HEALTHCARE AT HOME:
THE  ROWAN TECHNOLOGY REPORT

Serving the home health, home care and hospice industry since 1999.

Can technology help healthcare providers achieve the Institute for Healthcare Improvement's Triple Aim?

  • Improve the health of the defined population
  • Enhance the patient care experience (including quality, access and reliability)
  • Reduce, or at least control, the per capita cost of care

Let's imagine the future for a moment.

Turn on your computer every morning and, without clicking or typing, view a complete report of the latest vital signs, medications, hospital and doctor visits, and dozens of other data points for every patient on your service. Focus your gaze on the red-light warnings and see a summary of a comprehensive analysis arising from algorithms far beyond your comprehension of the meaning behind the relationships between and among every data point for every patient.

React to the alerts by calling or visiting the most crucial patients, those quite likely on the verge of dialing 911, and ward off one ER visit or hospital admission after another. Keep track of the miracles you have been working and deliver a report to each hospital, making sure they know how many millions of dollars you have been saving them.

A story out of 2025 or beyond? Not in the least.

ClinLogica is available now and likely to be regarded as essential as early as next year. The co-founder and former Chief Technology Officer of HealthWyse, Andrew Braunstein, has put his genius and experience and multiple MIT degrees to work designing the data synthesis and analysis system that the U.S. healthcare system in a reform era desperately needs but does not yet know is possible.

Perhaps the reader will excuse the above glowing description if an editorial comment were added. This writer was skeptical, saw ClinLogica in action, and became a believer.

"What the healthcare system needs in order to coordinate care among multiple provider silos is not only the ability to share patient data across disparate systems," Braunstein told HCTR, "but to identify at a glance the gaps in care created by moving patients from silo to silo."

For example, he continued, consider the number of medications prescribed to the typical elderly patient with multiple chronic conditions. It is good to scan a database for negative interactions among the drugs; it is also good to check a patient's weight every day, as we do for CHF patients. "Have you ever considered, however, that drug dosages are determined by the physician based on each patient's age and weight?" he posited.

"When weight changes enough to make the prescribed dosage dangerous, the absence of coordinated data creates several holes in care:

  • How does anyone know when it has happened?
  • How long after it has happened do caregivers begin to find out?
  • Whose job is it to respond to it?
  • How long might it take to pull together several caregivers to make an authorized decision?
  • Will an appropriate response be taken before the patient lands in the Emergency Department?

Multiply this scenario by the hundreds of missed events that can lead to a patient's exacerbation, Braunstein says, and you start to see how many holes there are when care is not coordinated. Keeping track of every data point for every patient, however, is prohibitively expensive. This is the reason he developed a system that introduces intelligent analysis and data accumulation into the equation.

Technology Selection GuideHow it works
The rarified air in which software designers and developers of Andrew Braunstein's caliber operate is shared by few. Perhaps "how it works" is too optimistic a title for this section. Therefore, do not look here for a comprehensive exposition of what lies under the hood of this product.

Essentially, ClinLogica communicates with and downloads data from every known database, both public and private, including hospital systems, HIEs, home care and hospice systems, publicly available marketing databases, government databases and many more. It organizes them for every individual patient and identifies the otherwise obscure data pairings that normally go undetected.

The user merely examines a screen populated with the results of the algorithm-driven results for the patient population to be managed. A familiar red, yellow, green alert system moves the patients needing attention to the top of the screen.

With the Institutes of Medicine estimating that 44,000 to 99,000 patients die in hospitals each year due to medical errors, overtreatment killing 30,000 Americans a year (the equivalent of a 747 airliner crashing and killing everyone aboard once a week) and the proper use of prescribed medications landing in the top 10 causes of death, it is clear that something must be done about clinicians trying to work with too little information.

So far, during its startup phase, Braunstein is focused on finding the best type of care locale to serve as the most effective ClinLogica hub. He has met with home healthcare providers, patient-centered homes, physician groups, payers and others.

"This software is not specific to any one type of clinical area," he concludes. "This is patient-centric. It belongs with the professional clinicians best positioned to keep track of a patient wherever that patient goes. That might be home care. If a home care provider were to take it on, it would be quite an enhancement to their standing among other care centers in the community."

Is Braunstein's creation a software product that will prove to be dependent on coordinated care? Or will its widespread use help coordinated care evolve? The answer lies somewhere in the future, perhaps as far away as next spring or summer.

 

2014 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com