Reinventing Healthcare Delivery

Visit a modern hospital, and it will quickly become clear that healthcare institutions have been investing heavily in innovation, including the most advanced medical technology and clinical and information systems designed to cut costs and improve patient care. But while modern technology abounds in medical settings, the healthcare delivery system itself is based on an outdated model, one that calls for providing care in brick-and-mortar settings.

Sharon Johnson, associate professor in the School of Business.

That model is out of step with the changes sweeping society, including an increasing focus on preventive care, an aging cohort of baby boomers with chronic health issues, the growing population of remote or disenfranchised patients, and the ubiquity of mobile devices that enable patients to communicate and browse for information remotely. Correcting that disconnect calls for nothing less than the reinvention of healthcare delivery, and WPI researchers are at the forefront of that quest.

“The new model for healthcare delivery is not confined within the walls of a hospital or a doctor’s office,” says Sharon Johnson, associate professor in the university’s School of Business and faculty director of the Healthcare Delivery Institute (HDI) at WPI. “Our work focuses on what this new healthcare system needs to look like in the future, and what tools, technologies, and processes will be required to support it and give people the care they expect from it.”

HDI, founded in 2011, has its roots in a research center established in 2009 by Johnson, Diane Strong, and Bengisu Tulu, faculty colleagues in the School of Business, and Isa Bar-On, professor of mechanical engineering. Initially focused on eHealth, the researchers have expanded their mission. Through the new institute, they are now leading the drive to create the healthcare delivery system of the future by harnessing technological and process innovation to transform patient care and improve health and well-being.

With close to $4 million in funding from the National Science Foundation and the Veterans Administration New England Healthcare System (VA), the team has worked with seven clinical partners on projects in four areas: studying the adoption and impact of health information technology (HIT) systems; developing wireless smart applications to support patient care; modeling and redesigning the way healthcare is delivered; and mining the digital data now generated and archived by HIT systems to identify opportunities to improve patient care or clinical operations.

“We have a powerful model because we are an interdisciplinary team working closely with clinical partners,” says Strong, professor of business. “That means we can work on solving problems that are directly applicable to improving patients’ healthcare and well-being while helping healthcare providers become more effective in delivering care.”

Our work focuses on what this new healthcare system needs to look like in the future, and what tools, technologies, and processes will be required to support it and give people the care they expect from it.

— Sharon Johnson

The Portal to Empowerment

Bengisu Tulu (left) and Diane Strong are part of the research team in the new Healthcare Delivery Institute at WPI.

Under the health information technology systems umbrella, the institute is winding up a three-year international study of the implementation of electronic medical records and related systems in five primary care settings. In Massachusetts, the team looked at Reliant Medical Group (formerly Fallon Clinic), which has about 250 primary care and specialty physicians; UMass Memorial Heath Care, an integrated clinical system with more than 1,700 physicians, five community hospitals, and an academic medical center; and the Family Health Center of Worcester, which addresses the health needs of the underserved of Worcester. They also studied a primary care network in Canada, which has universal coverage and a single-payer funding system, and two of the four major clinical groups in Israel, which have a hybrid healthcare delivery model with four “health funds” that provide care for the entire population.

The study is exploring how the implementation of HIT systems affects medical providers and patients and the operations of the healthcare delivery system. Some of its early results concern the use of a patient portal that provides direct access to clinical information through a web-based system. “We are tracking the roll-out of the portal, studying how it’s being used by patients and providers, and making recommendations based on that data,” says Tulu, assistant professor of business, who is leading the patient portal section of the study.

The patient portal gives people access to their medical records, laboratory test results, and a library of medical information screened and approved by the clinic’s physicians. It also lets patients send secure electronic messages to the primary care team and request appointments. The sample Tulu’s group chose for detailed study includes 18,000 patients of seven primary care physicians. The researchers tracked patient usage of the portal for 18 months after it first became available and then interviewed groups of patients and their physicians to get qualitative data about their views on the tool.

They found that while the portal was available to everyone, fewer than 10 percent of the patients registered to use it. Of those who did, older patients, who typically had chronic medical conditions, logged in more often than younger, healthier patients. While younger patients used the portal primarily to schedule appointments, older patients often checked out their laboratory results and medical history. All patients used the messaging and library elements far less than expected.

