Accelerating Innovation in Healthcare

The Health Affairs briefing “Diffusion of Innovation”, held at the National Press Club on February 6, 2018, examined the need to accelerate the spread of new and innovative healthcare practices to improve care but also to lower costs. The February 2018 issue of Health Affairs examines the factors that are accelerating the spread of new and innovative healthcare practices to improve care and lower costs.

Alan Weil Editor-in-Chief at Health Affairs, “If resources are available to innovate and diffuse innovation, then organizations can expand ideas. However, first they must understand the facts related to the diffusion of innovation and how it can be applied to the healthcare space.

One of the major innovations offered to the medical profession in recent years, has been provider e-consults using a shared EHR or web-based portal. In a study funded in part by the VA Boston Healthcare System, Melissa Afable of Partners HealthCare System plus coauthors conducted a study and found that physician perception and buy-in were the dominant factors determining adoption of using e-consults.

Interviews revealed considerable differences in the perceived impact of e-consults. Clinicians at sites with high use of e-consults noted that they improved workflow efficiency while clinicians at sites with low use preferred face-to-face visits.

Jay D. Orlander MD, Associate Chief, Medical Service at the VA Boston Healthcare System, and Professor of Medicine at Boston University’s School of Medicine, reports that the VA works very successfully using e-consults now operating all across New England.

He reports, “The majority of surgeons are using e-consults for pre-op assessments. The driver for the adoption of pre-op e-consults enables surgeons to determine the risk for the patient undergoing surgery by obtaining medical information on the patient from the EHR.

“Using Medicare’s annual wellness visits is promoting preventive care”, according to Ishani Ganguli MD, Clinician Investigator, in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital His team of researchers found that while visit rates were lower among practices caring for the underserved, adopting practices in general had a slightly healthier patient mix and saw increases in primary care revenue.

Discussing how data drives innovation, David Dorr MD, Professor and Vice Chair, Medical Informatics and Professor, General Internal Medicine & Geriatrics, at Oregon Health & Science University, looks for innovation to help meet the needs in the population, deliver innovation models so others can adopt, and for technology to assist in implementing innovative ideas.

Joseph Tanenbaum MD-PHD Candidate, Department of Epidemiology and Biostatistics, at Case Western Reserve University School of Medicine, has given thought to how regional health improvement collaboratives can possibly be used to reduce preventable hospitalizations and cut costs.

He discussed how his experience with the “Better Health Partnership”, a primary care-led regional health improvement collaborative located in Cuyahoga County in Ohio, was able to avert almost 6,000 potentially preventable hospitalizations. This was accomplished by using quality improvement initiatives and disseminating locally identified best practices in the county. As a result, cost savings of nearly $40 million were achieved over a six year period.

How to effectively provide care, Brian Cassel PhD, Assistant Professor Hematology/Oncology & Palliative Care at Virginia Commonwealth University’s Medical Center, examined effectively providing interdisciplinary palliative care. The program focuses on communicating effectively with the family and care teams to bridge the gap that distinguishes between care provided to produce a cure from end-of-life care.

Rebecca Onie, Founder and CEO Emerita, for Health Leads, has spent considerable time focusing on how to integrate healthcare along with social needs. Health Leads has been working to determine if addressing society’s needs as related to healthcare is a fad or does it really drive improved healthcare.

Treating people with serious mental illnesses has James Schuster, Chief Medical Officer Medicaid and Behavioral Services at the University of Pittsburgh Medical Center, studying the use of behavioral health homes to treat people with serious mental illnesses. He is involved in developing self-management strategies, how to better utilize the data found in registries, how placing behavioral health nurses in primary care offices can help the mentally ill, and actively encourages the use of health wellness coaches.

Arlene Bierman MD, Director, Center for Evidence and Practice Improvement at the Agency for Health Care Quality and Research (AHRQ) discussed several aspects concerning the intersection of AHRQ’s Learning Collaboratives and Health Services Research.

Learning collaboratives can show not only changes in healthcare but in the types of care, can enable effective communication with experts that can include online and in-person communications, can accelerate diffusion of innovation, help decision makers make better investments, and better inform researchers.

Looking to the road ahead, Sharon Arnold, PhD, Deputy Director at AHRQ, described how AHRQ looks what works and what doesn’t work by studying one innovation at a time. AHRQ supports the need for an effective infrastructure plus actively supports information systems for data collection in order to analyze precisely how much healthcare is actually improving in the population and in clinical settings.

She emphasized that the goal is to move forward and ask the right questions by holding important discussions with leaders in government, universities, and the public to seek out innovative solutions to enable the healthcare and medical system to meet the expanding needs of the 21st century.

Will Shrank at UPMC served as theme adviser for the February issue. In addition, the Peterson Center on Healthcare, Blue Shield of California Foundation, The Leona M. and Harry B. Helmsley Charitable Trust, and AHRQ provided support for the February issue

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