Using IT to Achieve Hospital-Physician-Patient Alignment

Steven A. Nahm, MBA, for HealthLeaders Media , April 7, 2009

The explosion of technologies that "connect" consumers online has shaped business models and created entirely new ways in which people network, socialize, and conduct business. E-mail, video conferencing, online retail, Google, LinkedIn, and YouTube have transformed our daily interactions with other people and the way we operate business. Ultimately, these same technologies will not only transform healthcare, but the way physicians and hospitals align to deliver care.

Consumers have demanded an enormous amount from the Internet in a short period of time. In the U.S. alone, online retail is estimated to have grown from virtually nothing a decade ago to over $130 billion a year. Consumers now routinely purchase products, pay bills, download statements, and make dinner or concert reservations online.

Although healthcare delivery has been slower to transform, many e-applications are in everyday. Among them are:

  • Live videoconferencing: Video and audio feeds over the Internet permit real-time communication among patients, attending providers, and consulting specialists. High resolution monitors, cameras, and broadband connections facilitate medical evaluations of patients by geographically dispersed practitioners, helping to alleviate access problems. Presently, this type of service is predominantly used by rural hospitals and clinics lacking specialty coverage. You can expect to see an increasing use of videoconferencing in clinic settings, nursing homes, emergency departments, and on acute-care patient floors, including intensive care units.
  • e-Interpretation services: Through the capture, storage, and forwarding of digital images and clinical data, local providers have access to specialty interpretations from remote specialists. This service is already common in specialties that rely on the review of images, such as radiology and dermatology. It is anticipated to expand to other services involving interpretations from images, including pathology, EKGs, echo-cardiograms, etc.
  • Patient direct e-Care: Originating from mail, telephonic, and e-mail-based technology, physicians offer consultative services directly to the patient. The services are provided through private organizations, hospitals, or through health plans with secured patient Web portals. Increasingly, the service will evolve to real-time clinical interactions using videoconferencing and electronic health records, especially as regulatory hurdles are reduced.
  • Remote patient monitoring: Home-based computers serve as devices to capture, trend, and transmit clinical data to healthcare professionals who monitor medical conditions of patients. Blood pressure, glucose levels, and weight changes are only a few measures that enable healthcare teams to respond quickly to clinical needs of the at-home patient. Expect to see usage of this technology expand in the home, but also in the hospital or skilled nursing settings. But what is the next phase? It is likely to focus more on the patient as consumer, with the aim of enabling hospitals and physicians to better communicate with their patients and deliver more efficient care.

Consumers will expect electronic delivery of healthcare advice and the ability to schedule services, access test results and reports, request refills, make inquiries, and dialogue with caregivers.

For certain conditions and patients, an entire episode of care may be electronic. It will include an e-inquiry into the primary care physician, followed by the medical issue identification question and answer process, to obtaining an e-consultation from a specialist, with relevant data transmitted back to the PCP and patient.

In addition to such transactions, online consumers will increasingly research the quality of providers. They will also want to socially network with their providers, either through medical blogs, online support groups, or social networking sites. Consumers will be comforted by watching YouTube-style videos of their providers performing the latest medical techniques and therapeutic applications. Healthcare providers without this virtual presence will suffer competitively.

As a result, applications such as community-oriented medical blogs, online support groups, video-based supplements, on-demand health advice, personal health records, and transactional applications will thrive. They will not only help to cement the bond between patient, physician, and hospital, but play an important role in broadening thinking regarding hospital and physician alignment strategies.

Moving forward, many alignment strategies will be a triad of hospital-physician-patient. They will be linked through systems designed to achieve clinically effective, efficient, informed, and safe care.

Recognizing this, Title XIII of the American Recovery and Reinvestment Act of 2009 (a part of the recently enacted stimulus bill) provides funding and incentives for the development, adoption, and upgrade of health information technology. The intent is to build a nationwide infrastructure that exchanges standardized health information, encourages the use of electronic health records, and trains clinicians on best practices.

As the options for "joint venture" types of hospital-physician alignment vehicles are defined through such legislation and regulation, taking ownership of the process to deploy these technologies presents an important opportunity to involve and align physicians and hospitals in a meaningful way.

The opportunity

The ability of the solo or small physician group to develop a comprehensive patient connectivity platform is relatively small. Therefore, it is incumbent for healthcare organizations to take proactive ownership of the process to build such platforms. In addition to serving as the foundation for a more highly integrated delivery system, the platform can reach out to patients and elevate their ties to both the healthcare organization and its individual clinicians.

Conceptually, the term "hospital-physician alignment" will give way to the term "hospital-physician-patient alignment," under which strategies and action plans are implemented to align the interest and needs of the hospital, physician, and the patient.

How these new affiliations mature will be just one component in a much larger strategy to reinvent healthcare delivery.

Steven A. Nahm is a vice president with the Camden Group, a hospital consulting firm in El Segundo, CA. He may be reached by e-mail at
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