Collaborative Workflows, Coordinated Care - Intel

WHITE PAPER
Collaborative Workflows

Collaborative Workflows, Coordinated Care:

Meeting the Challenges of 21st Century Healthcare

Mark N. Blatt, MD Collaborative Care: An Economic Imperative
Global Medical Director
Cost pressures, new payment models, and demographic trends are creating a global eco-
Intel Corporation nomic crisis as health systems struggle to care for an aging population of sicker patients.
Funds available for healthcare are constrained, and they’re being wasted by inefficient,
Bill Crounse, MD uncoordinated healthcare services.
Senior Director,
Across the nations of the OECD, health expenditures consume an average of 9 percent
Worldwide Health, of Gross Domestic Product, and real per capita healthcare expenditures grew more than
Microsoft Corporation 4 percent annually during 1997-2007.1 In the UK, the NHS wastes GBP 330 annually by
treating patients as emergency hospital admissions when they could be seen by their GP.2
Ben Wilson, MBA, MPH
Director, Global Healthcare An oft-cited study shows that in the U.S. in 2003-2004, almost one in five hospitaliza-
Strategy, Intel Corporation tions of Medicare fee-for-service patients resulted in a readmission within 30 days of
discharge; three-quarters of these could have been prevented by better coordinated
Collaboration is nothing new care, and the cost to Medicare for these readmissions was USD 15 billion.3 Even tradi-
to healthcare, but with more tional fee-for-service practitioners are under financial duress, with the U.S. Small Busi-
ness Administration reporting that SBA-backed loans to physicians’ offices grew more
patients to care for, more than tenfold from 2000 to 2011.4
stakeholders to coordinate, and
limited funds; traditional paper, Controlling costs starts with better management of patients with multiple chronic
phone, and fax communications diseases, and it puts a premium on coordination and collaboration. Medicare patients
with multiple chronic illnesses see an average of 13 different physicians in the course
are woefully inadequate. of a year,5 and their full treatment team can easily include another dozen professionals
This paper discusses collabora- and paraprofessionals. Reflecting the importance of collaboration in caring for patients
tive workflows and information with chronic conditions, nearly 80 percent of the scoring criteria for the National
Committee for Quality Assurance’s (NCQA) Recognition Program for Physician Practice
tools that better meet the Connections (PPC) Patient-Centered Medical Home (PCMH) relate to information-
demands of today’s complex sharing and teamwork.

healthcare environments. New payment models are forcing delivery networks to share the risks and potential
It shares examples, insights, cost savings of caring for these patients. By imposing direct or indirect financial conse-
quences, these models incentivize organizations to emphasize prevention, deliver care
and best practices from in the lowest-cost appropriate setting, and reduce readmissions, Emergency Department
organizations that are using (ED) visits, acute-care admissions, and bed days of care. “These have always been the
right things to do, and physicians have always tried to do them, but changing financial
collaboration to deliver models will make them increasingly imperative for financial survival,” says Dr. James P.
more coordinated, cost- Dwyer, Executive Vice President for Physician Services at Virtua and a former co-chair
of the National Committee for Quality Health Care’s Performance Measurement Tools
effective care. Task Force.

