Seeing the ‘Whole Patient’ Across the Vascular Care Continuum

Precise healthcare delivery now requires that physicians and administrators harness new technologies and targeted data to connect the dots for each patient across the vascular care continuum. This strategy relies on providers’ ability to gather, integrate and interpret data before, during and after intervention. Armed with this critical information, physicians and administrators can then determine the best treatment pathway for each individual patient.

Too often, however, healthcare systems tend to overemphasize “intervention” and “fixing things,” rather than harnessing the power of data to optimize care across the entire patient journey. This leads to diminished patient experiences and potentially poorer outcomes – driving even greater costs for health systems and society.

The good news is that many cardiologists and hospital administrators are now beginning to take a more holistic approach to vascular care. In a recent Abbott survey, “Beyond Intervention: Personalized Vascular Care Through Technological Innovation,”² physicians and administrators agreed that accurate decisions have the most impact either at diagnosis (named by 62% of administrators and 57% of surveyed physicians globally) or when determining the treatment pathway (administrators: 54%; physicians: 57%). Interestingly, they place less importance on the intervention itself (administrators: 39%; physicians: 22%).³

By gaining the ability to “see the whole patient,” health providers become better equipped to identify patients at risk, screen them via advanced diagnostics, triage them to the right professional, and then proactively support those patients on the back end. In Abbott’s survey, physicians view technology as playing a key role in flagging at-risk patients. First and foremost, this encompasses enabling greater connectivity between primary care providers (PCPs) and specialists (named by 64% of physicians surveyed globally by Abbott).

This is a communication gap that desperately needs filling. In a 2015 online Harris Poll survey of nearly 1,000 healthcare professionals commissioned by PerfectServe, 71% of clinicians indicated they had wasted time trying to communicate with the broader care team. Although 95% believe that successful care collaboration leads to reduced readmissions, clinicians felt hindered by a patchwork of antiquated or underutilized communication technologies, wasted exchanges and concerns about privacy and security.⁴

New technologies can address these shortcomings by fostering a better understanding of a patient’s socioeconomic or demographic risk factors (cited by 56% of surveyed physicians globally), allowing routine updates to family history and patient information (55%), enabling patient self-evaluations to identify warning signs (54%), and providing better, more complete electronic health records (EHRs) (47%).

To help fill the communication gap, the Association of American Medical Colleges launched a program called Project CORE, which uses enhanced referrals and eConsults embedded in the EHR to facilitate more efficient, effective communication between PCPs and specialists. In its first three years, Project CORE’s participating institutions experienced an 84% increase in timely access to specialty care and avoided an estimated 7,360 unneeded specialty referrals.⁵

These findings highlight the imminent need for better tools to enable more data sharing and meaningful attribution of patient data, which can enable more precise diagnoses. While physicians may have access to the raw data, they need to distill it to determine the most appropriate treatment approaches. Abbott’s research revealed that physicians struggle with mastering the new technologies needed to accomplish this. In fact, when asked to name the resources that are underutilized in improving patient throughout and staff workflow, nearly 40% of surveyed physicians selected “industry provided training to ensure ease of use of new technologies.”

Imaging heads the list of promising technologies

In Abbott’s survey, physicians and administrators named several diagnostic and treatment technologies that are driving improvements in the quality of care.

Heading the list are imaging tools that enable more precise interventions (named by 63% of physicians and 55% of administrators globally). In the world of vascular care, imaging technologies can be classified broadly into those that are non-invasive and invasive:

Non-invasive and invasive imaging enable physicians to make well-informed decisions for greater efficiency and improved procedural effectiveness.

When it comes to imaging, however, physician and administrator respondents to Abbott’s survey expressed the need for improvement in one key area: “technology that reduces imaging interpretation time” (named by 48% of administrators and 39% of physicians globally).

Artificial intelligence can fuel better outcomes, reduced costs

A 2017 survey of 300 PCPs commissioned by Surescripts reinforces Dr. Pinella-Echeverri’s assertion. This research showed that while electronic access to patient medication adherence, clinical history and prescription cost information are high priorities among these physicians, access to this data can be elusive. For example, 83% of physicians believe that access to medication adherence information is important, but only 17% can easily retrieve it electronically; more than half (56%) of physicians think prescription price transparency is a priority, but only 11% can easily retrieve out-of-pocket medication cost information. Further, 88% of physicians prioritize having patient history information, but only 30% report the ability to easily access it. ⁷

Artificial intelligence (AI) could provide the solution.

In the world of healthcare, AI has been called “the ideal population tool" based on its ability to enable comparisons of individual cases to results from broader populations, help providers identify individuals at greater or lesser risk of developing chronic diseases or related complications, tailor preventive therapies, and allocate limited resources to those most likely to benefit from them.⁸ AI has the ability to synthesize, assimilate and integrate genetic, environmental and lifestyle data from a wide variety of sources (wearables, social media, EHRs, smart devices such as phones, cars, televisions, home appliances, etc.) to create models that can predict the trajectory of both health and disease⁹, and in turn determine the best candidates for specific treatments. For these and other reasons, AI ranked as the No. 1 tool/technology for surveyed administrators from China in terms of its perceived value for providing information that ultimately leads to improved patient care (named by 71% of Chinese administrator respondents to Abbott’s survey).

