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Leah Kelley



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    OS14 - Keeping Patients Healthy at Home (ID 5)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 1
    • Coordinates: 5/28/2019, 10:00 AM - 11:00 AM, Area 2
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      OS14.01 - Using Wound Monitoring Technologies to Demonstrate System-Level Digital Health Barriers (ID 418)

      Leah Kelley, Institute for Health System Solutions and Virtual Care (WIHV), Women’s College Hospital; Toronto/CA

      • Abstract

      Purpose/Objectives:
      WIHV collaborates with the National Research Council’s Industrial Research Assistance Program to provide advice to small-to-medium size enterprises in the digital health sector. Innovators experience several system-level barriers, including a lack of visible incentives to providers and patients to adopt such solutions. We use a collection of wound care applications accessing our program as a window to demonstrate recurring system-level barriers to their adoption.


      Methodology/Approach:
      Three digital wound monitoring applications were assessed through our program. For the purpose of this analysis, we focused on the use of wound monitoring applications in patients accessing provincially-funded homecare services. We extracted system barriers to successful clinical integration and placed these barriers within the context of current funding and incentive models.


      Finding/Results:
      Three primary system challenges to integrating a digital virtual wound care solution into the homecare setting were identified: *1) Unclear payer: There is no obvious payer for most digital solutions; incentives aligned to in-person visits so virtual care often creates cost for the user despite system savings. 2) Lack of integration with surrounding system: Key processes, such as escalation in the care pathway if adverse events occur, are poorly defined. 3) Lack of data governance models*: There are no consistent processes for defining who is responsible to capture data, who must review it, and where it should reside. The value propositions for homecare agencies and clinicians to purchase and utilize wound monitoring apps are unclear, despite potential improvements in patient health outcomes (Table 1). First, the benefits may be accrued elsewhere in the system (e.g. reduced emergency department utilization). Second, the siloing of homecare from key participants in the tool’s success (e.g. primary care providers and dermatologists), creates a system whereby homecare must try to govern processes where they have no control. It is essential to capture the value proposition of the tool for each relevant stakeholder, especially payers and users, as these value propositions may not be aligned. The challenge is to create “wins” for all core parties. A non-bundled, fee-for-service context given is a significant disincentive for institutions to adopt a virtual service model. Alternatively, outcomes-based bundles could offset some disincentives by encouraging institutions to improve outcomes through methods (e.g. virtual technology) that maximize their efficiency. Table 1. Understanding stakeholder funding and value propositions Stakeholder Payment Engagement Value proposition Homecare agency/PSW Fee-for-service (in-person) Use application to monitor healing; Escalate care as needed Fewer visits of value because high homecare demand Primary care provider Fee-for-service (in-person/e-consult) Review application data; Escalate to specialist if needed No incentive to reduce in-person visits Dermatologist Fee-for-service (in-person/e-consult) Review application data in consult No value proposition Local Health Integration Network Fixed homecare budget from Ministry Purchase application If app reduces visits, can increase patient coverage


      Conclusion/Implications/Recommendations:
      The current system creates an entanglement of complex incentives and payment models that stifle the success of digital innovations. Outcomes-based funding models, such as bundled payments to homecare agencies, would enable institutions and clinicians to utilize innovations to improve the quality and efficiency of care provision, as demonstrated by the above use case.


      140 Character Summary:
      Digital health solutions face barriers in system incentives due to funding models; use case of wound monitoring application demonstrates key challenges.