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The Journey to Simplify Population Health: Intuitive Care Tools

By , MD, Lead Medical Director, Transcend Insights
Health IT
The Journey to Simplify Population Health: Intuitive Care Tools

The Journey to Simplify Population Health

Improving Health Outcomes with Intuitive Care Tools

By Tariq Dastagir, MD, a lead medical director  

The main challenge of improving population health and performing in a shared risk arrangement is keeping your patients healthier while maintaining a good quality score and keeping your costs down. Healthier patients means a healthier population.

The greater an impact a physician has on his or her patients’ future behavior like physical activity, diet and medication adherence during a time-limited clinical encounter, the more likely he or she will be able to attain the highest level of health. As a physician, it is very important to not overlook important clinical data that may keep me from giving my patients the best advice possible about his or her current and future (preventable) conditions. This is very difficult to accomplish unless I am able to review a complete, longitudinal view of my patient’s medical profile including their medical history, health problems, modifiable factors, test results and gaps in care.

 Electronic Medical Records (EMRs) provide enormous amounts of patient data to physicians and care teams however, it is very time consuming to effectively review all of this data and still have enough time to successfully care for patients. A study published in the Journal of Hospital Medicine, around the use of hospitalists’ time, concluded that “hospitalists spend more time reviewing the EMR and documenting in it, than directly with the patient.” Even though physicians are drowning in data, they are still finding it to be difficult to get this information when needed most. In my personal experience, here is an example of one of these challenges:

“Well, it seems like your blood sugar is under control now,” I told my patient on a scheduled follow-up visit for his diabetes after reviewing the glucose log he provided me with.
“Thanks doctor. How are my kidneys doing?”
“Well…. I don’t see a recent kidney test for you.”
“I got one a few days ago when I visited an urgent care center for my sinus infection. Did you not get that report?”

Here is another example of an encounter that emphasizes the need for a patient’s healthcare data to be available at the fingertips of physicians and care teams during for example, their hospital rounds:

“I have great news for you. You are not bleeding anymore.” I told my stomach bleed patient.
“Your blood count is stable now”.
“That is great Doc! What is my blood count today?” She asked.
“Mmmm…. I don’t remember the exact number now but when I reviewed your chart, it was stable. I will ask my nurse to get you the number.”

Although EMRs are a great source of patient data, there are certain limitations that prohibit effective population health management. Within my examples above, the absence of interoperability and patient data available at the point of care prevents a physician or care team from understanding a patient’s complete medical history or access to relevant patient data when needed. To address these limitations, we need intuitive care tools, such as a mobile point of care solutions that can synthesize, analyze and present a patient’s data at the hands of our care givers. This will allow physicians and care teams to make better informed decisions without having to spend a lot of time looking for patient information across different sources, ultimately improving their patient’s health outcomes.

How are you incorporating intuitive care tools into your population health management strategy?