For that reason, Iora has started from scratch to better meet patient needs. It's a high-service model, Packard says, one that pairs patients with health coaches skilled in "motivational interviewing" and other techniques that let the provider develop a care plan based around life goals, not just calling the doctor when youre in pain. After all, once that happens, it's typically too late for low-cost preventive care.
To that end, Iora assigns its patients a "Worry Score." This algorithmic system combines payer, clinical, hospital and patient-generated data to tell a practice's physicians which patients require their attention, Packard says. The system will also generate tasks based on that score, ranging from an automatic reminder to schedule an appointment to a call to action for a physician to visit a patient admitted to the hospital overnight.
"We think the killer app is the relationship," Packard says.
Must Remove Constraints From EHR, Clinical Systems
This relationship extends beyond individual patients and their physicians. Coordinated care among healthcare entities is a main tenet of healthcare reform's accountable care organization (ACO) — but even at a more basic level, collaboration improves research, care guidelines and decision support, all of which contribute to better care quality.
Here, as is so often the case in healthcare, technology needs to catch up. Speaking at Medical Informatics World, Dr. Jacob Reider, acting principal deputy national coordinator of healthcare IT, said the document-centric electronic health record (EHR) hinders providers as well as developers.
Paper records literally had no constraints, but trying to anticipate user needs in EHR systems has added constraints that "destroy usability of the products and destroy the workflow of clinicians," Reider says. Providers struggle, meanwhile, because records stem from single appointments (for the sake of reimbursement) as opposed to a series of observations about a patient's overall health and wellness.
In this case, the disruption, still not yet wholly achieved, involves a shift from official, government-defined meaningful use of EHR technology to more literal, sustainable "meaningful use," Reider says. This requires equal parts interoperability, safety, usability and health data infrastructure.
Then and only then will healthcare be able to advance as Christensen says it can — from intuitive medicine (based on one symptom that many diseases share) to empirical medicine (based on patterns that apply to a general population of patients) to precise personalized medicine.
Along the way, nurses, clinicians and retail pharmacists will be empowered to do "increasingly sophisticated things" that turn those expensive healthcare encounters into affordable ones. "This is the mechanism by which we solve that problem," Christensen says.
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