The Concept

Quality Healthcare

Cost Savings

Easy Access

New Model That Works

Drop In Clinic
By Phone

Overview

Convergence

Flow Chart

Trend Charts

FAQ

Challenges Solutions

Case Studies

Advisory Board

CONVERGENCE: A NEW MODEL FOR QUALITY HEALTHCARE

THE DECISION TREE PROJECT

Today, new and older technologies are converging to establish new methods of communication in business. We integrate these new technologies with established healthcare models and implement them realistically with our "Decision Tree Project." With our model, we provide personalized, prompt, and efficient access and interaction between patient, local provider, and the experts. In 85 percent of the cases, diagnosis can be made quickly and correctly without unneeded tests and treatment. This diagnosis is made using information from selected key history and observations obtained by less-skilled, though educated and coached, personnel with the aid of experts to indicate what to look for, etc. Forty to 60 percent of healthcare costs are attributed to unnecessary tests and treatment trials. This convergence is a win-win situation for healthcare providers, companies that provide employees with healthcare, and the patients/employees they serve. Each will save time and money, as well as become better informed about healthcare options. In addition, patients will receive more appropriate treatment for total health needs as well as specific disease issues. We empower the patient with access to reliable health workers and information. This leads to happier employees and fewer absences due to health problems.

Current Healthcare Model Issues

The present healthcare model financially penalizes care providers who spend time to take detailed patient health histories and who provide phone conferences. Failure to acquire these health histories or engage in open discussions often leads to faulty diagnoses. In turn, these faulty diagnoses result in costly and time-consuming tests and treatments that fail to alleviate patients' symptoms. In addition, the lack of interdisciplinary sharing of information regarding symptoms and causes further aggravates the situation, and prevents providers from assisting patients in finding relief from their problems. This hurts the morale of both patients and health providers.

A Workable Healthcare Alternative

Our proposed model integrates new technologies with existing healthcare infrastructures to provide access to existing, but often unused, information for both providers and patients. We involve existing medical workers (medical librarians, pharmacists, nurses, etc.) who are often not involved in the diagnostic loop. Since their time is less costly than medical experts, we maximize their knowledge and skills while expanding the resources available to providers and patients. This collaboration improves opportunities for effective treatments, and facilitates education for the patient, medical workers, and experts. It also blends a subjective human coordinator with objective data analysis. This results in providing patients with education and relief from ailments, boosting not only their morale, but that of all involved in the process-medical workers, experts, insurers, and employers. In short, our model provides efficient diagnoses, valuable education, and savings of time and money for all parties. It is a win-win situation.

Components of New Model

Using existing and developing technologies (phone, fax, websites, email, voice recognition, integrated databases, networking, etc.), we developed an interactive health screening and treatment system that:

• Operates 24-hours a day, seven days a week
• Exists in real-time


• Offers options of in-person dialogues between patients and health workers


• Is interactive to needs of both patients and providers


• Provides continuity of care (an often unavailable, but important, part of care)


• Allows access to health experts when necessary at any time of day or night


• Accesses interdisciplinary knowledge databases using the grand rounds model approach.


• Is a non-linear model: stages of the process can be re-accessed as needed in a circuitous fashion, providing a continuous feedback loop for all parties
• Takes whole-person approach to patient.

How it Works

Patients call their provider's office or our interactive screening system. In all situations, a specific member of the local provider's office staff becomes the patient's Human Coordinator (HC). The provider's office establishes a Core Team centered around the patient. This team consists of (1) the patient; (2) the patient's local health provider (doctor, RN, or other provider); and (3) an assistant working with a screening information database (involving the expert) and quick access to the experts. Having quick access to the experts is key to both patient satisfaction (correct diagnosis) and cost savings (avoiding unneeded tests and treatment trials due to quick and correct diagnosis). As stated earlier, we use less-skilled (although certainly trained) personnel-coached by the experts as to what to look for-to utilize key history and observations. After hearing the patient's concerns, the HC turns to the interactive screening process to best assess the patient's condition and viable treatment options. This is the preferred sequence of communication.

However, if the patient has initiated evaluation and treatment with his provider and would like additional information or possible second opinions through our interactive system, the patient proceeds to initiate contact directly. Additional options will be presented to the patient, and this information relayed back to the HR at the local provider to keep them in the loop. Whether options come from the HC, interactive screening system, or providers, the patient chooses the next step.

The process is interactive and individualized, rather than set in one standard linear form-there is no one way to describe the process. Below are the particulars of the process that can be assembled in customized fashion to suit the individual patient, which is The Decision Tree.

· An in-depth intake process occurs initially without involvement of the doctor or expert. It relies on involvement of above-mentioned medical workers whose time is less costly than experts, but who have specialized knowledge or access to it. Their involvement broadens and deepens the patient's health history screening and provides a better base on which the expert can make a diagnosis.

· This screening process involves a Call Center where the patient may either respond to questions about their health through interactive technology (fax, email, web, voice recognition, etc.) or through conversations with Call Center staff who provide human contact and assistance as needed.

· The information acquired by the Call Center is stored for access by the patient's Core Team. This facilitates continuity of care, which standard healthcare call centers do not provide.

