The Continuum of Care: Right Care, Right Place, Right Time
Two questions continue to be debated within healthcare:
What is the best way for care to be delivered?
How can patients and care teams best engage with each other?
Traditionally, answers to these questions centered on care delivered in a clinician’s office, hospital, or other institutional setting. However, within that delivery model, there wasn't much regard to what was happening within the regular course of an individual’s life, despite the fact that "regular life" might have significant impact on an individual’s health.
Today, this limited view is undergoing a significant transformation with new means of interaction gaining prominence, causing a serious re-evaluation of how to best deliver care. Answers to the questions above are deepening and broadening, particularly in the adoption and effectiveness of virtual care delivery as evidenced during the ongoing global pandemic.
Explosion of Telehealth
Prior to the onset of COVID-19, healthcare was primarily reliant on in-person, episodic interactions for gathering information and disseminating advice. However, that method of delivery quickly eroded due to protective measures necessitated by the COVID-19 pandemic. Telehealth adoption accelerated seemingly overnight. Physicians and clinical care teams quickly pivoted, relying on the full-scale use of technology for patient interactions to provide even the most basic forms of care.
The instantaneous shift to telehealth did not come without its challenges. For example, the federal government, in trying to support the speed of adoption, notified healthcare entities that it would not enforce usual regulatory requirements. The haste and regulatory blind eye resulted in less-than-ideal telehealth solutions being put into place, many of which would not be sustainable for the long-term. For example, use of common video-based conference platforms rather than dedicated telehealth platforms limited care potential. Further, introducing non-healthcare-specific technologies often created misalignment with realistic healthcare-specific workflows.
Aside from the technical challenges and shortcomings, clinicians and healthcare systems recognized that they could deliver effective care, realize excellent outcomes, address inequities and do so at scale. This collective a-ha launched a re-evaluation and re-imagining of healthcare delivery.
Telehealth's pandemic-driven acceleration and proliferation also led to user adoption, comfort and acceptance for both clinician and patient. Clinicians and other members of the care team gained experience and experimented with different platforms. In identifying what was working and was not working well within those platforms, care teams inherently informed and enabled technology refinement and evolution.
From “Telehealth” to Virtual Care
A common misconception is that telehealth is simply a video visit. The reality is that telehealth is an umbrella term that covers a whole host of digital-based modalities such as video visits, storing and forwarding images, remote monitoring, and more. The term "virtual care" is technology-enabled care that is made possible through telehealth capabilities.
The flexibility and capabilities possible include more personalized care, equitable opportunity for quality care and better data to inform clinical decision-making. Virtual care also aligns the healthcare experience to "real life" digital behaviors, such as online shopping and social networking, negating the potential stigma of it not having the same efficacy as care delivered in person. The pandemic experience proved that virtual care can provide the same benefit and may even, in the appropriate circumstances, be the preferred or optimal means of interaction.
The Continuum of Care
If all care, whether virtual or in-person, can be considered care, then the discussion can shift to figuring out what the best form of care is at a given time. This is the continuum of care.
Previously, the continuum of care may have been limited to a series of episodic, office-based interactions. However, this model was flawed. With challenges in scheduling, transportation or proximity, people may not have seen their clinicians until issues had grown into bigger problems. Clinicians were also limited to data gleaned solely within standardized visits.
Virtual care broadens and deepens the continuum of care to include in-person visits, the collection of data during a person’s regular life, virtual communications or interventions to handle some questions, and more. This expanded continuum creates more wholesome insight into an individual’s life along with fostering a deeper connection between the individual and the care team that they are working with. The broader continuum not only requires seamless integration of both virtual and in-person care delivery mechanisms, but also the ability to collect, transmit, and analyze data.
Remote Engagement: Powering the Continuum
Aggregated, appropriate data is central to creating a comprehensive yet actionable continuum of care. And the best source of that data is the individual being treated.
Today, many individuals already utilize a wearable device that is passively collecting data. If they don't, a care team can provide a specific medical device. Regardless of the source, the data is created and collected throughout the regular course of an individual’s life. While the amount of data can then be quite large, this information presents the opportunity to identify trends or changes that would otherwise be hidden by sporadic interactions. Intelligent technology that can aggregate and curate incoming data helps care teams cut through data noise and focus on what is relevant.
In addition to intelligent data curation, clinicians need individuals to consistently utilize their devices to ensure accurate data collection. Boredom, disinterest, complexity or lack of habit can disrupt usage. Easy engagement is critical to success.
That is why user-centered design is foundational within the Carium platform. User-centered design means actively considering how an end-user, such as the patient or clinician, will interact with the application, not just pay lip service to the concept. An engaging design must be easy and intuitive to use for patients and care teams. Any barriers will decrease stickiness with the tool, impact data collection and decrease potential improved outcomes.
With engaged patients and curated data, care teams are well-poised to provide information, intervene where necessary, and educate or coach patients. This level of engagement is focused, efficient and deepens the clinician/patient relationship.
True engagement can promote better outcomes by leading to identification of potential concerns earlier when a trend is seen, facilitating interventions, whether virtual or in-person, or providing information to help someone understand why a recommendation is being made.
Therefore, viewing remote monitoring as remote engagement makes it easier to understand how technology enables a new model of a comprehensive and appropriate continuum of care. Interactions and interventions are no longer limited to singular concepts or limited numbers. Instead, through virtual care, the relationship is collaborative with the aim of maintaining and improving health and wellbeing as opposed to being reactionary once something has already happened.
The Road Ahead
The vision of a more considerate continuum of care is well on the road to becoming a reality. Although the pandemic initially created a rush to telehealth, a thoughtful, deliberate, inclusive approach — grounded in easy, intelligent and comprehensive virtual care – will result in a better system for all.