Technology in Integrated Care?

Dr. Mehdi Khaled, Vice President, Healthcare and Life Sciences Asia Pacific and Japan, Oracle Corporation explains how!

In the age of modern medicine and at a time where translational medicine is getting up close and personal, the increasing burden of chronic and long-term diseases is reaching disturbing levels [1]. Although the shift in care delivery models from site- to person-specific represents an encouraging path, some key processes and tools used to enable the latter still lack wide adoption, maturity or both. Moreover while health policy researchers, practitioners and policymakers are increasingly referring to the need to establish a 360°-participatory care model the term ‘integrated care’ still remains vague for all too many and the IT tools to enable it widely misused.

Cycles of Care vs Discrete Services

Healthcare is increasingly being co-produced between the patient and the medical team. The patient and his/her family must be therefore actively involved in the care delivery process. Prevention, screening, and ongoing disease management are integral to the care cycle of every medical condition. Leading care providers make patient engagement and compliance monitoring an integral part of care delivery. Henceforth, medical condition management must become integral to the provision of care delivery, and cease from being an overlay.

As a consequence, the full value can only be created by the cycle of care, not individual interventions.

What is Integrated Care?

The World Health Organisation (WHO) gives the following definition: Integrated care is a concept bringing together inputs, delivery, management and organisation of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency. In other [simplified] words, integrated care is “the organisation and management of health services so that people get the care they need, when they need it, in ways that are user friendly, achieve the desired results and provide value for money”. Integration can therefore represent one or more of the following interventions:

• A package of preventive and curative health interventions for a particular population group
• A multi-purpose service delivery points (horizontal integration)
• Vertical integration of different levels of service (referrals)
• Continuity of care over time
• Integrated policy-making and management
• Insurance function and health care provision are delivered by the same organisation.

According to the aforementioned definition and the various setup options, it becomes clear that the integration of care is just a ‘means to an end’.

Drivers

Policymakers may be drawn to integrated care for different reasons. Five main drivers behind the integrated care agenda are [2]:

• Changing demand for care
• Recognition that health and social care outcomes are interdependent
• Integrated Care as a vehicle towards social integration of society’s more vulnerable groups
• Integrated Care may lead to better system efficiency
• Integrated Care may improve the quality and continuity of care

What it Means for the Patient

The concept of continuity of care is closely related to integrated care; it emphasizes the patient’s perspective through the system of health and social services, providing valuable lessons for the integration of systems. Continuity of care is often subdivided in three components:

• The continuity of information (through shared records such as electronic health records),
• The continuity across the secondary-primary care interface (discharge planning from specialist to generalist care),
• The provider continuity (seeing the same professional each time adding value can build the patient-healthcare relationship).

Serious illnesses and complex associations of medical conditions intensify the need for a ‘whole-person’ integrated service.

Key Considerations

It is important to ensure that the development of integrated care is consistent with other health and social care policies within a country or the value of attempting full integration is not as valuable.

Setting realistic objectives for integrated care models is fundamental to the success of the project and this can be facilitated by paying close attention to the possible challenges during the implementation.

It is essential to adequately invest in the training of all professionals to bridge the cultural divide between health and social care. This will facilitate coordination of care and encourage mutual respect.

It is also important to find the appropriate balance between user and provider integration. This can be established by harnessing closer links between policymakers, practitioners and researchers to learn from experience.

It is also valuable to share research and best practice within and across countries. The great advantage is that research can be conducted on the cost-effectiveness to determine the effects of different models of integrated care on resource use as well as health outcomes.

Information Technology can be defined as the fourth dimension of integrated care: it supports standardization, automation and ensures vertical and horizontal information integration at a minimum. Both the role and scope of information and communication technology need to be thoroughly assessed and revisited during the implementation of integrated care.

Conclusions

The urgent and emerging need for integrated care is already reshaping the way healthcare is delivered. Building consistency across health and social care policies as well as a global knowledge base for evidence-based successful practices maybe the most challenging undertakings for integrated care programs to succeed. IT tools and related governance models have reached a significant level of advancement to become a major success factor if rightly adopted. The Current PCEHR project in Australia will enable healthcare information sharing with the various stakeholders and solidify its consistency. This is not only the cornerstone for any modern healthcare system, but this consistency will also allow for an enhanced integration of care processes at many levels.

Suggested flow chart:

Source; Michael E. Porter, ‘Value-based Competition in Healthcare’; Harvard Business School, June 11, 2007

Mehdi Khaled is the Vice President for Healthcare and Life Sciences (JAPAC) at Oracle Corporation. Mehdi is a medical doctor specializing in internal medicine and holds a degree in IT and software engineering. He has a passion for Healthcare Informatics, an area in which he has been globally active for over a decade now. His early assignments as Senior IT Consultant and then Project Reviewer in major European and Latin American healthcare projects provided him with extensive experience. He subsequently became the Strategy and New Market Development Leader for T-Systems (Europe and Latin America) and later was appointed the lead at SAP for
Healthcare in Asia.

Mehdi has recently conducted extensive research on a series of Advanced Medical Devices, in collaboration with professionals from the Semi-conductor Industry, which resulted in filing for various patents under his name.