Healthcare provider organizations today strive to operate as one system of care, which can be a challenge. The pandemic has brought this issue into stark focus by magnifying the challenge and accentuating its impact on patient access, care and leakage.

The pandemic also has placed new strains on hospital intake and capacity, strains that can result in patients being transferred to hospitals far from home, even out of their state. Increased staff shortages due to illness and burnout have further compounded these issues.

Angie Franks is CEO of About Healthcare, which develops patient access technologies for hospitals and health systems. We spoke with her to discuss strategies for reducing patient leakage and tools to improve access across the care continuum.

Q. How has the concept of the health system – operating as one system of care – changed the way people think about healthcare and access to care?

A. Hospitals and health systems historically have operated in a transactional manner. Patients engage with health systems when they are ill and are provided the care they need. In addition to this reactive approach, very little interaction, communication or information sharing typically occurs among different care providers – even among distinct providers within the same health system.

In many cases, each individual entity within a health system has its own organizational and technological infrastructure. These facilities may have the same parent organization and share the same name and logo, but at the end of the day most still operate as independent entities, causing inefficiencies, gaps and friction.

With COVID-19, the demand for care increased exponentially, placing an unprecedented strain on our medical resources. This occurrence exposed the dire implications of the independent, transactional care delivery model. When the pandemic hit, many hospitals were working blind.

Even after spending millions on EHR technology and interoperability, overburdened hospitals were unable to quickly view and assess critical information, such as capacity across care settings with other in-network or neighboring out-of-network providers. 

Care coordination suffered as a result, with patients often being sent hundreds of miles away for treatment when capacity was available nearby. COVID-19 showed us how critical information sharing and operating as one system of care is to provider efficiency and patient outcomes.

The pandemic helped providers realize they need to implement controls that enable proactivity in guiding patients to the optimal setting for care, rather than just dealing with them when they arrive at the facility. 

COVID-19 has served as an accelerant, prompting healthcare providers to invest in technologies and protocols that improve visibility across the care continuum, reduce process variability, and enable prompt and informed care decisions.

Operating as one system of care requires two fundamental changes to the healthcare model.

First, it requires an investment in primary care infrastructure. Patients must be able to easily connect with physicians in a manner that works best for them – whether that's via a telehealth or in-person visit. By enabling an infrastructure where patients can easily connect with their physicians and preventative services on a regular basis, you can address illness before it progresses to a more serious condition.

And second, it requires the ability to proactively empower care navigation. In the instance where a patient's needs require more acute services (for example, surgical procedure, hospitalization), then a health system needs to be able to identify the optimal care setting for the patient based on their level of acuity while ensuring workloads are balanced across the network.

Furthermore, patients shouldn't be discharged from the hospital or ED with self-serve instructions for follow-up care. Health systems need to wrap their arms around their patients and proactively manage and coordinate each next step of their journey. Proper system utilization and proactive care coordination helps prevent patient leakage while maximizing throughput, revenue and the patient experience.

Q. How can health IT help with both patient access and patient leakage in a health system?

A. Hospital systems typically have preferred networks of care they leverage when moving a patient from one phase of care to another (for example, an inpatient stay to a post-acute provider). 

Using technology and best practice workflows to automate this process is the way to control the patient journey, facilitate decision-making and improve the patient experience to ensure patients stay in network for this next phase of care.

This approach of standardizing the decision-making and execution across the enterprise is much more effective than traditional approaches where a care manager asks a patient and his or her family to choose the post-acute care facility to which they want to be discharged. This is an opportunity for leakage and a poor patient experience.

Patient transfers from community hospitals are another primary source of leakage. Hundreds of thousands of times a year, community hospitals encounter patients that require a level of care that exceeds their capabilities. These patients are typically transferred to the facilities that make the process easiest on the community hospital, not necessarily those within the health system.

Facilities that not only accept incoming calls but also have the end-to-end logistics to execute on the patients' transfer needs ultimately earn these referrals. Technology and optimized workflows can help ensure these transfers stay within a health system by streamlining key steps in the process.

For example, health IT can consolidate data from different systems and quickly summarize the in-system hospitals that have the capability and capacity to address a patient's acuity needs, while also detailing on-call clinicians and transport options.

With all this data at the receiving health system's fingertips, a community hospital can make a transfer decision in a single phone call versus the multiple calls the process historically has required. This results in a better experience for the referring facility and drives repeat usage, ensuring reduced patient leakage through improved patient access and navigation.

Q. How can technology help with hospital intake and capacity, especially under strains like COVID-19?

A. The application of technology shouldn't be limited to one health system or system of care. In fact, its impact can be much more profound when it extends to multiple systems under different ownership. COVID is a prime example. With COVID, we saw an exceptional surge in healthcare demand in a compressed time frame. Moreover, many of these spikes were tied to geography.

Information technology can help health systems load-balance across extended regional networks to ensure patient demands for care are met. With technology, the boundaries of care aren't limited to a specific hospital, health system or state.

Healthcare becomes more ubiquitous, enabling patients to be moved from one geography to another, if necessary, to receive rapid access to the care they need. Compressing the time to care improves patient outcomes.

The network of information necessary to understand where your next move is as a healthcare provider in a pandemic environment is astounding. It's driving a connection of organizations across traditional boundaries and breaking down silos to improve collective capabilities to treat patients.

Q. Increased staff shortages for reasons such as illness and burnout exacerbate problems with access, intake, capacity and leakage. Is there any way technology can help with these four areas under these circumstances?

A. Staffing shortages are a huge problem facing healthcare providers today, and it has a direct impact on capacity. For example, a hospital may have 400 beds, but if it only has the staff to support 300, then it can only accommodate 300 patients.

One of the biggest reasons for staffing shortages is turnover related to the emotional stress and burnout associated with patient surges and infection protocols. However, another key contributor is disconnected and labor-intensive processes.

When processes aren't optimized, key clinicians may lack the information necessary to do their jobs effectively. They may also be required to perform manual tasks that prevent them from operating at the top of their licenses. These situations create friction, increasing workload and frustration while taking them away from patient care.

Technology and processes optimization are effective ways to automate and standardize tasks and functions, ensuring they are performed in a consistent way. Technology and solutions can help ease the burden on caregivers, allowing them to focus on caring for patients, instead of dealing with process bottlenecks.

Technology also can help automate and streamline the discharge process – a key bottleneck to patient throughput that exacerbates capacity constraints. By implementing standardized discharge processes that decrease a patient's length of stay and facilitate their transition out of the acute care setting and into the next phase of care, a provider can free up much-needed capacity.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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