Collaborative Workflows White Paper

Evidence for Coordinated Care clinical outcomes, reducing inpatient days • Sutter Health Sacramento-Sierra
and total cost of care, and increasing the Region, 2010: At a not-for-profit inte-
Collaborating with patients, families, and quality of life for patients and families.7 grated care system, a care coordination
the broader care team is crucial to achiev- program decreased hospitalizations by
ing these objectives. A growing body of • Geisinger Health System, 2010: 39 percent, ED visits by 16 percent, and
evidence shows that coordinated care A physician-led healthcare system in patient visits to specialists by 24 percent.
offers powerful ways to improve resource Pennsylvania, Geisinger developed a Sutter’s transitions-of-care protocols
utilization, outcomes, and both patient ProvenHealth Navigator* methodology achieved a 30-day readmission rate
and staff satisfaction. For example: as part of its adoption of the PCMH of 5.27 percent and also reduced care-
model. Geisinger practices that used giver anxiety.10
• Sweeney, 2007: At a large California- ProvenHealth Navigator showed a 40
based HMO, a patient-centered percent reduction in 30-day readmissions, Technology-Supported
management group had 38 percent 20 percent reduction in total admissions, Collaboration
fewer admissions, 36 percent fewer and 7 percent reduction in costs com-
inpatient days, 30 percent fewer ED pared to other Geisinger practices.8 Given the number of individuals and orga-
visits, and 26 percent lower costs nizations involved in the care of patients
than the HMO’s usual care.6 • New West Physicians, 2011: A primary with chronic conditions, the opportuni-
care physician practice and Level 1 PCMH ties for collaboration are plentiful—and
• U.S. Veterans Administration (VA) in Colorado has reduced 30-day readmis- technologies are rapidly evolving to make
Home-Based Primary Care (HBPC), sions to 1 percent—well below national collaboration simpler, more powerful, and
2011: Under this innovative program, averages of 6 to 18 percent. New more cost-effective.
an interdisciplinary team that includes a West has many characteristics of an
nurse, physician, rehabilitation therapist, Accountable Care Organization (ACO), Collaborative workflows start with
social worker, dietician, pharmacist, and and implemented best practices such securely sharing digital information and
psychologist collaborate to deliver com- as centralized discharge planning using it to function more effectively as a
prehensive, longitudinal primary care for and proactive follow up to achieve team. Technology-supported collabora-
patients with complex, chronic, disabling its results.9 tion builds on foundational technologies
disease for whom routine clinic-based such as electronic health records (EHRs)
care is ineffective. HBPC is improving and health information exchanges (HIEs).
It extends the return on investment (ROI)
of these technologies by adding capabili-
ties that enable organizations to securely
share data when and where it’s needed
and use it to empower care teams, pa-
tients, and families (Figure 1). “The current
status is too often one of information silos
that gather and store data,” explains Uwe
Buddrus, Managing Director of HIMSS Ana-
lytics Europe. “The crux of care coordina-
tion is the ability to mobilize and share
the data in the medical record.”

Figure 1. Sharing and mobilizing information
for collaborative care.
2

Collaborative Workflows White Paper

Collaborative workflows facilitate tasks The same approach could be applied at the “The most crucial member of
ranging from consultation requests and point of discharge, where case managers the healthcare team is the
treatment planning to patient education would share information securely and col- patient. The patient has to be
and engagement. Consider the example laboratively across the care chain as they fully involved in the collaboration
of a patient calling for an ambulance. With develop comprehensive discharge plans. and be viewed as a full member
collaborative workflows and technologies Digital information could flow without of the healthcare team. That has
in place, the ambulance service might use friction, saving time for each member of to result in a change in perception,
mobile devices to securely access relevant the care chain and avoiding gaps in the which has to result in a change
information about the patient’s treatment patient’s care. The case manager could in behavior.”
preferences and history. The service could organize a video conference that would
also initiate a multi-way video conference include the patient and his or her support – R achelle Kaye, PhD
or secure messaging conference with the network along with the physician, home Maccabi Healthcare Services
patient or their family member and the health nurse, and other professionals.
patient’s primary care doctor, community They can share relevant data, answer
care nurse, and an ED specialist. Pooling questions as a team, ensure that needed
their knowledge, the team might well services are in place, and leave everyone
conclude that the best course of action feeling more confident and secure. Table 1
involves something other than transport- lists some typical collaboration scenarios
ing the patient to the hospital. with supporting technologies, and the
following Collaboration Snapshots section
provides examples.

