Crossing the Global Quality Chasm Improving Health Care Worldwide (2018) / Chapter Skim
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3 Optimizing the Patient Journey by Leveraging Advances in Health Care
3 Optimizing the Patient Journey by Leveraging Advances in Health Care
Pages 79-128
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From page 79... ...
• Human-centered design approaches can shed light on the needs and per spectives of people using health technologies, thereby removing unnecessary barriers to high-quality care for patients and making workload more manage able for health care workers. • Although digital health technologies offer great promise, caution is needed in the areas of ethics and regulation, including data protection, bias, and equity.
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From page 80... ...
An algorithm determined her risk profile, which flagged her for an early midwife appointment because she has hypertension. Most of Fatima's appointments, however, take place at her house or down the street at her children's school, where community health workers and midwives meet community residents for checkups and to answer questions about their health conditions.
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From page 81... ...
This chapter begins by exploring global trends in health care and the growing number of digital health technologies that are coming into play across various countries and settings. Next, it examines the implications of these changes for quality, especially in terms of person-centered care, accessibility, and equity.
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From page 82... ...
At the same time, however, as discussed later in this chapter, these advances are not without risks, so while they present many opportunities, careful design and oversight are needed to ensure that they assure and improve the quality of care. Use of Systems Thinking and Digital Health Technologies Smart devices are creating revolutionary changes in health care by allowing people to accurately monitor their health remotely.
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FIGURE3-1 Future expectations for the quality of health care globally. FIGURE 3-1 SOURCE: Ipsos, 2016.
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. Digital Health Technologies and Tools With the explosion of new digital technologies in the past decade and new opportunities emerging each year, it is becoming possible to change and advance medicine and health care delivery systems in unprecedented ways.
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FIGURE 3-2 Trends in health care technology throughout the decades. NOTE: AI = artificial intelligence.
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From page 86... ...
Effects on the Patient Journey The increasing use of wearable health devices, such as Apple Watch and Fitbit, is making it possible for people to take greater ownership of their health. Furthermore, such devices are allowing people to become more aware of their risk behaviors and lifestyle choices, thereby creating a bridge to the formal health care system.
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From page 87... ...
This capability makes it possible for Apple's underlying health app, Apple Health, and the data it stores to be connected with other digital tools, allowing people increasingly to make health decisions independently (Chopra and Rab, 2018)
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. National health authorities thus have an opportunity to increase their contributions of quality health information to the Internet and social media.
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The need for improvement here in terms of the patient journey is clear. Enter Tencent's WeChat application communication service, with more than 900 million monthly active users.
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. Medical Advances in Other Areas In addition to the increasingly familiar digital health technologies of today, other medical advances offer exciting potential for health care and quality as well.
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. Precision and regenerative medicine are other new areas of clinical care that hold promise for improving future health.
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Leadership and involvement at the national level and alignment of the technology with the priorities of the country are paramount for successful implementation. Otherwise, health professionals could be faced with extra work, and patients would see no improvement in their patient journey or experience.
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Instead of focusing on specific events, the emphasis of analysis needs to shift to care processes over time, or what this report refers to as the lifetime "patient journey." Patients and their families traverse the health care system over time and through multiple places. Thus, they often have a greater understanding than clinicians of the care received longitudinally, and they have the ability to provide key information needed to identify causes contributing to an adverse event.
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From page 94... ...
SOURCE: PwC, 2017. "Yes." Involving users in the design of health care systems and the incorpo ration of digital health tools can ensure that the systems are well adapted for people and minimize the need for people to adapt to accommodate the system.
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From page 95... ...
Women in Tanzania receiving treatment for prevention of mother to child transmission reported three specific factors that decreased the quality of their health care experience, two of which were arguably related to communication issues: a visit time exceeding 2 hours, perception of poor communication skills by health care workers, and a lack of understanding of patient concerns (Naburi et al., 2016)
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Digital health literacy is also becoming increasingly important as the health care delivery system shifts toward digital tools and consumer ownership, as described in this chapter. The Shanghai Declaration for Improving
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From page 97... ...
provides an opportunity to emphasize people- and community-centered care and a new focus on the patient journey. If designed with the needs of users in mind and with contextual nuances of the community incorporated, primary care can be a critical tool in the quest for higher-quality care and better health outcomes.
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From page 98... ...
Investing in an evidence-based system using human-centered design can lead to lower costs, higher quality of life for patients, and a better overall patient experience. The recent joint global quality report from WHO, the World Bank, and the Organisation for Economic Co-operation and Development (OECD)
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FIGURE 3-4 Primary care acting as a hub of coordination to provide person-centered care. NOTE: CT = computed tomography; NGO = nongovernmental organization; TB = tuberculosis.
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. Another important resource for improved primary care is the utilization of community health workers (CHWs)
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Employing such design principles as co-design, continuous feedback, and solving problems at the source, the initiative regularly reviews data and identifies changes and adaptations that can improve quality in various areas. CHW models are applied successfully not only in LMICs but also among low-income populations in higher-income countries such as the United States, where these models have helped achieve a more holistic patient journey and better health outcomes.
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with low levels of literacy and technical skills. The CHWs conducted home visits and registered maternal health information directly to their mobile devices to increase coverage of antenatal visits among women with low income or little formal education.