According to Tulu, the most significant results may be how access to the portal empowered patients. “The data showed that the patient portal has changed the dynamics of patient-physician interaction,” she says. “People using the portal had more information in advance of their appointments. And because they had lab results, and saw how those new results compared with results from previous tests, it led to more informed questions about their health. Several patients said the visits with their doctor or nurse practitioner have gone from a monologue to a conversation.”

We have a powerful model because we are an interdisciplinary team working closely with clinical partners.

— Diane Strong

Wound Care: There’s an App for That

A different type of patient empowerment is at the heart of a project to develop a smartphone application for patients with advanced diabetes. Because such patients often suffer from reduced circulation to their extremities, they can develop chronic foot ulcers. Treating these wounds can be challenging, since traveling to a physician’s office for an examination can be stressful and traumatic for patients who, not infrequently, have other health complications — often caused by obesity and a sedentary lifestyle.

“If we can monitor the progress of the foot ulcer remotely, provide feedback to the patient that promotes a healthier lifestyle, and limit the number of times these patients need to be transported to a doctor’s office or clinic,” says Strong, “it’s better for everyone involved.”

HDI will build the smartphone app over the next four years with significant funding from the NSF. With the app, the patient will use the phone’s camera to capture images of a foot ulcer on a regular basis. The app will process the images to determine if the wound is healing, getting worse, or remaining stable, then provide feedback to the patient and indicate when additional medical attention is required.

Working with Strong and Tulu on this project are Emmanuel Agu, associate professor of computer science, who will lead the software development, and Peder Pedersen, professor of electrical and computer engineering, who will direct the image processing component. Clinical guidance is being provided by the diabetes and wound clinics at UMass Memorial Medical Center in Worcester, partners on the research.

The application will be integrated wirelessly with a glucose meter and a scale so it can also track a patient’s blood sugar and weight. “With all these parameters,” says Tulu, “the app could play an important role in the management of diabetes and lead to better clinical outcomes.

Adapting for Better Care

Isa Bar-On, professor of mechanical engineering.

While better healthcare is the goal, new technology can sometimes get in the way of effective delivery. And despite expectations to the contrary, the capabilities of new information systems and technology don’t automatically translate into better patient outcomes or institutional efficiency. For new technology to be effective, the clinical staff must be prepared to use it, and existing operating processes must evolve to leverage the systems’ capabilities.

In another series of projects, HDI has been working to help the VA New England Healthcare System better leverage the capabilities of its health information technology systems. The system’s 10,000-member staff serves 1.3 million veterans at eight major medical centers and 35 community clinics located across a six-state region.

“In many respects, the VA is ahead of the curve, because it has been using electronic medical records for a very long time,” Bar-On says. “Our role is to apply our engineering and operational expertise to help them evolve their processes.”

The team has modeled a number of processes, including the distribution of medications in the intensive care setting, the scheduling of physicians at clinics, and the workflows that support medical exams associated with veterans’ disability claims. “There can be up to 63 tests or examinations needed to process a disability claim, and the VA knows they will see a spike in demand because of the veterans returning from Iraq and Afghanistan,” Johnson says. “We have been modeling the processes used now and are presenting a series of recommendations for the VA to consider that may help them better serve that expected demand.”

The WPI team is also evaluating the implementation of a new tool that allows primary care physicians at the VA to check in electronically with specialists to answer questions about patient issues. Called e-Consult, the tool, which includes secure messaging and access to patients’ medical records, would, for example, allow a physician seeing a patient at a rural clinic to consult with a VA cardiologist, saving the patient a trip to a distant medical center.

Looking ahead, the WPI research team is in the early phases of one project that will mine patient medical data to study the incidence and treatment of stroke and another that will analyze existing data on how patients move through a major medical center to search for efficiencies.

“In all this work,” Bar-On says, “the common goal is to improve care, health, and well-being so patients have better outcomes and the system works more effectively. And there’s plenty of exciting and worthwhile research yet to do. To begin to tackle those challenges, we are reaching out to industry, additional healthcare providers and clinical partners, healthcare insurers, government, and other academic organizations to identify new partners who may be interested in working with HDI.”

The common goal is to improve care, health, and well-being so patients have better outcomes and the system works more effectively.

— Isa Bar-On
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