The Hidden Ingredient

Craig Joseph, MD
By: Craig Joseph, MD
Date: January 31, 2019

I was recently at a presentation with the entire C-suite of the hospital in attendance. We were talking about technology and listening to a few vendors predict their future as well as ours. A slide was projected showing data interfaces coming from multiple sources (patient, health system, payer, etc.) coming together with an algorithm at the center. And voila, from The Algorithm (my snarky capitalization added) came forth healthcare recommendations for the patient’s care. It was a moment I’d dreamed about, but never before witnessed.

Nah, who am I kidding? It was a moment I see pretty much every day. Tech companies have been lining up for years to disrupt healthcare. Here’s the new Uber of healthcare. There’s the new Amazon of healthcare. Oh wait, I forgot: Amazon is the new Amazon of healthcare. Anyway, you get the picture. Lots of folks want to take data from various sources and use them to make people healthier. It’s a great ideal to strive toward. But often, there is just one small thing missing. It’s a minor element, but without it, there’s a dearth of progress.

In the meeting I was attending, we were discussing how diabetic patients now have access to devices that can automatically check glucose levels many times an hour, and upload those readings to a third party in near real time. That third-party company uses math (aka The Algorithm) to predict problems and send warnings to the patient and doctor. These warnings often include lots of discrete data so humans can decide how worried they should actually be.

Someone noted that there are very successful companies that hire healthcare professionals to be on the receiving end of these warnings. These doctors and nurses work with the patient and the physician to get the patient the care that is needed. Someone noted that this seemed ridiculous, an unnecessary middleman between the data and the care provider. Why not just send the information to the doctor taking direct care of the patient, and leave it to the physician to figure out next steps? Why not indeed!

That’s where this hidden ingredient comes into play. It may come as a shock to readers who live outside the United States or who haven’t interacted with our “system” of healthcare in a decade or two, but doctors are sort of busy in the outpatient setting. They’re seeing more patients in less time. They’re being asked, no commanded, to document information that may not be directly relevant to the care that they are providing. They’re responding to more patient requests. They’re caring for sicker patients who no longer qualify for inpatient hospitalization. And while they’re doing all of these things, The Algorithm is calling/texting/emailing the doctor about a patient that may (or may not) be really sick and in need of urgent (or maybe not urgent) care.

The hidden element is . . . the care team. We talk about teams of care here in the U.S., but most of us can’t actually practice that way. While I have no data (I’m sure it’s out there somewhere), my experience is that most physicians act not so much as the captain of the ship, but more like the captain, chief engineer, cook, and bosun’s mate. Doctors are doing work that assistants did decades ago: writing replacement scripts, giving routine advice, performing minor procedures, etc. I could spend several blog posts discussing why this is, but let’s not go there now. Suffice to say that doctors are overloaded and feeling burned out. Adding another task involving constant interpretation of glucose data in near real time, and you often have a camel eyeing a piece of straw.

Healthcare leaders need to invest in putting a care team in place to surround the physician. These care team members must be well-trained and work at the top of their scope of practice. As with any sports team, these members are not interchangeable. They must work with the same team members (and same captain) day in and day out in order to function like . . . well, like a team! It costs some money to be certain, but a team allows doctors to focus on what they do best while delegating routine issues to others. A registered nurse, especially one with experience and specific training, is a terrific first contact when The Algorithm notes a peculiarity. The nurse might know the patient well, and can respond even more appropriately than the physician. The nurse has the tools, insights, and know how to deal with what he or she can and escalate to the physician when danger is lurking.

Math will never replace the care team. And without honest-to-goodness care teams, math can’t be nearly as effective at saving lives and stamping out disease.

Are you using care teams? Are they stamping out disease?

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