An Introduction to Digital Care Pathways

1. An Introduction to Digital Care Pathways (DCPs)

Today, care pathways are increasingly digital care pathways. What does that mean for patients and healthcare providers in the era of value-based care?

They have been called "clinical pathways," "care pathways," "care maps," and "patient journeys," but no matter what term is used, the meaning is essentially the same: the step-by-step movement of patients through the healthcare system, starting with the realisation of a problem or concern and followed by the efforts to address it. The concept of care pathways was born in the US in the 1980s, a result of applying documents used in industrial quality management to improving efficiency in the process of delivering healthcare. Changes in reimbursement underway at the time were a driving factor. While reimbursement had traditionally been tied to the volume of care an organisation delivered, the focus was shifting to outcomes or value-based care. Establishing pathways based on groups of patients' shared conditions, and the consistent and predictable steps that made up their care, allowed treatments to be standardised based on medical evidence known to improve outcomes while reducing costs.

2. Care Pathways Are Becoming Digital Care Pathways

Like much else in today's world, care pathways are increasingly being digitised. "Digital Care Pathways" (DCPs) employ digital technologies to follow and support patients through their healthcare journeys. DCPs present healthcare systems with a way to more deeply understand each patient's health and deliver more streamlined, proactive, and patient-centric care. Ideally, this approach also proves to be the most cost effective.

The process of digitising care pathways has been underway for years and is steadily advancing. Consider these facts:

• 77% of hospital patients in a US study used an online search to find their hospital

• 89% of physicians use electronic medical records (EMRs)

• 94% of hospitals use EMRs

• 88% of healthcare leaders from a New England Journal of Medicine survey already use or have plans to implement a patient portal for their organisation

• 80% of Americans who have access to their electronic protected health information (ePHI) use it. More than 60% of those who do not have access say they want it.

All of the above are examples of the use of digital technology to support healthcare and patients' effective interaction with the system. There are numerous other examples, and more are arriving on the scene almost every day.

The growth of digital care pathways (DCPs) is good news, because DCPs offer patients and healthcare providers many benefits. We'll touch on several of them in the paragraphs that follow.

3. The Three Basic Types of Care Pathways

1.The Traditional Analog Care Pathway

The traditional patient journey has no digital component. Every interaction the patient has with healthcare providers and the healthcare system is analog.

In the analog scenario, if a piece of paper is lost, that information will be lost with it. Time and resources are repeatedly sacrificed throughout the process as all parties wait for paper to move from one locale to another in order for progress to be made. Capturing and sharing information is burdensome and uncertain. And, information that could be useful in many quarters of the system, often doesn't get there—or doesn't get there in time.

2. The Hybrid Care Pathway

Today, in most parts of the world, a patient care pathway is not likely to be entirely analog. It will almost certainly be a hybrid of analog and digital systems and practices. There are many forms this can take. We'll look at just one possible example.

Introducing digital or electronic elements in this scenario allows for several improvements in the process versus a traditional, fully analog care pathway: To begin with, information provided digitally is automatically and securely stored and readily shared with appropriate stakeholders. Patients, in turn, can share vital information with healthcare providers via their own devices from the comfort of their own homes. This touchless, instantaneous exchange of information saves time for everyone involved, while keeping all better connected and better informed.

Imagine if the potential of this model were fully realised.

3. An Integrated, Digital Care Pathway

In the not-too-distant future, every possible element of the care pathway will be digitised and integrated to maximise ease and efficiency, as well as quality of care. Consider this potential scenario:

In this scenario, the relative ease of collecting health information from patients and making it available to HCPs in real-time facilitates efficient, shared decision making and more person-centred care. Every stakeholder across the system benefits.

Some pathways will be far more complex than others, pathways for cancer treatment, for example, but the efficiencies and benefits are fundamentally the same: Care improves and is more patient-centric, healthcare providers and systems gain efficiency, and payers see costs reduced.

4. The Benefits of Enabling DCPs

For Patients

While it may seem paradoxical, the digital experience, even when it's remote, can enable a deeper relationship between patients and HCPs. The relative ease and timeliness of virtual encounters reduces stress and complications. Collecting information directly from patients at home and making it available to HCPs in real time enables shared decision making and care that is more personal and person-centered. Further to that, digital interactions are more frequent and more detailed than traditional interactions between patients and HCPs typically are, allowing patients to reasonably feel that their HCPs, and in fact, the healthcare system as a whole, is more readily accessible to them, and more interested in the details of their experience.

Also, in this system, proximity, geography, or ability to travel are not barriers to receiving quality care in a timely fashion. By enabling healthcare to be monitored and delivered outside traditional care settings, patients are saved time, money, and energy that would otherwise be spent unnecessarily accessing health services. But let's consider the hard health benefits. For example:

• Integration of PROMs into the routine care of patients with metastatic cancer has been associated with reductions in ER visits by 7% and increased survival of 5 months compared with survival with usual care1.

• A meta-analysis has shown that telehealth programmes had significant overall effectiveness in reducing all-cause mortality by 34% among patients with chronic heart failure.2

• Web-based monitoring of advanced-stage lung cancer patients was shown to improve overall survival by more than 50%.

While it may seem paradoxical, the remote/digital experience can enable a deeper relationship between patients and HCPs.

For Healthcare Providers (HCPs)

HCPs and healthcare systems also benefit when DCPs are enabled. The efficiencies provided by digitisation give HCPs the ability to effectively monitor and manage more patients without the need to invest in more staff. Existing staff can enjoy a reduction in administrative tasks, and as a result, more time to focus on delivering care.

Digitisation of standard tasks and information exchange between patients and HCPs also enhances the quality of care by enabling alerts to be generated immediately should patients experience adverse events or deterioration. Early detection and notification of deterioration gives HCPs the opportunity to act quickly to prevent hospitalisation, for example. Care improves system-wide over time as the DCP ecosystem enables ever more precise predictions and recommendations for HCPs based on big data analysis and machine learning.

DCPs also lower the cost of care by fostering a more efficient system that better monitors and manages patients, supporting adherence to care plans, reducing unnecessary re-admissions, and shortening the length of hospital stays by providing greater options for remote care.

Finally, DCPs can expand the potential patient population and encatchment area for a hospital as they make proximity of patients to services less important.