Harnessing technology to join up primary and secondary care and enhance patient experience.
Unified communication plays a key role in creating modern models of integrated care across primary and acute services. And the reason is quite simple. It enables information to flow seamlessly across care pathways and be securely accessed from anywhere in the health system, allowing for enhanced real-time communication among providers.
Integrated care enablers
A 2014 Health Research Board (HRB) review of international evidence concluded that effective information sharing and management are essential enablers of integrated care. It’s not just coincidence, say the review’s authors, that the best examples of integrated care have in common high levels of investment in advanced communication technology.
NHS England is already moving in this direction. In 2015, it announced the first nine integrated primary and acute care systems (PACS), which bring together GP, hospitals, community and mental health services.
They’re expected to reduce delays, duplication and errors, whilst preventing hospital admissions and readmissions, thanks to technology-enabled data sharing, patient remote monitoring and team collaboration.
This is of particular value for patients with multiple chronic conditions. It means that, in the future, people who suffer, for example, from depression and diabetes, will not have to go through separate assessment, diagnostic, referral and care processes.
They will be cared for by a single multidisciplinary team, who will assess all their needs and will consistently follow them across primary and secondary care and at home, from the first meeting to recovery.
Importantly, as the HRB review found, integrated care works only if incorporated at all levels of service delivery:
- The macro level of whole populations.
- The meso level of groups with the same condition or care needs.
- The micro level of individual patients.
This blog describes evidence-based ways of integrating primary and acute systems to enhance patient experience. It includes examples of how this has already been achieved in health systems worldwide, at the macro, meso and micro level.
1. Keeping patients in their homes
Remote patient monitoring, management and support are a cornerstone of effective integrated care. Patients can live independently at home without missing out on vital treatment. Doctor and hospital visits are reduced. And so is the likelihood of needing emergency care due to a crisis.
The US Veteran Health Administration (VHA) is routinely using an advanced remote monitoring system nationally – a good example of integration at the macro level. The system collects real-time patient information and triggers warnings when problems occur, enabling prompt intervention by providers.
Adam Darkins, of the Department of Veterans Affairs, led a four-year study on the VHA system. He reports “a 25% reduction in numbers of bed days of care, [a] 19% reduction in numbers of hospital admissions, and a mean [patient] satisfaction score rating of 86%.”
In England, research published in the British Medical Journal shows that technology-enabled self-management at home within the Whole System Demonstrator Programme (WDP) – set up by the Department of Health in 2008 – significantly reduced patient mortality and hospital admissions and length of stay.
2. Enabling effective collaboration
The integrative nature of unified communications makes it vital to effective collaboration across care services. Think, for example, of video consultations or systems that enable doctors and nurses to be contacted on just one number on all their computer devices at the first attempt. They make collaboration easier. So primary and secondary providers can truly function as one team.
Thanks to enhanced collaboration, as in the scenario further up patients with multiple conditions can be managed through a single integrated care package, rather than separate services. This could be pivotal in putting mental and physical health on equal footing, as set out in the Five Year Forward View for Mental Health.
3. Managing care proactively
Another advantage of effective collaboration is that it enables the transformation from reactive to proactive care which contributes to integration across services.
An English example of proactive care and integration at the meso level is Torbay Care Trust. The target group is elderly people. Multidisciplinary teams manage their care by regularly reviewing their condition, so they can anticipate and prevent problems.
Undoubtedly, proactive care is facilitated by intelligent systems that, for example, allow care providers to reach out to one another at a touch of a screen, without constraints of time or space.
And the benefits are worthwhile. King’s Fund researchers report that Torbay has “the lowest use of hospital bed days in the region and the best performance in terms of length of stay.” What’s more, it ranked “highest in the south-west for the proportion of people reporting confidence with NHS services.”
4. Breaking down barriers through sharing
As described earlier, unified communication allows for the effective sharing of information, a key contributing factor to quality patient-centred care, according to work published in The American Journal of Managed Care.
One of the best examples of harnessing patient information sharing to deliver patient-centred, integrated care is the Care Connectivity Consortium created by five leading US health systems, including Kaiser Permanente and Mayo Clinic.
If a patient moves from one system to another, the treating doctor or nurse can access information about their medications and health condition and, consequently, provide timely treatment whilst avoiding errors.
5. Empowering patients and providers
At a micro level of individual patients, unified communication supports integration by enabling the following:
- Collaboration among primary and acute providers, who can interact in real time with one another.
- Enhanced clinical decision-making, through the use of electronic medical records, practice guidelines and drug libraries.
Plus, patients can:
- View their records and book GP or hospital visits.
- Receive medication or appointment reminders.
- Connect with providers via texting, phone or video.
Solutions like the above have been implemented at Kayser’s HealthConnect, reducing visits to primary and secondary care providers by 25.3 and 21.5, respectively.
- Caring for patients in their homes is a key component of integration across services.
- Employ solutions that enable collaboration among providers regardless of location.
- Proactive care improves service performance and patient satisfaction.
- Consider information sharing a core enabler of patient-centred, integrated care.
- Empower providers to work effectively, and patients to remain in control.