Table 1. Collaborative Workflow Summary

Workflow Collaborative Tasks Collaborators Tools and Solutions
Emergency Medical Services Make treat-in-place decisions based Emergency medical technician,
Admission from ED on patient’s current status, history, homecare nurse, community care Secure EHR with role-related access
Acute Care Inpatient Consults and preferences worker, patient/family and forms registries, HIE, secure
Discharge to Home or Care Center Assess patient, initiate treatment, ED physician and nurse, floor mobile devices
Chronic Care Outpatient Consults coordinate transfer to floor physician and nurse, pharmacist,
Homecare case manager, other clinicians, Shared EHR, decision support soft-
Patient Outreach Develop and implement a comprehen- patient/family ware, order entry software, case
and Empowerment sive inpatient treatment plan Multiple physicians, pharmacists, management software, secure laptop
clinical and other specialists PCs and tablets
Develop and implement a coordinated
discharge plan, ensure appropriate Hospitalist, primary care physician or Shared EHR, HIE, decision support
follow up GP, homecare nurse, community care software order entry software, uni-
worker, pharmacist, patient/family fied communications, laptop and
Enable a smooth transition between desktop PCs, secure tablets
inpatient and primary care, consult Hospitalist, GP or primary care
with specialists, manage patient’s provider, clinical specialists, Shared EHR, HIE, unified communica-
on-going care case manager tions, care management software,
Create, share, implement and monitor pharmacy databases, video confer-
a unified care plan GP or primary care provider, homecare encing, laptops
nurse, community care worker
Provide on-going monitoring, Shared EHR, HIE, patient registries
coaching and support Physician, homecare nurse, com- and other population management
munity care worker, case manager, tools, order entry software, video
telehealth response team conferencing, PCs, laptops

Shared EHR, HIE, case management
software, remote monitoring tech-
nologies, video conferencing, secure
laptops and tablets

Shared EHR, HIE, case management
software, remote monitoring technol-
ogies, video conferencing and other
integrated communications, mobile
apps, PCs, laptops

3

Collaborative Workflows White Paper

Facilitating Collaboration • In-home telemonitoring technologies in- risks, clarify questions, and identify next
through Next-Generation Tools clude high-resolution video conferencing steps. “The patient and family only have
capabilities that allow for individual and to tell the story once,” explains Dr. Nevin.
Healthcare applications and tools are evolv- small-group consultations as well as pa- “Everyone hears it at the same time and
ing to support collaborative workflows. tient reporting of health data. They’re can start their part of the workflow imme-
While continued progress is needed, the also incorporating features that support diately. Physicians formulate the plan of
following trends are expanding the capabil- data-driven workflows based on real- care. The clinical pharmacist does medica-
ities available to assist healthcare teams: time patient information. tion reconciliation in real time and assists
in generating orders. The social worker
• Traditional solutions such as EHRs and • Laptops incorporate advanced encryp- starts discharge planning while the family
portals are adding groupware-oriented tion and anti-theft technologies to better is still there. The attending can do bedside
capabilities that enable secure two-way ensure the privacy of confidential data. teaching. The case manager helps clarify
information flow and real-time, collabora- Tablets are adding enterprise-worthy any questions or concerns.”
tive decision-making. E-mail and other security and privacy capabilities, making
communications can be integrated into mobile consumer technologies more suit- The areas using the collaborative process
the EHR, ensuring that they are docu- able for healthcare settings. have cut 1.5 days off average length of
mented without added steps. EHRs stay (ALOS), reduced readmissions and
and other healthcare applications are Collaboration Snapshots increased patient satisfaction. “When you
also adding more sophisticated refer- do the right things up front, everything
ral tracking and population management Healthcare leaders are using a variety of goes better,” Dr. Nevin says. “We have had
functionality. collaborative workflows to deliver more zero Rapid Response Team calls within the
coordinated care. This section discusses first 24 hours of admission in areas where
• Unified communications platforms pro- just a few examples of how these organi- we’re using this process, which tells us
vide a consistent interface for managing zations are collaborating more effectively. that we are assessing patients correctly.
patient and clinician contacts and ini- The patient moves through the hospital-
tiating or joining in a phone call, web Synchronized Admissions: ization process faster, and at discharge, it
conference, or video conference. With Christiana Care, Wilmington, Del. only takes 10 minutes to reconcile meds
a single, intuitive interface, healthcare instead of 45 to 60 minutes.”
professionals can save time and choose Christiana Care Health System has imple-
the communication method that is most mented numerous care coordination initia- Mobile technologies support Christiana’s
convenient and appropriate. Video con- tives, including a synchronized admissions synchronized process. Currently, the ad-
ferencing solutions are affordable and process. Christiana is a not-for-profit, non- mitting nurse uses a small laptop on a mini-
simple enough for routine use with col- sectarian healthcare system and major cart to document the admission in Cerner
leagues, patients, and families. teaching hospital with 1,100 beds on two PowerChart,* but Dr. Nevin sees great
campuses. Two of its primary care clinics potential for members of the synchronized
• Solutions are adding support for mobile are certified as PCMHs, and its CMO, Dr. team to use secure, high-performance
usage models, reflecting the many envi- Janice Nevin, says the organization plans tablets to take additional notes. Video con-
ronments in which care team members to convert all its clinics to PCMHs. ferencing could add flexibility by allowing
operate and the on-the-go nature of life team members to participate in the confer-
in a modern hospital, clinic, or community When a patient at Christiana’s Wilmington ence without being physically present.
care environment. Hospital is admitted from the ED, a full
care team assembles to collaboratively Holistic Patient Support:
• Case management software is expanding handle the admission. Together, the resi- Virtua, Marlton, N.J.
to provide a more holistic and longitu- dent, attending physician, admitting nurse
dinal record of a patient’s medical and on the floor, social worker, clinical pharma- Virtua is a non-profit, comprehensive
social conditions and circumstances. cist, case manager, and other profession- healthcare system that includes four
als meet with the ED staff. Working as a hospitals plus outpatient clinics, surgery
• Patient portals provide richer avenues team and using mobile technologies, they centers, home care, and other services.
for patient empowerment, education, interview the patient and family, assess Virtua recently became self-insured and is
coaching, and social support. moving toward becoming an ACO.

