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Delivering clinical experience as a service

Clinical experience as a service unites fragmented clinical software. Here's how it works.

In the medical field, a decades-long reliance on proprietary records standards is finally reaching a breaking point.

A colleague recounted their experience with a recent emergency admission to the hospital. Presenting at the local ER with the symptoms of a heart attack, they were promptly admitted. After hours of tests, it was determined that they were suffering from pancreatitis and would need to stay.

Due to a lack of beds because of the pandemic, they were eventually transported to another hospital that had available space. Unfortunately, that hospital system used a different electronic health records (EHR) system, and there was an hours-long delay before the paperwork from the ER was delivered and treatment continued.

Fortunately, the delay didn't impact the patient outcome in this case, but it did underscore the potential for additional medical problems to develop as a result—or the need for tests to be redone, increasing the cost to the patient.

"Health systems have two customers: the medical professional and the patient," says Aivars Apsite, healthcare practice manager at Hewlett Packard Enterprise. "Clinical experience as a service merges several applications and systems into one workflow to optimize processes and dramatically improve the experiences for both provider and patient."

Forrester notes that the healthcare industry has lagged behind in customer experience but that its "members and patients are eager for better experiences that mirror the level of service and ease they're used to from consumer experiences."

Clinical experience as a service (CEaaS) aims to help medical providers hit that mark. So far, the concept is resonating with many medical professionals and organization administrators who are realizing that if healthcare organizations and patients are to survive and thrive despite the overwhelming healthcare challenges of today, the experiences of both must be rapidly improved and maintained. Cloud integration platforms have worked well in solving similar problems in other industries in the past, and CEaaS, at its core, is a cloud-based integration platform.

Fragmentation in healthcare limits cooperation

"For example, your PCP [primary care physician] may use an EHR provider that they carefully researched and decided was the best for their business model, while your specialist, such as an ear, nose, and throat doctor, uses a different system put in place when their practice was acquired by a large healthcare system. You go to a hospital, and they use another proprietary system. None of these systems talk to each other. Transferring data via PDFs is the norm," says Michael Luna, founder of Pi Tech. While this is only an inconvenience for standard office visits, consider what happens when a standalone ER or a rapid care doctor's office needs to do an admittance to a hospital that uses a different records system. It is possible to be in a situation where all of the paperwork, including test results, needs to be rerun at the current location, delaying treatment and increasing the costs significantly for the patient.

Please read: Cloud to the rescue: EHR as a service drives the future of healthcare

Fragmentation of software and systems in healthcare occurs in, and impacts, several dimensions. Problems rapidly balloon for healthcare organizations treating hundreds or thousands of patients each month and the clinicians who are themselves using different systems.

Most providers use some form of an EHR, technology that was originally envisioned as the answer to fragmented patient care records in the real world and that later became a key part of healthcare digitalization. But even EHRs are highly fragmented systems. For example, even though two EHR providers, Cerner and Epic, have the lion's share of the market, integration isn't always straightforward.

This situation adds to the workload of overburdened medical staff, provides ample room for errors, leads to bad patient outcomes, fuels provider burnout, and can even increase legal liabilities.

The business implications of fragmentation

In the business dimension, patient experience continues to be the top differentiator for healthcare organizations, and the pandemic-fueled digital experience is now a prime factor in that overall patient experience. A recent Lumeon report found that 57 percent of healthcare providers identify fragmented processes and technologies to be leading obstacles in both patient and provider experiences.

Fragmentation can lead to other complications as well, such as complex workflows, budget restrictions, and compliance issues. In addition, requirements related to audit trails, disease and injury reports for public health and government organizations, and payment claims to insurers can become unduly complicated.

"Lack of interoperability between clinical software systems leads to worse patient outcomes and makes it challenging to provide cleaner information to payers or audit capabilities for the government," says Luna. "During COVID, the problem worsened with the rise of telehealth. The data isn't shared very easily across these siloed systems."

Regulations cresting on the horizon—some new and some triggered in the present by dates specified in the past—will also affect the unsustainability of fragmented systems on the business side of healthcare.

Please read: Advancing medicine with AI at the edge

Take, for example, the 21st Century Cures Act, a U.S. federal mandate to improve healthcare data sharing among health systems, applications, and devices. The Cures Act was signed into law in 2016 but its final rule doesn't take effect until later this year, completing the push for seamless interoperability and patients' control of their healthcare data. Additionally, the Cures Act final rule mandates that patients can electronically access all their structured and unstructured electronic health information at no cost.

