Successful innovation relies on people, planning, and purpose.
This article appears in the March/April 2019 edition of HealthLeaders magazine.
Too often, healthcare leaders are caught by the idea of the bright, shiny object of innovation, without thinking through to the application. The industry today may be in the immature arc of the adoption curve, where the ability to create technology is outpacing the ability of providers to effectively deploy them.
Leaders need to ask: Do the people using a new tool or executing an innovative idea find it helpful or burdensome? What specific healthcare goal does a specific innovation improve? Is it achieving a desired outcome?
This intersection of innovation and adoption is the nexus of discussion at the HealthLeaders Innovation Exchange held July 17–19 in Ojai, California, where four dozen executives will come together to share best practices in identifying, funding, vetting, and applying healthcare innovation.
The two-day forum involves roundtable discussions as well as fast-paced executive presentations on how they are achieving results.
1. Can you see the healthcare value in the innovation?
Despite the push toward population health, Mouneer Odeh, vice president, enterprise analytics and chief data scientist at Thomas Jefferson University and Jefferson Health in Philadelphia, says the healthcare arena chiefly operates in two worlds.
"For most health systems, management focus is still on the fee-for-service world, but we have another world that we're working toward to achieve value," says Odeh.
"From a management perspective, how do we embed value thinking in everything we do? It's a shift in mindset that hasn't fully occurred yet; we're still bifocal," he says. "We need an integrated understanding about population health objectives that's fully integrated into everything we do, rather than a separate effort that is disconnected from our daily activities."
2. Is the innovation effective for the people using it?
Odeh encourages leaders to think carefully about how to achieve objectives.
"With clinical workflows, we have historically used bolt-on technologies. But now EHRs are guiding integrated pop health capabilities that give physicians triggers and alerts—so they are better informed and can take action as they see patients," he says. "It's a great innovation that is rapidly maturing, but we haven't fully understood how to make this technology truly work for our providers and ultimately for our patients."
"We're also dealing with physician burnout, so we need to make sure we're not just layering additional responsibilities on them," Odeh says. "We need to make sure technology works for everyone involved and is having the impact on patients that we're wanting to achieve. Innovation needs to be from the human-centric viewpoint, instead of being driven by technology. It needs to be tested to make sure we've got feedback mechanisms to ensure it's having the intended effect."
3. Is the data from the innovation measurable?
As a medical data analyst, Bradley Brimhall, MD, MPH, helps determine the effectiveness of population health programs led by Liem Du, MD, medical director at University Health System in San Antonio.
"I was asked to quantify the value and success of new approaches Dr. Du is taking in population health management in financial and quality terms. But getting data into one place so that it's easy to analyze is a challenge," says Brimhall, professor of pathology and laboratory medicine, and medical director of healthcare analytics & bioinformatics at University of Texas Health-San Antonio, University Health System.
"Data tends to be scattered because we're getting it from lots of outside sources, not just the EMR," he says.
"One barrier we encounter is getting data structured so that it's easy to organize and analyze—clinical data, cost information, health information exchange data, community resource information, etc. We have several large relational databases from multiple sources that need to be linked together. How do you tie all these disparate pieces together?"
"For example, the cost of care (supplies, services) must be integrated with quality and other performance data to understand the financial and service impacts of clinical decisions," he says. "Some solutions to the cost of healthcare are likely to be simpler steps but measuring the quality and financial impacts are more complicated."
Brimhall cites the lack of integration hindering predictive modeling as well. "Understanding the data can save money and hassle for high-risk patients who don't have to be hospitalized and can be treated more proactively. But integrated data is much better for predictive model development."
"To design a project, I need to analyze the data, and it takes longer than it should," he says. "If we could design better data structures and my team could access the data better, then we could be cranking out projects faster."
Another challenge is having people with the skills and proficiencies to understand information and arrive at solutions, says Brimhall. "We need to train a subgroup of physicians in clinical informatics to focus on analytics. We also need to train some nurses, technologists, and medical laboratory scientists."
To help further this goal, Brimhall has established a clinical informatics fellowship for physicians to be trained in data analytics.
"Incremental improvements can yield high savings and value improvement if you can overcome the barrier of data integration and measurement."
4. Does the innovation need to span the care continuum?
Hospitals are dinged for readmission penalties, but often providers are sending patients to other settings, such as physical therapy rehab, home health, or skilled nursing facilities (SNF), in which they have no control over patients' continued care.
"We face a lot of challenges with smooth transitions from inpatient to what comes next," says Peter Charvat, MD, vice president and chief medical officer at Johnston UNC Health Care in Smithfield, North Carolina.
To improve coordinated care, Charvat is piloting a program with one of the system's SNFs. "Rather than sending a patient immediately back to the hospital when something goes wrong, as often happens, we have conversations with the SNF to help avoid readmission."
Helping the effort are UNC Health Care's preferred-provider SNFs to ensure the system is partnering with facilities with quality and outcomes, says Charvat.
"More than anything, providers need to set clear expectations when patients are discharged—which means a provider-to-provider call that details what they saw and what they anticipate the stay will be," he says. "We're training physicians and our hospitalists group to have the calls."
"In addition, we have a secure messaging app that we give to the SNFs to text each other," he says. "They also have access to our EMR and can pull up reports for any patient encounter to get more complete information."
Johnston Health is also piloting a program that gives community paramedics access to the SNF.
"Medicare pays for a short-term stay for up to 21 days, and we know that on day 19, if the patient is not ready to go home [but is discharged], then the paramedics will visit the patient's home on day 22," he says.
"Hospitals need to work on communication with home health, case management, transition calls, [and] community paramedics to call patients and ask if they are taking their meds and following up with a doctor's appointment. It's keeping a patient well at home."
5. Will real people be able to use the innovation?
Another quality improvement hindrance is providers' capacity to motivate patients regarding their lifestyle practices.
"Health systems have an important, but limited role in improving the health of patients," says Odeh. "When a patient visits a provider or is in one of our hospitals, we have the ability to influence, but when they go home our influence is limited. And while we have care coordinators to help with that, the needs are much greater.
"Our CEO, Dr. Steven Klasko, calls this ‘healthcare without an address,' " he says. "How do you take the things that promote better health and push that out to where people live—at work, or home, or in the community?"
"Addressing real-life experiences is a challenge requiring a high degree of technological innovation," says Odeh. "But it's not an area that health systems can naturally affect, so how do we work with the community—religious institutions, nonprofits, public health entities, respected leaders, and other influencers—to remove barriers and make it easy to practice the right, healthy behaviors?"
One of the ways Jefferson Health is working to foster a healthier community is through establishing the Philadelphia Collaborative for Health Equity (P-CHE).
"While Jefferson Health is currently leading it, our goal is to be a facilitator of dialogue, to develop an institutional framework and collaborate with other institutions and community organizations regarding what is needed."
Odeh emphasizes, "The key message is that innovation has got to work for people in order to achieve our goals and objectives."
Julie Auton is the leadership programs editor for HealthLeaders.
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