All Hands on Deck

Realizing the Health Cloud mission will require full participation from the care continuum. Every provider a patient interacts with will need to collaborate; gaps in provider participation will omit key information needed to truly fulfill the ambitious goals Salesforce holds as it comes to market.

Yes, providers are being incentivized to provide quality care and leverage technology in a meaningful capacity. But providers are struggling with the basics (functional websites that offer some form of convenience or value-added service for their patients; e.g. appointment scheduling or issuing appointment reminders).

Doctors may have more tools to manage quality, but only at the expense of access since they will be able to see fewer patients per day. As the bulk of reimbursement is not tied to quality, providers are still incentivized to chase quantity over quality.

Even if we ignore technology-adoption foibles, any time spent above and beyond existing documentation and processes will take precious time away from care delivery. Time is a fixed commodity. Adopting supplementary tech in healthcare and into workflows WILL have some inherent trade-offs. Doctors may have more tools to manage quality, but only at the expense of access since they will be able to see fewer patients per day. As the bulk of reimbursement is not tied to quality, providers are still incentivized to chase quantity over quality. Unless quality incentives comprise the majority of potential reimbursement, providers will choose to operate high quantity practices over high quality practices every time—their paycheck depends on it.

What about capitated arrangements? Where providers are paid to manage the health of a population on a per member per month basis? Even here the incentives are misaligned. Providers will still seek to have a larger population to manage and will seek to be as ruthlessly efficient as possible when providing care to maximize their coverage and their paycheck. The importance of physician reimbursement models as a factor in the success of Health Cloud can’t be overstated.

While the technology behind Health Cloud is sound, these barriers to adoption will impact patients, manifesting themselves in varied care coordination and delivery. If we judge the effectiveness of Health Cloud and similar technologies based solely on metrics surrounding the improvement in health outcomes, we’ll be missing a big part of the story and we’ll be led to believe that technology in healthcare has less value than we thought.

 

EMR Integration (sort-of)

While Health Cloud does receive information from the Electronic Health Record (EMR), it doesn’t populate it. If providers choose to share health records for care coordination, the rich data available in Health Cloud doesn’t transport with the EHR. Whether through positioning or old-fashioned failure to follow through, the absence of bi-directional data flow between the EMR and Health Cloud will prevent caregivers who do not use Health Cloud from leveraging all available data to help their patients.

It is likely that the information captured in Health Cloud will be relevant to everyone in the care continuum, especially when you consider the patient-supplied information that Health Cloud will capture—things like medication adherence, diet, exercise, etc. If the EMR doesn’t capture this content, providers won’t be as informed as they could be, otherwise.

 
Wear Your Heart on Your Wrist

Including data from wearables is absolutely helpful. Providers need to understand their patients’ habits. However, most health wearables were crafted and marketed specifically to avoid being classified as a medical device. The absence of this classification gives them the freedom to measure health data without so much government oversight. It also provides variation in the data that is collected from one wearable to the next, even for similar readings.

While the trend-line for any given type of data (steps measured, calories burned, etc) will likely be similar, it will be important for healthcare providers to understand that these data inputs are not standard and can demonstrate variability, and even malfunctions, that would otherwise not be tolerated in the medical device market.

However, most health wearables were crafted and marketed specifically to avoid being classified as a medical device. The absence of this classification gives them the freedom to measure health data without so much government oversight.

 

Innovation Requires Participation

Overall, Health Cloud is an astounding advancement in care coordination and is equipped with all the tools required to make meaningful advancements in health outcomes through the application of tech-industry know-how. However, if providers refuse to use it, a variety of pressures from both consumers and regulatory agencies will be needed to achieve critical mass and deliver on its mission.

Salesforce may want to consider regional-pricing for providers, and, generally speaking, focus on building out provider side features and functionality that DECREASE the administrative burden of documenting patient data and managing health outcomes —not adding to the existing strain on providers.