Mandates like this may be the final nail in the status quo. Healthcare organizations will soon have no alternative but to make patient data completely accessible, no matter where it resides. The as-a-service changes to the clinical experience can help foster these improvements to the patient and provider experience.

The care implications of fragmentation

Meanwhile, at the patient care level, fragmentation often shatters any hope of finding a single-pane, holistic view of the patient's health. Providers often find themselves hopelessly entangled in time sinks all day, every day, as they fight to figure out what is going on with any given patient's health.

"For example, a clinician wanting to assess a patient's renal status and determine if it is being managed effectively must navigate between a medication list, then to laboratory results, and then to encounter notes, which are often stored in an unstructured, free-text format. With the enforcement of the 21st Century Cures Act, clinicians will be flooded with even more data, exacerbating the situation," explains David Lareau, CEO of Medicomp, a maker of enhancement tools that allow clinicians to do data analysis on the information stored in EHR systems. While the Cares Act stresses the need for better integration in healthcare data, it doesn't itself point to a solution.

"Many players are focused on solving niche problems such as integrated pharmacy systems, remote management systems, and remote point-of-care systems. There is considerable difficulty managing the clinical workflows on top of those niche products, not only for large hospitals but also for small providers," explains Luna.

"Orchestrating the right components of care, for the right patient, at the right time, and doing so by incorporating decisions around whether a patient's presentation can be dealt with entirely remotely, partially remotely, or entirely physically—as well as how to navigate among these modes—is going to be one of the great challenges that providers will wrestle with," warns Robbie Hughes, founder and CEO of Lumeon.

The rise of clinical experience as a service

With the success of as-a-service platforms in so many industries, it is unsurprising that there is a move to put the clinical experience into this same format. Medical care providers tend to move slowly when it comes to updating their healthcare technology, and record keeping is not at the top of their priority list, despite its clear impact on patient care. The as-a-service model allows any size provider to have the most up-to-date technology at hand. But even though healthcare systems are moving toward a hybrid IT model that duplicates as-a-service offerings, the concept of CEaaS is just taking hold in the industry.

Given that all these forces are simultaneously bearing down on healthcare providers, it is no wonder that adoption rates of CEaaS are expected to be high, and not just among early adopters. Cloud services have long proved advantageous to healthcare organizations in accessing new features and capabilities quickly and economically. It stands to reason that using a cloud-based system would be the best path to rectifying problems ranging from poor patient outcomes and increased liabilities to complying with new regulations by the latest deadlines.

But there is another reason why CEaaS is a clear favorite now: Other options have failed to perform.

"There are at least 13 different types of clinical types of software: EHR, remote patient monitoring, pharmacy/e-prescription software, clinic appointment management, lab systems, imaging systems, and more," says Luna. "[EHR vendors] are trying to build integrations between these systems and workflows. Everyone is trying to solve it, but nobody has."

In other words, many alternative attempts tend to tackle problems piecemeal. For example, Cerner is building new patient engagement channels with Amazon, such as a direct integration between the Cerner EHR and Amazon's new wearable, Halo, according to a Forrester report. Meanwhile, according to the report, Meditech is all in on Google as its medical tech-as-a-service provider, and Epic is doubling down on integration with Microsoft. All of these initiatives have pros and cons, but they, too, pose the risk of creating additional patient data silos. While these vendors are likely hard at work addressing any issues, the fact remains that integration to solve fragmentation remains the top need in healthcare today.

To help health systems address these challenges, Hewlett Packard Enterprise's consumption model, HPE GreenLake, is capturing the attention of health systems leaders. It lays a foundation of flexible, consumable technology along with an array of consumable services that are easily and quickly adapted to meet clinical experience challenges.

This includes the disparate edges of healthcare delivery. As healthcare embraces hybrid cloud strategies, patient information is also stored at those edges. Having the technical capability to interface with and integrate those edges with their core EHR, health systems can begin to stitch together a cohesive longitudinal patient record.

To make this all work, it is critical for vendors to partner with health systems and EHR providers to implement this new breed of agile platforms. These enable health systems to encapsulate their disparate clouds of patient data and utilize the cloud in the way that makes sense for them. This is how health systems are defining the new clinical experience for their patients.

This article/content was written by the individual writer identified and does not necessarily reflect the view of Hewlett Packard Enterprise Company.