Executive Summary

As care becomes more centered on the patient and the number of touchpoints and data inputs increases, care teams need a “single pane” view of the entire patient journey. In response, many health systems have begun to partner with a variety of CRM platforms such as Salesforce that have developed workflows and capabilities to meet the unique challenges of patient engagement and enable system-wide “care traffic control.” Bringing together data from parer apps and services, the platform gives the organization a shared view of the patient – including medical history, insurance, scheduled appointments, preferences – all in one place.

Hardly a day goes by without another new entrant declaring its foray into healthcare. Through a series of strategic acquisitions, Best Buy expanded from selling electronics and deploying its Geek Squad for repairs to providing home health services and remote monitoring. As the company’s president suggested, achieving the goal of reducing healthcare’s spiraling costs will require some “interesting new bedfellows.”

Among these bedfellows is Lyft, which launched a healthcare-specific offering to reduce costly no-shows and remove transportation barriers for patients, especially those with chronic disease. Care teams can now order a ride in the same workflow as they do blood tests and, under some plans, have it covered by insurance. Then there’s the explosion of apps, virtual consults and health chat bots making up the telemedicine market, which is expected to grow to $64 billion in the U.S. over the next five years.

Insight Center

What these trends point to is a dramatic expansion over the coming years of healthcare’s “front door” as the locus of care shifts from the hospital or clinic to patients themselves — at work, home, or wherever their smartphones take them. Paired with a shift to value-based care and alignment of incentives to outcomes, this burst of innovation offers the promise of a more personalized approach to medicine focused on keeping patients well and out of the hospital, reducing overall cost of care. But it also brings with it some significant challenges that demand new approaches and safeguards.

“Care traffic control”

As care becomes more centered on the patient and the number of touchpoints and data inputs increases, care teams need a “single pane” view of the entire patient journey — what John Halamka, executive director of the Health Technology Exploration Center of Beth Israel Lahey Health, has cleverly termed “care traffic control.” Orchestrating care and integrating data across an increasingly diverse and potentially virtualized care team requires new tools and what Halamka has called “a new paradigm for team-based communication and wellness.” Just as the retail industry has embraced knowledge sharing and omni-channel engagement through CRM platforms, so is healthcare recognizing the need for a coordinated approach to managing patient relationships.

In response, many health systems have begun to partner with a variety of CRM platforms that have developed workflows and capabilities to meet the unique challenges of patient engagement and enable system-wide care traffic control. For example, Piedmont Healthcare, a health system serving more than 2 million people across Georgia, partnered with Salesforce to help them deliver, engage and personalize care at scale. Bringing together data from partner apps and services, the platform gives the organization a shared view of the patient — including medical history, insurance, scheduled appointments, preferences — all in one place.

Piedmont care teams can get a more complete view of the patient by seeing medical history alongside information on employment, socioeconomic status, and other social determinants of health. In-home providers can access the same patient profiles to flag gaps around things like healthy food access or transportation that could land patients with chronic conditions back in the hospital. Armed with this data and the insights generated, outreach teams can send reminders or run targeted campaigns around things like nutrition classes to engage patients in more personalized ways. The ultimate goal is to deliver a more coordinated, tailored patient experience at a lower total cost of care.

While some might argue that EHRs can and should play this role of a unifying platform, most were never designed around patients and their full journey of care beyond the walls of a hospital or health system. Also, the average health system is challenged with integrating data and coordinating care across 18 different EHR systems across its various affiliated providers. A patient-relationship platform that sits atop these otherwise disconnected systems can provide a coordinated view of the patient journey that’s otherwise sorely lacking.

Achieving the goal of truly personalized, patient-centered care still runs up against chronic and systemic interoperability challenges. But the expansion of digital health and the entry of Big Tech players such as Apple, Amazon and others have gradually shifted the calculus and created incentives for legacy EHR vendors and health systems to embrace a more open exchange of data. The rapid move across the industry to data-sharing via APIs using FHIR (Fast Healthcare Interoperability Resources) standards is a positive sign that the industry’s information silos may finally be breaking down.

Navigating the healthcare data tsunami

Even with the right tools in place, coordinating patient care across an expanded and more diverse ecosystem will only get more challenging with the tsunami of data coming from these new sources. A recent International Data Corporation report predicts a 36% growth rate for healthcare data over the next five years, faster than in any other industry. With every month that passes, new smart medical devices appear and more app-using patients begin to monitor their health, expecting the resulting data to be sent to their doctors and EHRs. Early in 2019, the Centers for Medicare and Medicaid Services responded with a proposed rule calling on the healthcare industry to take steps to give patients “safe, secure access to, and control over, their healthcare data.”

But what does this actually mean? With no certification process in place for medical apps, how are newly empowered patients to choose which are trustworthy and effective? Likewise, what criteria are providers to use for prescribing apps or accepting and validating the data coming from them? As John Torous, MD, director of digital psychiatry at Beth Israel Deaconess Medical Center, has demonstrated, we have yet to figure out how to conduct randomized trials for apps the way we do for drugs. Thus, it’s hard to distinguish apps with therapeutic benefit from those that are just marketing hype. Along with questions of validation come equally important questions of usability. For the data from a validated app or device to be usable, rules need to be written to separate a signal from the noise — for example, what heart rate patterns from a remotely monitored CHF patient get ignored and which trigger an alert to the EHR. Much more work is needed to wrestle with these thorny issues in order to effectively translate clinical skills into digital care delivery.

Finally, as empowering as it sounds to give patients control over their data, we know all too well from recent breaches and scandals how this opens up their data to exploitation. A recent study of 24 of the top medical apps available on the market found that 79% shared user data in ways that might compromise privacy. As data moves into patient hands, the traditional role of the physician as trusted gatekeeper begins to break down. If you share health information with your physician, she has privacy obligations. If you share it with Alexa or Google Home, the same privacy rules don’t apply. We need to educate patients to the risk versus reward of these technologies and evolve data privacy regulations to match new realities.

Healthcare is at an inflection point, awkwardly poised between traditional care delivery models — with their benefits and well-documented shortcomings — and a wave of new, exciting but largely untested offerings and interventions. A healthy dose of skepticism and vigilance is needed as companies and investors look to ride the wave and seize near-term rewards. But the promise of more personalized, patient-centered and outcomes-based healthcare is real, worthy, and within reach.