the patient's history and genomic profile (available via the Vituity EHR), he deduces there's a 74 percent chance that vitamin C will help abate the infection within a few days. So he sends an electronic prescription to a nearby pharmacy that delivers vitamins to Mr. Smith's office.

Thanks to the vitamin C, Mr. Smith feels better within days. Then Mrs. Smith wakes up with a cough and fever. She seems to have caught the same bug.

Fortunately she's scheduled for an elective knee surgery, so she already has a pre-op appointment set with her anesthesiologist (a Vituity physician). For the pre-op appointment they'll meet at the local urgent care center (also staffed by Vituity).

A Seamless Continuum

Dr. Comfort, the anesthesiologist, examines Mrs. Smith and finds signs of possible pneumonia. He consults with Dr. Efficient the urgent care physician on site, who orders a round of tests.

The results do indeed show signs of pneumonia but there's also a concerning lung mass. It's clear that Mrs. Smith should be hospitalized.

Mrs. Smith takes out her smart phone, opens the Hospital Compare app, and quickly researches which local hospital has the best outcomes for pulmonary care at the lowest cost. She decides St. Compassion is the obvious choice.

As luck would have it, St. Compassion's hospital medicine program is also staffed by Vituity. Dr. Efficient calls her hospitalist colleague Dr. Brilliant for a patient handoff. She enters all the data from Mrs. Smith's visit into the EHR so that it's instantly accessible. She also arranges for Mrs. Smith to be admitted directly to the floor.

When Mrs. Smith arrives at the hospital, she doesn't have to repeat her story. Instead, Dr. Brilliant recaps for her everything that's already taken place, including her lab and exam findings from the urgent care center. This reassures her that she's being cared for by one integrated team.

Dr. Brilliant finishes Mrs. Smith's exam, creates a plan for her hospital stay and writes it on a whiteboard in her room so the entire family is on the same page. Over the next few days, Mrs. Smith receives IV antibiotics and has a workup performed. Sadly, she's diagnosed with advanced lung cancer. But for the moment, she's feeling well enough to go home.

Patient-Centered Care

The entire care team gets together with Mrs. Smith before she's discharged and develops an outpatient care plan for her. The hospitalist, nursing staff, case manger, clinical pharmacist and home care team all participate in this process.

Recognizing that the patient has advanced cancer, Dr. Brilliant also sits down with her to discuss goals of care and develop an advance care directive.

Before she leaves the hospital, Mrs. Smith's case manager helps her upload the Vituity telehealth app to her phone. Now if she has a question or concern, and her family doctor isn't available, she can easily reach out to Dr. Brilliant.

She's also given some portable devices. One is a wristband that records her vital signs and sleep patterns. The other, which looks like a Band-Aid, monitors her blood electrolytes, blood glucose and other metrics. Both connect wirelessly to Vituity's telehealth platform, giving her care team real-time access to this data.

Back home, she's cared for by an advanced home care team made up of Vituity and St. Compassion personnel. She receives antibiotic therapy and even chemotherapy in the comfort of her own living room. At each visit, the team enters findings and updates into the EHR. Her physicians have instant access to all of this information. They order the medications she needs to stay comfortable.

Respecting Patient Wishes

About a month later, Mrs. Smith wakes up one morning feeling nauseated and short of breath. Her wearable devices transmit abnormal vital signs and lab findings, triggering the Vituity app to schedule a telehealth call with Dr. Brilliant. He reviews the lab data, examines Mrs. Smith and recognizes that she has reached a critical point in her illness.

He tells Mrs. Smith that he'd like to readmit her to the hospital. However, she recognizes that her disease is advanced. After discussing her options with Dr. Brilliant, she decides to remain at home and to discontinue medical care.

Dr. Brilliant schedules a palliative care team to visit the Smiths later that day. The team helps the patient and family develop a new care plan. They make sure Mrs. Smith has all the support and medications she needs to keep her comfortable at home.

About a month later, Mrs. Smith passes away in the comfort of her home with her loved ones at her bedside.

Our Choices Matter

The care that I've just described is the level of quality that our patients deserve. It's what we'd want for our own loved ones. And it's completely within the realm of possibility.

Sure, I described some technologies that aren't yet available. But technology is advancing so rapidly — on a weekly basis, in fact — these capabilities are just around the corner.

As healthcare leaders and providers, we can deny change. We can fight against it. Or we can step forward and embrace the tremendous opportunities that lie ahead. Together, we can transform hospital care and extend it into our communities.

By achieving this, we will shatter the walls that have fragmented healthcare over the past 40 years. We will be able to reach new heights in delivering medicine without walls.

For those who continue to be blinded by fear and uncertainty, consider that it's not what you look at that matters. It's what you see.

For those who see opportunities, let's come together to make our vision a reality.

[Image Credit: Photo by NEC Corporation of America licensed under CC BY - SA 2.0]

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