4

Collaborative Workflows White Paper

Among the steps Virtua is taking to help Collaboration at Landskrona Hospital, Integrated Collaboration Between
clinicians collaboratively care for patients Skåne, Sweden Hospital and Primary Care:
with complex needs, the organization New Pueblo Medicine, Tucson, Ariz.
is restructuring its case management A 69-bed community hospital, Landsk-
workloads. Instead of focusing only on rona Hospital provides coordinated care Hospitalist-based care offers significant
utilization review, case managers now within its walls and is working to extend benefits, but it often produces a discon-
spend half their time on care coordina- collaboration across the continuum of nect between primary practices and
tion. This change enables Virtua to better care. “Healthcare has traditionally been inpatient care. New Pueblo Medicine,
identify patients who are at higher risk of organized into drainpipes, where informa- an independent practice of seven board-
readmission, for example, and collaborate tion flows vertically,” says Dr. Marcus certified internal medicine physicians,
across the care continuum to ensure that Larsson, Head of Unit, Local Health Care avoids that disconnect by making one
services are in place to support these Unit, Landskrona Hospital. “We are work- of its physicians, Dr. Andrea Miller, a full-
patients post-discharge. ing to improve communication horizon- time hospitalist at Tucson Medical Center
tally, when we transfer a patient between (TMC). Dr. Miller works collaboratively with
Patients with complex needs are offered institutions or discharge a patient to the other physicians in the practice to provide
“navigation services” upon discharge or care of their GP.” efficient, coordinated patient care.
when seen in a primary care clinic. Under
this program, a nurse or other staff Landskrona serves the elderly popula- Dr. Miller has fingertip communication
member facilitates scheduling diagnostics tion of Skåne, and its average patient is with her New Pueblo colleagues and full
procedures, consultations and follow-up 83 years old. The hospital has a small ED, remote access to the practice’s NextGen
appointments, and assists with pre- but ambulances take the sickest patients EHR from the hospital, office, or home
authorizations. The program increases directly to Skåne University Hospital, using a desktop, laptop, or other mobile
patient satisfaction, helps ensure that where they are stabilized and may be device. She uses TMC’s EpicCare* Inpatient
patients receive prescribed services, transferred to Landskrona for further Clinical System to chart her work at the
and gives patients another reason to treatment. Hospitals in the region use the hospital. The practice shares admission
choose Virtua providers for ancillary Siemens Soarian EHR, providing a basis planning information with Dr. Miller for
or follow-up care. for collaborative treatment planning and any scheduled admission, and the hospital
decision-making. notifies Dr. Miller via text message when
“If patients choose to stay within our sys- a New Pueblo patient comes to the ER.
tem for the services they need, then we Landskrona has established collaborative Whether the patient’s visit is planned or
have all the documentation within our elec- inpatient processes for treating conditions spontaneous, Dr. Miller can immediately
tronic medical records, which enables us such as strokes. Neurologists, nurses, determine when they were last seen in
to provide more coordinated care,” says Dr. dieticians, counselors, therapists, and the office, by whom and what their latest
Dwyer. “For patients being discharged from others healthcare professionals access diagnostics showed. She can consult with
the hospital, readmission rates are lower, a comprehensive EHR that includes lab her colleagues and they can view the
and patients feel much more supported.” and diagnostic results. The hospital also patient’s records simultaneously and make
collaborates with the region’s GPs, ambu- joint treatment decisions.
Another collaborative initiative created lances, and community care organizations,
teams of hospitalists, nurses, and case primarily through paper-based communi- The collaborative model has proven
managers for inpatient care. This initiative cations since EHRs are not yet compat- popular with patients and physicians. The
has reduced readmissions while dramati- ible. Pharmacists in Sweden collaborate practice operates more efficiently, and the
cally increasing patient satisfaction. through a national prescription database, other six physicians see more patients per
and recent legislative changes in Sweden day. Patients like the consistent care they
Virtua’s hospitals use Siemens Soarian* will allow hospitals and physicians to get from Dr. Miller while they’re hospital-
EHR. Practices are deploying NextGen access the prescription database. “With ized, and everyone appreciates not having
Healthcare* EHRs, with data exchange better information-sharing, we can better office scheduling disrupted by delay-
through a Siemens portal and a private HIE. manage the care transitions, and that is inducing emergencies at the hospital.
Virtua also employs Microsoft Amalga* for our current focus,” Dr. Larsson says.
patient-level and population-level health-
care analytics. Navigation services use both
EHRs and Virtua-developed software.