· Medical Workers on the patient's Core Team can now analyze the culled information and apply their specialized knowledge or their access to such interdisciplinary knowledge. Using key words from the intake process and access to many diverse medical data systems, they can analyze the information and offer a number of trial scenarios (treatment options) for the patient's local provider and outside expert to consider.

· Information culled from the screening process is now reviewed by the patient's local provider (their primary doctor or expert). In one minute, this expert can interpret the gathered information in a way that would take others substantially longer time. We have already saved money by involving the expert only after thorough data retrieval and review have occurred by the screening process workers.

· Crucial to this whole process is having the patient and health providers assess the patient with the use of Health Trend Charts, which score their health in five key bio-psychosocial areas. The patient's score in each area, and the interrelationship between these five, impact the patient's whole person and deeply affect their health. These five areas are the Physical, Psychological, Social, Work, and Random realms of each individual's life. These scores/charts can be read by all members of the Core Team and are readily understood by inter-disciplinary teams-providing clear communication by all team members on best ways to assist the patient.

Case Example

Old Approach: A patient suffers from abdominal cramps, nausea, vomiting, and distress. Using traditional healthcare models, she saw doctors for several years and underwent numerous lab studies, including a barium enema, a Cat Scan of her abdomen, as well as other consultations. These were extremely costly and unpleasant for the patient and her insurers. She finally obtained a diagnosis of lactose (dairy) intolerance and put on a special diet that relieved her symptoms.

New Approach: Using our new healthcare model, a rigorous intake screening of the patient would cull key words such abdominal cramps, etc. Medical workers would pass these key words through various databases to obtain varying diagnostic options, among which would be lactose intolerance. Review of data by primary health providers or experts would allow focus on this correct diagnosis years earlier in the treatment process, and relief (both health and financial) would be given, saving the patient pain and money.

Adapting This Model

This interactive model is adaptable by organizations to suit their own unique culture. The components can be customized to include various technologies as they are available to that group's client base, and in such a way that saves money for the client's employees when seeking healthcare. Employees will buy into this new model when they realize they get higher quality care and save money as well. In turn, because large organizations offer health providers so many patients and streams of revenue, health providers will be motivated to buy into this model when they see that they can provide better health care while saving time and money by using their personnel resources in the best ways. The experts spend their time on diagnosis and valuable consults rather than time-consuming but necessary intake, while medical workers use their knowledge to accumulate and synthesize patient intake at less cost to patients and their sponsoring employer or insurer. It is a win-win model.

Note: A workable template for The Decision Tree Project exists that can readily be implemented by a large corporate group.

A Brief Walk-Through Scenario

You are 48 years of age, and you have low back pain. You have seen your family doctor who, after a brief history and examination, is not certain whether this is due to arthritis, herniated lumbar disc, muscle strain, emotional problems, or the rear-end accident you had two weeks ago with possible litigation pending. Rather than refer you to a neurologist, orthopedist, or rheumatologist-or order many blood tests and an MRI of your lower back-the family doctor contacts a resource database by phone with a technician's (advice nurse) assistance. The technician either assists the patient on the phone to complete a screening questionnaire, or faxes this to the patient or doctor's office. This screening questionnaire would be limited and if needed, expanded to deal with questions posed. More time involved would be between the patient and the technician. This information could then be forwarded with the doctor's observations to an appropriate specialist (if semi-urgent, this could be dealt with using a database resource with 24-hour phone access to specialists around the country). After the specialist reviews this, additional questions could be forwarded to the patient and technician, or an interactive phone conference could be arranged between the patient, family doctor, and specialist to ask for more information or observations. There are ways to gather, summarize, and display all this information graphically so the interaction and time involved is more efficient. Relationships between history, observations, and findings over time would be illustrated.

How It Is

Extensive testing and treatments-not coordinated-recommended by a rheumatologist, psychiatrist, and orthopedist. Studies include extensive blood work and immunological testing, CAT scan of the low back, MRI of the low back, psychological testing, and physical therapy treatments at intervals of two to three times a week. Complicating this was the development of an addiction due to the extensive medication, which was contributed to by the treating parties. This leads to hospitalization for treatment of a fall from medication abuse and to detoxify the patient, as well as to get an integrated evaluation and treatment program implemented. Two years after the initial visit, the situation is coming under control, and the patient improves sufficiently to be back to work part-time.

How It Should Be

Problems and general metabolic problems (example: thyroid disease, diabetes): By screening and telecons with the practitioner, the psychiatrist identifies probable depression compounding the situation. The neurologist and orthopedist recommend an MRI of the thoracic and lumbar spine, which reveal suggestive partial herniation of the lumbar 34 disc on the left. Patient is referred to neurologist or orthopedist, who decides that physical therapy in conjunction with pain medication, appropriate muscle relaxants, and antidepressants monitored by psychiatrist and family practitioner should be started. A home health and physical therapist are sent to the home to evaluate the home site on how it bears on the problem.

Recommendations include bed boards, advice re: how to use the car and bathroom facilities, and that it would be cost-effective to provide his wife help with the baby to decrease the stress of the home situation as part of the therapy program. The lawyer was advised of the plan, who decides on a contingency level that the case isn't going to be worth her while.