A vision for measuring success in digital health
The following is a guest post from Dr. Travis Good, founder and CEO of Datica.
With so much energy and momentum around digital health technology, it may come as a surprise that there is still a big question mark around how to measure digital health success.
Everybody is grappling with this challenge of judging the effectiveness of digital health, and I’ve not seen anyone do a good job of figuring out the answer. With dwindling margins and an imperative around evidence, it’s a critical question for any hospital, whether you are launching a new large-scale initiative or just plugging in an application. The problem is that people in health care, like in most large organizations, tend to work in silos with different and sometimes even competing interests.
To address this question, we need to take a hard look at who is engaged in making the recommendations and ultimately the decisions regarding digital health technologies.
From my experience, these are the people who need to be at the table to develop the success criteria for digital health.
- The chief medical information officer (CMIO), a rather new position within health systems, is usually an MD speaking on behalf of physicians.
- The chief information officer (CIO), responsible for how the digital health infrastructure fits within the broader IT organization
- The IT team, to connect the product to the current system
- Onsite representatives of the EHR supplier
- An internal champion, possibly an early-adopter physician who wants to pioneer the digital health product.
- The director of innovation, and people from teams like marketing, security and compliance, legal and procurement.
- And possibly an external consultant to help with strategy.
The easiest way for this diverse group to measure digital health success relates to costs or revenues. For example, if you plugged in a telemedicine solution, people start paying $25 or $50 to see a nurse practitioner over video chat instead of going to a pharmacy or coming into the office or emergency department. The outcomes may be a new source of revenue or it might be a cost savings from directing patients to appropriate, and less expensive, care settings.
Success also links to strategic initiatives of the health system. If a health system targets provider satisfaction, then an outcome for better clinical communication might be that physicians or nurses don’t have to carry pagers anymore. If the strategic initiative is patient ease of access to services, providing better access to scheduling appointments online might be the measure of success.
All of these people at the table need to collaborate, but their incentives can collide, or even become dysfunctional. The compliance officer with a long checklist is often at odds with the head of innovation, for example. Or the EHR team doesn't want to relinquish control of the data, whether for some concerns around safety or because the EHR vendor wants to sell their own product that does the same as what the digital health product being integrated does.
In my vision of a successfully digital health solution, the first step is to make sure that people making the decisions have a shared incentive.
There's a strong parallel here between the new alternative payment models and the concept of these stakeholders at the table for digital health. Basically, the new models drive value-based care instead of fees for each service along the way. In a hip replacement, for example, the surgeon doesn't get paid until outcomes are shown 90 days later, after the patient goes through the rehabilitation clinic and the physical therapist.
The focus is on a successful outcome for the patient. If everybody in that chain does their job, then on day 90, everybody in that chain gets paid what they expected to get paid. You don't want to be the weak link in the chain.
Digital health is going to help alternative payment models be successful, and so everybody must work together for that to happen. The CMIO has to work with the EHR team, who has to work with the digital health solution, and so on. If anybody in that chain is selfish or makes a mistake, your organization will not be successful.
The second step is to make sure the right people are around the table. Collaboration takes time, but it will help hospitals get to the real question: Is this the kind of product that is going to improve patient outcomes? You hit a turning point when it all comes together and new efficiencies are found.
I think the model to follow is Cedars-Sinai Medical Center in Los Angeles. Initially, they decided to build their own EHR, but it was such a disaster that it became an MBA case study for how not to do an operational roll-out. Then they went in the opposite direction and created an innovation group managed by the CIO to essentially pilot new ideas, get buy-in from doctors, figure out how it fits into their system and create a plan to roll it out. Now they are widely recognized as a success, and even commercialize what works so other health systems can benefit too.
I'll know my vision of the future is successful when the people who sit at the table have a shared stake. Everyone in the chain, from doctors to accountants, wants everyone else to succeed because they all have the same incentive, which is that people get healthy.