Health / 2013
OPENHealth Central Putting the care back in healthcare
Placing patients at the center of care: OPENHealth Central Obamacare is increasing the number of people with access to health insurance in Los Angeles, but that won’t automatically translate into better care. LA's healthcare systems serve more people than anywhere else. However, given the geographic, economic, and social disparities in the county, meeting the needs of the newly insured is a huge challenge. Making matters more difficult, no software service exists that is designed specially to assist primary-care teams in managing their most complex cases. Fortunately, these challenges offer an opportunity to create an innovative system and forge new partnerships that can improve care for everyone in Los Angeles and serve as an example for the entire country. Taking advantage of this opportunity will be easier with the open-source software service that we call OPENHealth Central, whose purpose is to put the 'care' back into the healthcare system. OPENHealth Central helps doctors and patients plan for visits more effectively, track experiences between visits, boost the quality of care and self-care, and provide the psychological support that comes from a rich human feedback loop. The system does this by triggering action on the part of doctors, while collecting data that drives evidence-based improvement in patient care, population health, and healthcare costs. OPENHealth Central provides patients with effective ways to organize and use their healthcare information in order to be more active participants in their own care. Beyond helping people make and prepare for medical appointments, keep track of prescriptions, and decode lab results, OPENHealth Central also encourages people to set and reach health goals through tailored care plans that offer both medical and lifestyle suggestions. Engaged patients make healthier choices, which means a healthier population—and reduced healthcare costs—overall. LA's healthcare challenges require a systematic response The newly insured have significant health needs and social circumstances that make it difficult for them to take full advantage of healthcare services. Meanwhile, this population is often treated at clinics that are already tending to those living in under-served communities where caseloads are high, funding is minimal, and compensation is restricted to face-to-face services only. A shortage of primary-care doctors in these communities already makes it more difficult to help people achieve optimal health. Fortunately, physician-led inter-disciplinary "care team" models are emerging to address this shortage while improving care. And yet there is no integrated software service that will help with this transition to a more efficient and effective care model. Placing patient needs at the center of healthcare Los Angeles can bridge the gap between insurance reform and healthcare reform in a systematic and innovative fashion by supporting OPENHealth Central, a web- and mobile-based system that helps clinical care teams better manage the health needs of patients with complex and costly chronic illnesses. When operational, OPENHealth Central will help clinical care teams: • screen, assess, and coordinate the care of patients whose complex health problems and social situations pose barriers to timely and economical care • communicate with and monitor the health of patients remotely, in order to improve data quality while saving on time and expense associated with face-to-face clinical encounters • support individualized preventive/chronic/acute wellness planning to keep people out of the hospital whenever possible • develop a primary care model of continuous personal relationships that are data-driven and accountable; doing so will help ensure that clinical quality data can be more easily shared within medical practices and across hospitals and clinics, to improve the overall quality of care of Angelenos • increase patient access to healthcare and community assistance programs, facilitating 'warm hand-offs' to people in agencies who can help the patient with their health-related needs OPENHealth Central will help Angelenos and their care-providers lead more healthy and satisfying lives regardless of their social advantages.
What are some of your organization’s most important achievements to date?
OPENHealth Central is being designed by Lybba, a 501(c)3 nonprofit based in Los Angeles that design networks, tools, and events that help people better care for themselves and one another. We engage patients, physicians, and researchers in collaborations that create breakthrough solutions.
Over the past three years Lybba is a founding designer of the Collaborative Chronic Care Network (C3N), a new model for devising and testing innovations in clinical care and research. We are designing tools that help patients track their health between appointments, visualize their health over time via clear and engaging graphics, communicate with physicians using online and mobile applications, and choose to share their medical data with other patients and researchers. By increasing patient engagement, the C3N can transform the experience and outcomes of illness, and accelerate the discovery and application of new knowledge. (Supported by the National Institutes of Health.)
Lybba is currently designing and building an automated decision-support aid for doctors and patients to use together to achieve better outcomes. By using this product, patients with serious chronic illnesses will arrive at decisions about the treatment options most suitable to their particular situation. (Supported by a major LA research medical center.)
Lybba designed a Genetic Care Interchange that networks the collective experience of patients, their genetic information, and medical knowledge to supply insight for creating new genetically defined targets for drug development. (Supported by southern California life-sciences company.)
Lybba designed knowledge base of medical diagnostic, including knowledge-sharing models for how potential contributors–such as MDs, patients, organizations, and others–will participate in the creation and cultivation of an online knowledge base of medical diagnostic information and techniques. (Supported by the California Endowment.)
Lybba is a co-designer of the Regional Resource Network of quality improvement leaders throughout the country. With the Institute for Healthcare Improvement, we are devising prototypes that will make it easier for people to develop, curate, and spread knowledge. (Supported by the Robert Wood Johnson Foundation.)
Lybba conceived of and created an immersive DIY bio-design event for high school science classrooms in partnership with The California Endowment and their Building Healthy Community initiative in South LA. Focused on career opportunities in the life sciences and the cross-application of biotech knowledge, Biohackathon L.A. 2013, held in South L.A., was the first in a series throughout the state. (Supported by the California Biotechnology Foundation.)
In addition to the programs above, Lybba has designed, constructed, and created content strategy for a dozen healthcare websites. Lybba has also produced two dozen films on science and healthcare with our film-making partner, Wondros.
Please identify any partners or collaborators who will work with you on this project.
OPENHealth Central will be built in an open-source fashion, relying on multiple software and data providers to achieve rapid, widespread transformation of healthcare for the public good.