5

Collaborative Workflows White Paper

Sharing data through the EHR is critical around privacy and information shar- Specialist Consults:
to the model’s success. “The minutes that ing. The system links Maccabi to private The Children’s Hospital at
I don’t have to spend asking the patient pharmacies as well as plan pharmacies, Westmead, Westmead, Australia
about their history, which is already giving physicians a fuller picture of their
well-documented, are minutes that can patients’ medication patterns and facilitat- Located 28 km from Sydney, The Children’s
make a difference in their care,” Dr. Miller ing collaboration between physicians and Hospital at Westmead is committed to
says. “Having the EHR as the founda- pharmacists. A broad range of commu- ensuring that sick children in remote
tion also makes it much more possible to nication functions are incorporated into parts of New South Wales are not dis-
work together to get the follow-up care the EHR, enabling communications to be advantaged by unequal care. The hospital
nailed down before the patient leaves the documented without added effort. conducts outreach clinics across the state
hospital. Our practice is doing great on bed and provides telepsychiatric services to
days, and our results are solid—we’re not Maccabi uses predictive modeling soft- children in New South Wales. Recently,
discharging prematurely.”11 ware and experienced nurse reviewers the hospital began using PC-based
to identify patients who are at high risk teleconferencing to facilitate consulta-
Comprehensive Collaboration that of readmission, and a multidisciplinary tions between primary care providers
Includes the Patient in the team in the community provides intensive and hospital-based specialists.
Health Team Communication Loop: support that includes both physical and
Maccabi Healthcare Services, Israel virtual visits to ensure continuity of care. Dr. Geoffrey Ambler, a pediatric endocri-
Patients with conditions such as cardiac nologist and tertiary diabetes specialist
Maccabi Health Services is a not-for-profit insufficiency have home monitoring at The Children’s Hospital, reports that
insurance fund and healthcare provider equipment and transmit the results to he used to travel great distances to
that delivers coordinated care to more their clinical team. “Given the shortage of consult with pediatricians and their
than 1.9 million members. With healthcare doctors and nurses, there’s no option but most complex patients at distant primary
IT investments dating back to 1984, Mac- to use telemedicine,” says Dr. Rachelle care clinics and hospitals. This frequently
cabi today is an advanced user of compre- Kaye, Director of the Maccabi Institute for involved airplane flights, hotel stays, and
hensive information, including centralized Health Services Research. “It’s the only time away from his family. With telecon-
medical records, decision support, lab and way to deal with the resource issues.” ferencing-based collaboration based on
teleradiology results, and automatic incor- Maccabi physicians also use video the Microsoft Lync* unified communica-
poration of referral results into the EHR. conferencing to consult with each other tion system, Dr. Ambler supports his
and to have specialists meet remotely remote medical colleagues and their pa-
At Maccabi, all members of the patient’s with primary care physicians, patients, tients without the cost and disruption of
care team have appropriate access to and families. travel, enabling him to see more patients.
EHRs, and Maccabi called on its eth- Patients and their families meet with
ics committee to help establish policies Several recent Maccabi initiatives use their primary pediatrician to conduct the
technology to provide added convenience conference. Dr. Ambler says physicians,
“We have a tremendous opportunity and support for collaborations with mem- patients, and families all love the service,
bers. Patients have access to a 24-hour-a- with one pediatric patient commenting,
to improve care by providing day call center and can use a secure online “I like seeing my doctor on TV.”
portal, kiosk, or smart phone application to
a better transition from the make appointments, find urgent care in-
formation, check lab results, manage their
hospital to the community. medical records, and more. Increasingly,
patients expect these services, accord-
We need to do better discharge ing to Dr. Kaye. “People are demanding
that we use technology,” she says. “They
planning, and give GPs greater can do their banking online, and don’t
see any reason not to be able to refill
visibility into what has been a prescription or check their lab results
online.” Maccabi has also created a “voice
done while the patient was of Maccabi” program that enlists members
and patients to engage in Internet-based
in the hospital.” dialog with the institution.

