Innovation as evolution. So often we see “innovation” as a one-time event, but it usually happens over time. But can you plan for evolutionary innovation? The American College of Cardiology (ACC) spent over a year engaging their stakeholders from multiple disciplines, patients and caregivers to develop a comprehensive roadmap for innovation.1 Transitioning from horses and trains to widespread use of automobiles took new infrastructure development, navigation tools, rules of the road to ensure safety, consumer education and a paradigm shift in thinking about travel. Likewise, transitioning from fax machines and paper to digital systems and tools involves changing communication expectations (clinician to patient, clinician to clinician and among the professional organizations), data acquisition and use, research practices, roles of patients, payers, clinicians and caregivers, financial and legal concerns and more. Change will not happen overnight, and it won’t always be predictable. I believe that ACC is to be congratulated for its work to identify in advance the variables, plan for their potential interactions and identify goals of patients and clinicians that will smooth the transition and result in better outcomes. To make this happen, the ACC brings together multiple disciplines and patients to create an Innovation Collaborative to support innovation research for improved patient care processes and more empowered patients and clinicians.
Identifying today’s key trends and defining the goals. Today’s healthcare services are based on last century practice and discoveries and are sustained with reimbursement mechanisms. Even documentation of care is driven by reimbursement requirements, making it less effective for communicating problems, treatments and recommendations. The ACC Roadmap looks at what’s available today and envisioned for the future. The ACC Roadmap key points:
- Complex care requires more disciplines’ involvement. In addition, patients and caregivers need to be more involved in goal setting and decision-making. Today and in the future, more care is provided for chronic conditions, requiring ongoing treatment and monitoring done by patients and family members, with multiple disciplines helping them to reach agreed-upon goals.
- Patients need convenient ways to submit data to platforms accessed by clinicians and researchers. Today’s clinicians and patients are less likely to want to fill out paper forms, especially if it needs to be done repeatedly. Clinicians will find new ways to acquire, manage and use patient-generated data when providing care so it is not too burdensome for patients or clinicians.
- Virtual communication will continue to expand. Better care occurs with more targeted discussions that could easily be facilitated by one or more video visits or email exchanges. How can those new types of encounters be documented? Research is needed to determine which kinds of communication are the most useful for various purposes. For example, a follow up exchange may require a different method than an educational exchange or a discussion about a new diagnosis. Some may require patients to think about options and discuss with family members. Patients may also seek advice from other clinicians, either as a second opinion or as a more convenient follow up. Having an accurate and succinct summary of the issues makes it easier for other clinicians to address them.
- Analytic tools are now available that utilize more data sources but getting all the data in a usable format has been difficult. Privacy, security and transparency are issues still being addressed, and keeping patients informed about data sharing and allowing patients to share their own data for research and other purposes will improve transparency and data accuracy. These new tools are in their infancy today but are rapidly gaining experience.
Identifying barriers and ways to overcome them. Health information technology was adopted rapidly and, as a result, has experienced unintended consequences. Clinicians are deeply dissatisfied with today’s systems because of documentation requirements and lack of harmonization with complex workflows. New systems will need to incorporate new types of data and enable analysis to improve efficiency and clinical outcomes. In the end, new next-generation “learning health systems” enabled by continuous data collection and analytics will impact both research and care delivery.
Research opportunities. Although randomized study designs have dominated the research world for some time, new ways of collecting and analyzing data are needed to keep up with rapid advances in the science of healthcare. The technology itself will need to be studied to assess its usefulness, its acceptance by users and its ability to improve quality, safety and cost of care. New methods of collecting and utilizing data add complexity and require oversight to make sure patients and clinicians are on the same page with data sharing and collaboration. I believe ACC has started a process by which new research findings can be generated. Because each specialty has different patient and clinician issues to address, it can be a model that other medical societies can follow to accelerate innovation.
As new technologies become paradigm-shifting enablers of change, healthcare organizations and clinicians need to be ready to meet patients’ expectations. The way that patients and clinicians engage and communicate will evolve, and the ACC Roadmap creates a focused guide for more efficient research and clinical care. The ACC’s goal is to engage stakeholders, facilitate partnerships and provide feedback to those working to accelerate healthcare transformation and transparency and enable creation of rich datasets for fostering the next generation of research and patient care. In the end, these efforts will foster continuous improvements and optimize practice management in ways that bring value to patients, clinicians and other stakeholders.
1Bhavnani SP, Parakh K, Atreja A, Druz R, Graham GN, Hayek SS, Krumholz HM, Maddox TM, Majmudar MD, Rumsfeld JS, Shah BR. 2017 Roadmap for Innovation – ACC Health Policy Statement on Healthcare Transformation in the Era of Digital Health, Big Data, and Precision Health. J Am Coll Cardiol 70(21):2696-718 (2017).