Brian Prestwich, MD, Assistant Professor of Clinical Family Medicine at the Keck School of Medicine of USC, serves as Medical Director for OPENHealth Central. We also have the support of Libby Hoy, founder Patient & Family Centered Care Partners, which contribute knowledge, insight, as well as a test-bed for the OPENHealth Central. PFCC Partners is committed to building a community of health care providers, administrators, patients, and families to improve the quality, safety, experience and delivery of health care.
Please explain how you will evaluate your project. How will you measure success?
OPENHealth Central, at its core, is a data system that tracks the quality of the care experience, the care process itself, costs, and outcomes. It will provide much needed information to practice leaders and policymakers so that funds can flow where they will be of greatest value.
The Recovery Act (“Meaningful Use”) and the Affordable Care Act are leading patients, payers, purchasers, and the clinical leaders to demand information that sheds light on the true value of healthcare services. This historical alignment of payment for value has the potential to fuel the improvement of healthcare delivery in the U.S., but only if new metrics and methods are created to define value for all involved.
OPENHealth Central is designed to help provide better means to manage care, particularly at clinics in under-served communities and for patients with complex chronic diseases and their attendant co-morbidities. Costs associated with caring for these populations are staggering, and OPENHealth Central will provide the means for clinics in these communities to screen, care for, monitor, and collect evidence about these populations. This evidence-based model has the potential for creating the conditions for systemic change, particularly when such a software service is adopted by clinical care teams around Los Angeles using similar means for collecting and analyzing data about individual patients and whole populations.
Use of this and other systems across Los Angeles lays the groundwork for methodical multi-site clinical quality-improvement initiatives that can help healthcare providers demonstrate that their care is working and why. Such data will better satisfy the information needs of communities, private insurers, Medicare/Medicaid, and community-health researchers.
Finally, OPENHealth Central will promote transparent and appropriate data-governance mechanisms that will ensure fairness, openness, data sharing and hence a more level playing field for less-powerful players in multi-stakeholder projects such as this.
How will your project benefit Los Angeles?
The personal, community, and healthcare costs associated with treating chronic illness are crippling Los Angeles; the costs associated with not treating such cases are even greater. The influx of newly insured people in Los Angeles is taxing an already burdened system, because a significant number of these families have serious untreated illnesses and challenging social barriers to negotiate. Many new strategies must be adopted now if we are to make headway by 2050.
OPENHealth Central is designed to help clinics better plan and coordinate the in-home and clinical care of patients with chronic illnesses before their conditions grow serious, complex, and expensive. Baked into the shape and purpose of OPENHealth Central is a data-collection regime that aids clinics in improving quality of care and reducing costs. In addition to directly benefitting the patients and clinics using OPENHealth Central, these data will help identify which ‘needles’ to move across Los Angeles, helping to determine what is achieving positive results, and sharing those insights broadly.
These data, in turn, will provide policymakers and clinical practice leaders the information they need to channel resources where they are most needed.
LA’s current safety-net approach to healthcare (like the rest of the state’s) is limited to face-to-face strategies, emphasizing the volume of medical encounters over the value of medical attention. This must change if we are to improve outcomes while decreasing per-capita healthcare costs. OPENHealth Central is designed to increase the volume and value of care encounters while driving down costs, in part by providing digital tools that make it easier to make care decisions more accurately and swiftly.
Community-oriented care organizations (such Lybba’s collaborator, Family & Parent Centered Care Partners) strive to achieve the IHI Triple Aim of improved patient experience and care processes, improved outcomes, and better cost controls. But these organizations lack the computational infrastructure to make methodical and swift progress. Without data and the IT infrastructure to direct care resources optimally, even the most dedicated physicians and their care teams have difficulty discriminating between effective and ineffective care strategies. The business model for OPENHealth Central is centered around providing that infrastructure at low cost to clinical practices that would otherwise be unable to build their own.
The good news is that people actually will take better care for themselves and one another, especially when they have continuous, personal relationships with healthcare providers who know their case well and can help them achieve lifestyle and wellness objectives. Primary care practices in under-served communities are best positioned to be partners with these individuals, provided they have the tools they need to manage the care of their population.
What would success look like in the year 2050 regarding your indicator?
By 2050 the Los Angeles healthcare system can orient itself around the needs of the vast number of people who are currently ill-served by the current system. This will happen because we will have used our know-how, passion, and community assets to create resilient peer networks that are focused on outcomes for all residents, not just those with the most luxurious insurance policies.
Currently, only half the U.S. population with chronic illness receives the care they need, and only half of those patients successfully follow the wellness plans provided by their physicians. Depression, diabetes, heart disease, renal failure, and other prevalent chronic ailments can quickly escalate without screening, monitoring, and timely intervention. With so much data being produced by and on behalf of patients, systems will emerge to offer a more continuous model of care and that reinforces best practices and collaboration between patients and their care-providers.
Just as important, these systems will convert data into care insights and meaningful action, helping to ensure that patients have access to and control over their own health information. Los Angeles in 2050 will be driven by its citizens not just because laws such as HIPPA says that they have a right to their data, but because systems rise up to help citizens use that data to improve their own care and the care of whole populations.
The healthcare system of Los Angeles in 2050 can keep people informed, connected, and ideally out of the hospital via a continuous care model that saves time, money, and lives. It can provide care-providers better ways to connect with their patients and each another, enabling more continuous and symmetrical flows of information.
The design of OPENHealth Central, which will be made available to the public, will provide an example that can be adopted, adapted, and/or emulated, thus contributing to the common good by offering an alternative to the profit-oriented companies offering billing systems in the guise of EMRs and PMSs.