– B arbara Stuttle, PhD, RGN,
National Clinical Lead for Nursing, UK

6

Collaborative Workflows White Paper

Overcoming Obstacles Build teamwork skills. Collaboration is at technologies can provide added insurance.
heart a people process. Provide training On the other hand, don’t make a fetish
Delivering coordinated, collaborative care experiences that help physicians develop out of privacy and security. “Privacy and
is not easy. It requires profound cultural team leadership skills and help individual- security are important issues, but don’t let
shifts, payment restructuring, new roles ists learn to work as teams. “Physicians them become an excuse for avoiding prog-
and responsibilities, redesigned work- may not traditionally see themselves as ress, as some nations have,” says Buddrus.
flows, and advances in information tools part of a team,” says Dr. Dwyer. “Getting
and technologies, among other changes. them to understand how to drive per- Help shape the future. Technologies
Where do you start? Many healthcare formance improvements as team leaders will continue to evolve, so get involved
leaders suggest focusing on what’s best is new—we need to figure it out.” Break in creating the changes you want to see.
for patients. Look at what is preventing down traditional hierarchies by having Talk to vendors about the enhancements
you from delivering great care, and iden- physicians and nurses pair up and shadow and new features that are necessary
tify who you can work with to remediate each other for half a day. Invite hospital- for the ways you want to collaborate.
the situation. Here are other suggestions: ists to visit practices, and hold educational Participate in focus groups and user group
forums. Don’t underestimate the power of forums. Advocate for making collaboration
Communicate the reasons for change. cultural resistance, but don’t be cowed by and teamwork an integral part of profes-
Change is not easy, so it’s important to it either. sional education for physicians, nurses,
emphasize the goals and necessity for and others.
new approaches. “Establish collaboration Have physician champions. Build support
as a clear goal and objective,” says Dr. for collaborative tools by giving physicians Don’t wait. Look for a payer partner, but
Kaye. “Devote time, energy, and thought and others a role in shaping them. Engage don’t let the lack of one deter your ef-
to bringing it about.” Everything you clinicians early and involve them in all ma- forts. Understand that there are financial
learned in deploying EHRs will be equally jor decisions. Since physicians, nurses, and risks in delaying the move toward collab-
relevant as you design and implement col- other clinicians are notoriously busy, make orative care. “As Wayne Gretzky used to
laborative workflows. tools as easy and automatic as possible. say, you want to skate to where the puck
is going to be,” Dr. Dwyer says. “Collabora-
Be systematic. “Coordinated care Understand the workflow impact of tive care is the right thing to do, and it
involves a paradigm shift from thinking new technologies. Dr. Dwyer relates an takes a significant amount of time to do
I’m only responsible while you’re sitting in early Virtua project that provided in-home it. If you wait too long, you may be at a
front of me in the office, to being respon- remote monitoring technology for high- competitive disadvantage, because you
sible for your care whether you’re coming risk patients. The project aimed to reduce can’t just turn it on in a day.”
into the office or not,” says Dr. Nevin. “To ED visits, but instead, they went up. “We
make that shift, you need to be very rigor- did a great job of identifying problems, but “W e kept focusing on what