AI can especially assist beleaguered physicians struggling to spend more time with patients and discern data insights relevant to each patient. At the same time, it can help address administrators’ desire to reduce costs by boosting efficiency. When asked to indicate how recent technological advances are impacting workflow and staff experience, administrator respondents to Abbott’s survey were almost unanimous in selecting “allowing us to map the care journey more efficiently” and “making procedures more efficient” as their top two choices.

According to an article in the Journal of the American College of Cardiology, artificial intelligence is poised to “provide a set of tools to augment and extend the effectiveness of the cardiologist.”¹⁰ For example, reinforcement learning algorithms can operate in the background while helping physicians to streamline clinical care. In addition, AI-driven advances in unsupervised learning could lead to better treatment selection and better outcomes, and remove much of the tedium from everyday clinical practices by automating tasks, such having to interact with EHRs and billing on a manual basis.

Monitoring technologies can bolster aftercare, reduce readmissions

Monitoring technologies for treatment adherence continue to evolve.

The biggest trends are occurring in the area of remote patient monitoring (RPM), through which patients’ health can be examined from a distance. Rather than needing to see a patient in person, the physician can conduct consultations via a video call and access patient readings through a digital or combined digital/physical platform. Cardiovascular RPM involves usage of several connected medical devices in the home, with innovative wearables such as skin patches, accessories and smart clothing. Smart software and AI are also being incorporated into wearables and app algorithms to detect abnormally high heart rates, arrhythmias and other factors, and to alert patients to contact their doctors. This early-warning network could play a big role in the coming years to automatically triage patients and help them know when they should seek professional healthcare help¹², and has recently been demonstrated to diagnose early-warning signs of angina. ¹³

Telemonitoring tools are already yielding benefits for cardiovascular patients. For example, one telemonitoring program implemented by Geisinger Health Plan (GHP) targeted patients suffering from heart failure. Over a five-year period, GHP measured hospital admission rates, readmission rates and total cost of care for patients enrolled in the telemonitoring program versus cardiovascular-disease patients not enrolled in the program.

This study clearly shows that this group of cardiovascular patients is significantly more likely to stay out of the hospital by using digitally connected solutions that help manage their chronic condition over time.¹⁴

Further, interest in use of novel telemedicine techniques (another form of telemonitoring) has been accentuated and accelerated by the COVID-19 pandemic. In the United States, CMS granted reimbursement for remote telemedicine consultations¹⁵, perhaps signaling a new future for remote follow-up.

Conclusion

Abbott’s survey results have highlighted the importance of moving care from a point-in-time, intervention-only focus to a holistic, “whole patient” approach.

By harnessing technology and data to see the whole patient, physicians and administrators can help make the Institute for Healthcare Improvement’s (IHI) “Triple Aim”¹⁶ objective a reality by:

1. Improving the patient experience of care
2. Boosting the health of populations
3. Reducing the per-capita cost of healthcare

As a result, healthcare providers can lessen the pressure on publicly funded healthcare budgets, ultimately helping communities boost the vitality and economic wellbeing of their inhabitants.

About the Survey

To obtain a global view of how cardiovascular treatments could be improved by employing technological advances and better data visibility, Abbott surveyed 1,432 physicians, administrators, and patients between December 2019 and January 2020. Respondents to the online survey represent nine countries: the United States, the United Kingdom, China, Japan, France, Germany, India, Italy, and Brazil. Characteristics of the respondents were as follows:

References

1. “Cardiovascular Diseases (CVDs),” World Health Organisation, May 17, 2017
2. Abbott asked over 1,400 patients, physicians and healthcare executives across nine different geographies to share their insights into the state of vascular disease care today – and into how technology could help remove the barriers to optimal, tailored, patient-centric care.
3. Physician respondents to Abbott’s survey are cardiologists and other specialists that refer patients to interventional cardiologists, vascular surgeons, or interventional radiologists.
4. Jeff Bevis, “Plugging the Gaps in the Continuum of Care,” Forbes, October 29, 2018
5. Julia Haskins, “5 Ways eConsults Benefit You and Your Patients,” AAMC, May 3, 2019
6. Hong SJ, Kim BK, Shin DH et al. Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial. JAMA 2015’ 314: 2155-63.
7. Tracey Walker, “Survey Uncovers Key Gaps in Provider Access to Patient Data,” Managed Healthcare Executive, May 4, 2018
8. “Trends in Cardiovascular Medicine: What May Be Ahead for 2019?”, American College of Cardiology, January 18, 2019
9. Ibid.
10. Codrin Arsene, “9 Cardiovascular Health Technologies Doctors Should Know,” Digital Authority Partners, January 2, 2019
11. “The Cardiovascular Disease Technology Market Will Exceed $40 Billion by 2030,” Diagnostic and Interventional Cardiology, December 18, 2019
12. Dave Fornell, “8 Cardiovascular Technologies to Watch in 2020,” Diagnostic and Interventional Technology, January 24, 2020
13. Drexler M, Elsner C, Gablemann V et al. Apple Watch Detecting Coronary Ischaemia During Chest Pain Episodes or an Apple a Day May Keep Myocardial Infarction Away. Eur Heart J 2020; ehaa290. doi: 10.1093/eurheartj/ehaa290. Online ahead of print.
14. Codrin Arsene, “9 Cardiovascular Health Technologies Doctors Should Know,” Digital Authority Partners, January 2, 2019
15. CMS Medicare Telemedicine Health Care Provider Fact Sheet March 17, 2020. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
16. “IHI Triple Aim Initiative: Better Care for Individuals, Better Health for Populations, and Lower Per Capita Costs,” Institute for Healthcare Improvement, 2020