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5 See https://www.cityblock.com (accessed June 2, 2018)
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Such models share elements that include empowering patients to take more responsibility in the management of their own health; using nontraditional health care providers to optimize screening and diagnosis opportunities; linking them to the health care system through digital tools; and offering first-line treatment through community health care providers, thereby reducing the burden on the health care system. Digital technology and tools described previously can facilitate and accelerate many types of interventions necessary to address NCDs.
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. Costa Rica is also struggling with the increasing burden of NCDs, but its strong primary health care system, described earlier, should help in adapting to the challenge.
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Additionally, the systems thinking and design principles underpinning quality care discussed in Chapter 2 will be necessary to overcome the current fragmentation and paternalistic dynamic still present in many places. To better understand what will be needed for health care to complement the rapid development of digital health technologies, the committee identified and interviewed 12 subject-matter experts in the area of digital health ethics and regulation.
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. To this end and to leverage the opportunities offered by digital tools, a community of global health nongovernmental organizations (NGOs)
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. HCD approaches can shed light on the needs and perspectives of people using health technologies, thereby removing unnecessary barriers to high-quality health care for patients and making the workload more manageable for health care workers.
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emphasizes that "effective and efficient primary health care requires integrated health care services." Finally, given the ICT advances, HCD approaches, and community care delivery elements discussed throughout this chapter, successful integration of systems will depend on intersectoral collaboration. For example, evidence emerging from Bangladesh, Pakistan, and Nepal suggests that integrated packages of community- and facility-based services provided across the continuum of maternal care, from pre-pregnancy through the postpartum period, could reduce neonatal mortality by 11 to 34 percent.
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Workforce Competencies The need for education in the rapidly growing and changing digital health sector is absolute. Given that health care quality will depend on the quality of the health care workforce and its pipeline, crucial changes in education are needed now.
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Optimists may believe that digital health technologies will alleviate the current fragmentation and geographic limitations of health care systems. Yet, ethical considerations arise.
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, Kenya, and Tanzania (Domasa, 2017) are in the process of passing laws on protection of personal data, but "more than half of Africa's 54 countries have no data protection and privacy laws, and of the 14 that do, 9 have no regulators to enforce them" (Fick and Akwagyiram, 2018)
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. Another example of this concern is emerging in China, where patients and providers are very familiar with digital health technologies.
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In fact, 81 percent of health care executives interviewed for one study expressed the view that health care organizations are not prepared to explain AI-based actions should societal or liability issues arise (Accenture Consulting, 2018)
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While some countries or regions within countries are still operating via a paper system for health records, many have begun migrating to digital health information systems. As the use of such systems grows, countries at all stages need to take note of important considerations related to data governance and management.
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Tedros Adhanom Gebreyesus highlighted the impact of digital technologies on training health care workers, empowering patients and families, and improving patient safety and quality. For effective and sustainable improvements to occur, however, strong leadership at the national and local levels, clear policies and governance mechanisms, and data-driven improvements will be necessary (WHO, 2018b)
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SUMMARY AND RECOMMENDATIONS The health care system of the future will differ fundamentally from those of the present and past. Digital technologies are a key enabler to optimize health systems and improve the quality of care for individuals and populations.
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Successful programs highlighted in this chapter have already begun this transition, shifting the focus to utilization of digital health technology as well as predictive rather than reactive care models. While the programs' successes are specific to the context in which they were implemented, they offer insight into methods and strategies that have the potential to be scaled and altered to be successful in a variety of contexts: • The Brazilian Family Health Strategy, which focuses on the uti lization of CHWs, has resulted in increased breastfeeding rates, near-complete immunization coverage among children, decreased inequality and inequity in health care utilization, and a patient satisfaction rate of 85 percent approval for CHWs.
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Recommendation 3-1: Build a Global Community for Digital Advances in Health and Health Care Delivery The United Nations System should convene an international task force with multisectoral representation to provide guidance to the global community on advances in digital health technologies. This task force should develop: • data standards, norms, ethical frameworks, and guidance for mod ernized regulation and human resource capacity to enable countries to better benefit from the transformative technologies in the health sector; • engineering and design standards that emphasize interoperability, human factors, and human-centered design to align technologies and innovation with the aspirations of global health care quality; and • an international resource to guide countries in incorporating regu lation of digital health technologies so as to protect users and their privacy while fostering innovation, with input from an external board of experts.
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• Governments and organizations should develop and support mul tisectoral task forces to guide their digital health strategies so as to ensure that all deployed digital health technologies are evidence based and coordinated, that patient safety is protected, and that risks are mitigated. • Government and private-sector leaders should revise competency requirements and educational curricula to better meet the work force needs created by digital health advances, including skills in data science and analytics, interpersonal skills for teamwork and person-centered care, and systems-based thinking.
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The WHO's report on task shift ing to community health workers for AIDS care in poor countries. Global Public Health 6(2)
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2015. Strengthening primary health care through community health workers: Investment case and financing recommendations.
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2013. Effectiveness of community health workers delivering pre ventive interventions for maternal and child health in low- and middle-income countries: A systematic review.
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2017. Implementation research on community health workers' provision of maternal and child health services in rural Liberia.
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https://www. telegraph.co.uk/news/0/pointing-way-medical-drones-saving-lives-africa (accessed June 2, 2018)
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2018. Paying and investing in last-mile community health workers accelerates universal health coverage.
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2016. Brazil's family health strategy: Using community health care workers to provide primary care.
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2018b. Delivering quality health services: A global imperative for universal health coverage.
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