ous about what your processes are, who’s we hadn’t created the alternatives to go-
doing them, and how you are going to ing to the ED to assess them,” he recalls. was best for the patients.
make the most of each encounter with the Since then, Virtua has collaborated with
patient. In high-functioning collaborative long-term care nursing staff, urgent care Some of our biggest skeptics
environments, every member of the team centers, and primary practices to provide
understands their role and knows what alternate assessment paths when tele- became very vocal champions
they need to do for the model to succeed.” monitoring indicates a potential problem.
once they saw the benefits
Define new roles. Collaboration can Match devices to the user, task,
involve adding new roles and modifying environment, and compute model. for patients.”
existing ones. “As we incorporate telecom- Mobile devices can enhance productivity
munications and telemonitoring into the and convenience for most collaborative – Janice Nevin, MD
day-to-day care of chronically ill patients, workflows, but no single device is right for Christiana Care
we’re impacting the relative roles of doc- every situation. Devices should align with
tors and nurses,” Dr. Kaye says. “Increas- organizational objectives and be embed-
ingly, the nurse is the primary contact, ded within a comprehensive information
with physician backup. We’re reconceptu- architecture that provides necessary lev-
alizing the role of the doctor in caring for els of connectivity, security, and privacy.
the chronically ill patient. We’re trying to When confidentiality must be maintained,
conceptualize the call centers as some- devices with hardware-assisted security
thing that supports and extends rather
than supplants the primary care physician,
but it’s tricky.”

7

Collaborative Workflows White Paper

Building Success
Information technologies are an important enabler and success factor for collaborative
care initiatives. Well-chosen solutions and platforms, grounded in well-implemented
change processes, can give each member of the healthcare team—including patients
and their families—the information and support they need to improve outcomes,
accessibility, and costs.
Intel and Microsoft can help you envision how technology can augment your strategic
initiatives and provide the communication and collaboration capabilities your organiza-
tion and your patients require. Learn more about how Intel and Microsoft can help you
apply the power of technology to improve healthcare.
• Talk to your Intel representative or visit Intel’s Healthcare IT site:
http://www.intel.com/healthcare. Visit as a guest, or join the Intel community of
health IT professionals at: http://premierit.intel.com/community/ipip/healthcare
• Connect with Microsoft health leaders and resources at
http://www.microsoft.com/health/en-us/Pages/index.aspx

Intel and Microsoft gratefully acknowledge the healthcare professionals who shared information and insights for this paper:
•U we Buddrus, Managing Director, HIMSS Analytics Europe, Germany
• James P. Dwyer, DO, MBA, Executive Vice President for Physician Services, Virtua, New Jersey
• Rachelle Kaye, PhD, Director, Maccabi Institute for Health Services Research, and Deputy Director, Department of Planning and Finance, Maccabi Healthcare Services, Israel
• Janice E. Nevin, MD, MPH, Chief Medical Officer, Christiana Care Health System, Delaware
• Marcus Larsson, MD, MSc, Medical Director, Emergency and Internal Medicine Department, Landskrona Hospital, Skåne, Sweden
•B arbara Stuttle, PhD, CBE, MHM, DN, RGN; Deputy Chief Executive and Chief Nurse, NHS South West Essex, and National Clinical Lead for Nursing, UK
• Nancy H. Vuckovic, PhD, Senior Ethnographer, Intel Corporation

