Digital Health Closing the Gap on the Last Mile in Chronic Disease
Successful delivery system redesign requires a focus on secondary prevention (early detection and intervention), tertiary prevention (treating established disease to prevent deterioration), closing gaps in care, managing care transitions (e.g., from hospital to home), treating behavioral health issues, facilitating self-management and, if appropriate, offering palliative care. Home-based care is preferential to hospitals and skilled nursing facilities. Digital transformation, as exemplified by telehealth, potentially enhances timely access and intervention, and facilitates care coordination.
Digital transformation requires clinical information systems and decision support. Electronic medical records facilitate physician documentation, computerized physician order entry and closed-loop medication administration, provide clinical decision support and create a central repository for input by multiple providers.
Systems have been and are being developed that integrate electronic medical records, claims and remote monitoring data, as well as social determinants of health. The latter include metrics related to healthcare access and quality, economic stability, education access and quality, neighborhood and social and community context. Algorithms driven by artificial intelligence and machine learning are being developed and applied to case management platforms and elsewhere to generate actionable insights.
In conclusion, we are at the beginning of digital transformation in healthcare. Chronic diseases account for a disproportionate amount of spending. Opportunities clearly exist to increase patient engagement, improve clinical workflow, and enhance clinical outcomes. Healthcare needs to become more efficient and effective for affordable sustainability. The alternative is likely Medicare-for-All or another single-payer initiative.