The HealthVault team recently presented session CSCRM26 at the annual Microsoft Dynamics Convergence conference.  Our session is entitled Improving Healthcare Outcomes with Microsoft Dynamics CRM & HealthVault.  Specifically, we demonstrated a chronic condition population management clinical system solution composed using online platform services including Microsoft HealthVault and Microsoft Dynamics CRM. 

Our solution utilizes HealthVault/CRM “plug-ins” for implementation of a clinical CRM system that may be used to efficiently manage patient populations.  HealthVault thus serves to bridge the information workflow gap between enterprise clinical systems, individual consumers, and a host of participants involved in effective healthcare management scenarios.  

This report provides an overview of the information we presented during the conference.   We first established a situational problem context, identified implications, and subsequently accomplished needs analysis.   We think that Microsoft HealthVault, when combined with Microsoft Dynamics CRM, provides a compelling healthcare informatics solution for management of a patient population.  

Download a PDF version of this article.

Solution Motivation

The Centers for Disease Control (CDC) describes Chronic Condition Management as “The public health challenge of the 21st century”.   A number of statistics validate that claim as indicated below.   Examples of chronic conditions include hypertension, lung conditions, diabetes, heart disease, obesity, and about 15 others.   Typically, a person experiences a normal lifestyle with little day-to-day awareness of their disease promoting behaviors.  Significantly, chronic conditions, if treated early, are manageable.   Unfortunately, oftentimes low-cost treatment is ignored or delayed until an acute incident necessitates costly healthcare intervention.   Although such conditions are life-long and life-style inhibiting, treatment regimens are effective and several conditions are preventable.

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Studies have documented serious deficiencies and large gaps between the care people should receive and the care they actually do receive. Deficiencies were observed in all health care settings, in all age groups, and in all geographic areas. In other words, the problems are systemic and permeate the healthcare industry.  A very limited number of chronic conditions account for the bulk of healthcare problems. If we targeted those conditions, we could make tremendous progress and affect a sizable proportion of the health care delivery system, as well as of the general population.

The good news is that there are successful workflow solutions for Chronic Condition Management!  Every healthcare provider has a different way of engaging patients in their management of chronic conditions.  However, each methodology derives from a few key common workflow activities.   The following illustration demonstrates this pattern.   Healthcare providers typically monitor a patients adherence to a prescribed Care Plan.   The Care Plan typically specifies prescriptive medications, a regimen of measurements, a schedule of lab tests and exams, and corrective actions or goals and tasks.  Resultant performance is monitored, analyzed, and subsequent treatment activities adjusted.   In fact, this pattern works really well in some cases and most-often within a small population of patients.   However, the pattern tends to fail dramatically when applied over a much larger population.   Hence, the primary need for intelligent and scalable population management solutions.   This is a data-driven methodology for which Dynamics CRM is a great fit!  Within the context of healthcare, it’s relationship management for patients.

 

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The Consumer Reach Challenge

Healthcare providers around the world are looking for ways to reduce costs related to management of chronic conditions.  The models that are most useful in caring for the chronically ill are very different from our current delivery system. Providing high-quality care to chronically ill individuals requires well designed care processes focused on information that meets the self-management needs of patients and their families. Patients with chronic illnesses require multidisciplinary care from teams of physicians, nurses, social workers, aides, and others. Team care is essential for high quality care.

Healthcare performance was and still is unreliable.   From a purely business operations perspective, healthcare enterprises have systemic quality improvement challenges.  We can’t improve what we can’t measure, and we don’t have adequate measurement mechanisms at critical points in the data-driven methodology.   How do we increase the fidelity of data measurements?   How can we improve our ability to quickly gain analytical insights and iteratively improve our processes?

From a Health Informatics methodology perspective, a significant chasm exists between participants in the data-driven enterprise-to-consumer chronic condition management workflow.

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Within this scenario, Microsoft HealthVault provides a key intrinsic value proposition.   Consumers already know HealthVault as a home for all their health-related information.   HealthVault supports consumer-centric management of healthcare information including device-data (e.g. daily glucose readings), medical images, faxed images, continuity of care documents, emergency medical information, and many other data-types.   Families utilize HealthVault’s support for custodial-record relationships enabling information management within parent-child and elder-care situations.  Users are able to securely upload, view, download, transmit, and receive healthcare information in concert with a rich ecosystem of information sources and destinations.  

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Importantly, underlying each of these consumer usage scenarios is a platform that also enables a rich ecosystem for solution vendors and healthcare providers.   Simultaneously, HealthVault enables information-channels useful to both individual consumers as well as to participating enterprises.  

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As illustrated, enterprise solutions integrated with Microsoft Dynamics CRM and Microsoft HealthVault benefit from both of these platform technologies in ability to concurrently bridge the information workflow chasm with consumers while concurrently enhancing the fidelity of information exchanged between multiple workflow participants.   For example, a diabetic patient may utilize common off-the-shelf devices (e.g. glucometers, blood-pressure monitors, weight measures) that automatically transmit readings to a person’s HealthVault account.   This dramatically increases the fidelity of measurements now available to their healthcare provider whose CRM enabled clinical systems programmatically synchronize with HealthVault to accomplish data-analytics.   Background processes identify abnormalities in the patient’s adherence to their treatment plan.   Alerts are generated to healthcare professionals who further validate the observations and initiate timely, and perhaps life-saving, patient feedback.   The healthcare informatics workflow gains in a real and measureable quality improvement aspect.

Crossing the Quality Chasm

The Institute of Medicine publication, Crossing the Quality Chasm, provides an extensive assessment of the quality of healthcare in our society along with a concise contextual framework for improvements.   Recommendations include a five-part agenda for change along with ten rules for redesigning and improving healthcare.   The publication is available in its entirety online including a must-read summary page.   Under-pinning each of the author’s recommendations is the dependency on a patient-centric information system enabling workflow-based collaboration amongst healthcare organizations, clinicians, private and public entities, and patients. We think that HealthVault is uniquely positioned to fulfill this vision.

Microsoft HealthVault, in combination with Microsoft Dynamics CRM, provides compelling integrated solution capabilities that go a long way in meeting the coming demand for efficient and customizable patient population management solutions.  Healthcare information technology providers may extend this concept in very rich ways by utilizing Office 365, Windows Azure, Skype, and a number of other readily accessible subscription-based online services.

Learn more about using Dynamics CRM and HealthVault for Chronic Condition Population Management.  

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