1. OECD Health Data 2009. www.oecd.org/health/healthdata.
2. Ian Blunt, Martin Bardsley and Jennifer Dixon, Trends in Emergency Admissions in England, 2004-2009. July 2010. http://www.nuffieldtrust.org.uk/publications/detail.aspx?id=145&PRid=714.
3. S.F. Jencks, M.V. Williams, and E.A. Coleman, E.A. Rehospitalizations among patients in the Medicare fee-for Service Program. New England Journal of Medicine. 2009, 360(14), 1418-1428.
4. Reported by CNN Money, http://money.cnn.com/2012/01/20/smallbusiness/doctor_loans/index.htm.
5. Testimony of Gerard F. Anderson, Ph.D., Johns Hopkins Bloomberg School of Public Health, Health Policy and Management, before the Senate Special Committee on Aging, The Future of Medicare: Recognizing the Need for Chronic Care

Coordination, Serial No. 110-7, pp. 19-20 (May 9, 2007).
6. L, Sweeney A. Halpert, and J. Waranoff . Patient-Centered Management of Complex Patients Can Reduce Costs Without Shortening Life. American Journal of Managed Care. 2007;13:84-92.

http://www.ajmc.com/publications/issue/2007/2007-02-vol13-n2/Feb07-2452p084-092.
7. Nancy H. Vuckovic, Thomas Edes and Linda O. Nichols, “I Couldn’t Make It Without Them”: Patient and Caregiver Perspectives of Home-Based Primary Care, presentation at the Gerontological Society of America, Nov. 22, 2011.
8. James Arvantes, Geisinger Health System Reports that PCMH Model Improves Quality, Lowers Costs, AAFP News, May 2010.
9. American Hospital Association and McManis Consulting:, ACO Case Study: New West Physicians, January 2011. http://www.aha.org/content/11/aco-case-new-west-physicians.pdf.
10. A HRQ Health Care Innovations Exchange. Innovation Profile: Chronic Care and Disease Management Improves Health, Reduces Costs for Patients with Multiple Chronic Conditions in an Integrated Health System, 2010.

http://www.innovations.ahrq.gov/content.aspx?id=1696.
11. Download a whitepaper on New Pueblo Medicine’s approach to coordinated care: http://premierit.intel.com/docs/DOC-6490.

INFORMATION IN THIS DOCUMENT IS PROVIDED IN CONNECTION WITH INTEL® PRODUCTS. NO LICENSE, EXPRESS OR IMPLIED, BY ESTOPPEL OR OTHERWISE,
TO ANY INTELLECTUAL PROPERTY RIGHTS IS GRANTED BY THIS DOCUMENT. EXCEPT AS PROVIDED IN INTEL’S TERMS AND CONDITIONS OF SALE FOR SUCH
PRODUCTS, INTEL ASSUMES NO LIABILITY WHATSOEVER, AND INTEL DISCLAIMS ANY EXPRESS OR IMPLIED WARRANTY, RELATING TO SALE AND/OR USE OF INTEL
PRODUCTS INCLUDING LIABILITY OR WARRANTIES RELATING TO FITNESS FOR A PARTICULAR PURPOSE, MERCHANTABILITY, OR INFRINGEMENT OF ANY PATENT,
COPYRIGHT OR OTHER INTELLECTUAL PROPERTY RIGHT. UNLESS OTHERWISE AGREED IN WRITING BY INTEL, THE INTEL PRODUCTS ARE NOT DESIGNED NOR
INTENDED FOR ANY APPLICATION IN WHICH THE FAILURE OF THE INTEL PRODUCT COULD CREATE A SITUATION WHERE PERSONAL INJURY OR DEATH MAY OCCUR.
Copyright © 2012 Intel Corporation. All rights reserved. Intel and the Intel logo are trademarks of Intel Corporation in the U.S. and other countries.
*Other names and brands may be claimed as the property of others. 0512/BW/HBD/PDF 327320-001US