Dr. Chris Hobson, Chief Medical Officer, Orion Health – Diabetes Management

Thought leaders and other experts throughout the healthcare industry have long been aware of the increase in chronic diseases, such as diabetes and the often affiliated conditions such as obesity and hypertension.  The trends clearly indicate that it’s no longer sufficient to conduct another study. What’s needed now is an affordable, relatively simple way to rise to the seemingly impossible challenge of improving care while at the same time reducing costs and coping with the predicted surge in incidence and prevalence of the lifestyle diseases such as diabetes and cardiovascular disease.

There is ample evidence that the current approach to chronic disease management based on an acute-care paradigm is not delivering the best value for patients and is indeed part of the problem rather than the solution. In the United States today, for example, even though $132 billion is spent each year on diabetes care, simultaneous control of glucose levels, blood pressure and lipid levels is achieved in less than 10 percent of people with diabetes.

As a result of our research, we implemented a population-wide approach to improving the management of diabetes using information technology as a key component. Among the major benefits of managing health information with a region – wide IT-based solution as opposed to paper based or siloed EMR systems, is the ability to enrol a much larger number of patients and providers into a systematic care program that can be sustained over a longer period of time, with much more complete information.

This approach addresses major problems found in health care delivery systems including high rates of preventable hospital admissions, overuse of expensive care, low use of primary care and low adoption rates for electronic medical records (EMRs).

At Orion Health, we have found that we could identify and standardize the large majority of our clients’ requirements for delivering a regional disease management solution by focusing in on key questions such as the minimum data set required by clinicians and the key guideline based recommendations. After studying and implementing the technology at many sites both in the U.S. and internationally, we found we were able to standardize a large proportion of the clinical needs arising at most sites in respect of the major chronic diseases such as diabetes, hypertension dyslipidemia and cardiovascular disease. We have been successful using this approach with additional customizations built around the work-flows tailored to meet each client’s exact needs.

Improving overall care: We have seen health care organizations that consistently monitor and report on delivery-quality, on real time clinical data extracted at the point of care, have realized significant improvements in the quality of the care they deliver. Collecting data and then sharing it with those who provide the care facilitates improves how and when the care is provided. Those improvements, in turn, have a positive impact on patients and the cost of care. Without high quality clinical data, it’s difficult to identify patients with the more severe problems and enable clinicians to address them rapidly and effectively.

A fully informed care team: An electronically shared, multi-disciplinary care plan is an essential resource for all providers caring for each patient. This is the best way to ensure that all members of the care team are aware of the patient’s condition, the proposed plan of care and that each provider consistently reinforces the care plan goals and objectives consistently.

Integration with other systems: The solution Orion Health developed has proven its ability to integrate with other systems, enabling the disease management solution to be built on a foundation of existing technology (where this exists.) We have been able to leverage our experience with system integration to build a comprehensive regional population-based disease management solution that is fully integrated with relevant existing systems.

Reporting:  Clinicians working at the point of care need comprehensive access to information in respect to the patient in front of them, and this is the primary focus of our solutions. However they also need to know how well their patient population is performing, are there patients that are either not seeking care or are missing planned follow-ups. Furthermore, clinic managers and bodies such as the health insurers, need to know how their base of providers are performing, and whom the patients are that are missing agreed upon guideline based care. The system therefore provides reports tailored to meet the needs at all levels for appropriate clinical or unidentified information.

Impacting the bottom line: It’s no secret that providing better care in a proactive rather than reactive manner leads to a reduction in costly and traumatic events such as hospital stays and visits to the emergency room.

Broad appeal: Policy makers are very sensitive to the need to more appropriately manage all chronic disease patients and to provide the best chance of managing the emerging epidemic levels of diabetes and cardiovascular disease. Almost always this translates to increasing the use of primary care and multidisciplinary care teams. Multidisciplinary care teams of necessity need a shared care plan. This approach is clearly beneficial to payer organizations that are well aware that a small percentage of patients contribute a disproportionate degree of cost to them. Single payer health systems also find a population-wide comprehensive solution to be of great value.

We are seeing a big increase in the number of potential clients seeking a population-based disease management solution. Both the costs of care and the number of people living with chronic diseases such as diabetes are on an inexorable upward climb. For those charged with managing healthcare quality and cost, it’s critical to take a strategic look at the ways a smart investment in technology can deliver improved results.

For more information about how Orion Health can help you achieve your objectives, please visit www.orionhealth.com