Care management is fed by information, much of it electronic. Clinicians rely on electronic health records and other healthcare information systems to give them the data they need to make informed decisions to optimally manage care.
But what if optimal could become more optimal? What if clinicians could have access to real-time patient information in the mix with EHRs and other HIT? How would that impact care management and outcomes?
Chris Novak, LCPC, can answer these questions. He is vice president and COO at Ascension Illinois Behavioral Medicine Service Line. We sat down with Novak to find out how access to much more patient information impacts clinicians and care.
Q. How is Ascension Illinois using digital health tools to gather more data about patients? And for what purpose?
A. We use assessment tools through our measurement-based care platform to gather insight into patients’ clinical needs. This includes the patient’s clinical presentation, as well as the impacts on their quality of life.
But it’s what we do with that data that is key.
The data helps us customize treatment plans for each individual patient. Behavioral health patients present their symptoms in a variety of ways, and we need to understand what the clinical presentation looks like for each individual patient and how it impacts their daily life.
Personalizing care for every patient is key because doing so allows us to develop a treatment plan that will lead to a faster reduction in symptoms. By having customized data for each patient, we can identify the specific impacts on their lives and develop a treatment plan that addresses those distinct areas.
We want to understand what the clinical presentation looks like for each patient, and then observe and measure throughout the course of treatment. If necessary, we can adjust a patient’s treatment plan based on the data to address changes in symptoms.
Of course, we don’t just look at the data at the patient level, but also at a programmatic level. On a macro level, we take that data and aggregate it to be able to understand if the programs and services we are delivering are meeting the needs of the patient populations that we’re serving, or if we need to adjust our services to ensure we are helping our community sustain meaningful change.
Q. Data is key to improving clinical care, but sometimes providers are unsure how to leverage the data. How is Ascension making the data actionable?
A. Our patient-level data from our measurement-based care platform is being utilized throughout the clinical course of treatment – whether that be in our inpatient levels, ambulatory-based programs, residential programs or traditional office settings. The data also is aggregated to ensure that on a macro level, our clinical services are demonstrating meaningful change within a defined diagnostic group.
For example, if we have patients in a program for an eating disorder or substance use disorder, we can take the data on an aggregate level and see if we are seeing changes in the clinical presentation of that diagnostic as that group as a whole to determine if the clinical intervention we are providing to that group is demonstrating the reduction in symptoms and improvements of quality of life that we would expect to see.
Sometimes, the severity of illness presents itself in different ways over time. A good example is to compare people’s lives during the pandemic. During this time, we saw the severity of symptoms increase across most diagnostic groups. This data was important to adjust the delivery of our clinical services.
We also compare admissions data with the data at the time of discharge to measure improvement. If we see that the improvement level starts to wane, it sends a signal to us that we need to adjust our clinical programs.
When you have a variety of clinically validated instruments that you’re using to assess symptoms, you get very specific data about symptoms and the impacts of symptoms, which allows you to adjust the skills or interventions that we’re teaching patients.
Lastly, the patient-reported outcomes data also gives us the ability to compare and contrast with other metrics, such as length of stay. By looking at the data we collect, perhaps, we can see the length of stay is elongating for good reason.
But without having that data, we sometimes subjectively make assumptions about what that data can mean. There are a variety of metrics we can use that determine the success or effectiveness of the treatment we provide.
Q. What digital health trends and tools do you see gaining adoption across healthcare during the next five years?
A. In order for health systems to be successful, we need evidence-based assessment to be able to understand that the care we are delivering is effective and efficient.
Measurement-based care actually accomplishes this for behavioral health: It allows us to gain insights to know the treatments we are delivering improve clinical outcomes.
We use Owl as our measurement-based care platform to provide us with this type of data that leads to improved outcomes. More behavioral health organizations will adopt measurement-based care so they can prove their treatments are effective and efficient, particularly as we prepare for more value-based contracts that will require proof of improved outcomes for patients.
We also will see a proliferation of the current apps and online services that people – particularly the younger generation – like to use. There clearly is an appetite for more self-guided, online services, especially to treat mild symptoms of depression and anxiety, which I believe will only grow over the next few years.
We also will see more utilization of computerized adaptive testing. So instead of using the same 10 questions for every patient, the assessment is customized to the patients’ responses. This allows the assessment to work more in line with individuals’ needs, ultimately providing a more customized report for patients.
And more behavioral health organizations will adopt and use tracking apps so patients can more easily recognize their own progress and day-to-day changes. Tracking apps, such as Fitbits, provide insights into our daily activities and behaviors.
Are we hopping out of bed more easily in the morning? Have we made more phone calls to our contacts this week? Are we getting to work on time? These small indicators of progress can sometimes go unnoticed by the patient, but it’s important they recognize them.
Tracking apps will gain adoption in healthcare because they will help patients check in on themselves regularly and will provide a more objective versus subjective view of their current state.
Q. On a related note, what do you believe is the answer to the current healthcare staffing shortage that we’re seeing nationwide?
A. Due to the stress and strains of the pandemic, the national turnover and quit rate for all industries has been quite alarming – 2.9% in February 2021, versus 1.9% in December 2019. In healthcare specifically, job openings increased by 57% in 2021 from 2020. The staffing shortage and burnout were consistently stated as a reason why healthcare workers are unlikely to stay in the field.
There is a clear industry-wide mismatch between supply and demand: There are too few clinicians/physicians available to manage the high demand of patients.
Investing in training our staff will help immensely. We also need to redefine roles and required skills for specific tasks. Is a certain task being performed by the most appropriate person, or can that job be completed by a different staff member with a more aligned skill set? Doing this right will eliminate wasted time and increase productivity for staff, ultimately helping with burnout.
We also need to do a better job using technology to help take the burden off staff and ensure our clinicians are working at the top of their licenses.
We know there are tools out there today that can provide clinicians with the needed insights into patients that will help with clinical assessments. These automated tools can spare clinicians the administrative tasks of collecting patient-reported outcomes that require additional time and effort.
Of course, this is an evolution for healthcare as the personal touch becomes a bit removed. Yet, our younger patients are very adaptive and open to picking up tablets or phones and entering information. So, not only can tech tools help decrease staff burnout; they can help attract the energized, younger generation of workers into healthcare as well.