Hospitals can often get you healthy; they have more trouble keeping you well. One in 5 Medicare patients discharged from the hospital is back within 30 days. Repeat trips to the hospital are expensive — by some estimates they cost the government $17 billion Medicare dollars a year. Parkland Hospital’s Center for Clinical Innovation is pioneering a new approach to keeping patients well — and it isn’t focused on what’s done in the hospital.
“Good health is so much more than just health care,” says Dr. Ruben Amarasingham, president of Parkland Center for Clinical Innovation. He says whether someone winds up back in the hospital depends on social factors like education, housing, poverty and substance abuse.
“And if you don’t attack those problems then you won’t make much progress in a patient’s health,” Amarasingham says.
The problem is, hospitals and the organizations in the community that help patients find shelter, access education and get food are not connected.
Which is where the Dallas Information Exchange Portal comes in. Armed with a $12 million dollar grant from the the W.W. Caruth, Jr. Foundation, Amarasingham is creating a digital infrastructure to link community groups with health information for Parkland patients.
Building An Information Bridge To Crossroads
At Crossroads Community Services in downtown Dallas. Dozens of men and women are waiting for their turn to select cans and bags of food.
Crossroads Director Rev. Jay Cole estimates 70 percent of the low-income people who visit rely on Parkland – yet Crossroads can’t easily help them follow doctor’s orders.
“Often times someone leaves Parkland and they’ve been given four to six prescriptions,” Cole says, “They may not have the money to fill all of them.” Cole wants to be able to help patients keep track of their prescriptions, maybe help fill them if there’s a money shortage.
“And we don’t spend another $10 thousand dollars at Parkland,” he says, “but more importantly they’re getting the care they need.”
Meeting Patients Where They Are
Jeffrey Wilhelm, who’s 47, comes to Crossroads to pick up food every other month. After he had a stroke in 2010, he had trouble swallowing and needed to avoid bread.
“I had to start eating vegetables, different things that were already moist. I could put a piece of bread in my mouth and I couldn’t swallow it,” he says, “I get choked real easy.”
With an information exchange, food bank employees could make sure Wilhelm is taking home the types of foods that won’t land him back in the hospital. Someone could take his blood pressure, even remind him about an upcoming appointment.
Next Generation Approach
“I think the next generation of readmission prevention is the kind of stuff we’re seeing at Parkland,” Karen Joynt says, “This is pretty different.”
Joynt is an Instructor at Harvard Medical School and the Harvard School of Public Health.
“Fundamentally this is about building systems that support patients to care for themselves,” she says.
Something like this has never been done before, Joynt says, in part, because of logistics and privacy concerns.
“We have enough trouble just sharing data within a hospital, so thinking about how we’re going to do that with organizations is a real challenge.”
Luckily I think it’s an overcome able challenge, I think we’ve come a long way with data security and the kinds of safeguards you would need in place. But that’s the biggest logistical challenge is seeing how can we connect systems that have never tried to speak to each other before.”
The Task At Hand
Ruben Amarasingham and his team are busy figuring out how to safely share the minimum amount of health data necessary to do the job.
“This is the question of our generation, Amarasingham says, “because we have the potential with large amounts of data to do great good but there is this enormous concern about privacy and security. It’s the number one issue we think about.”
He hopes within the next twelve months, a dozen community organizations will be hooked up to Dallas’ information exchange, and health care can become more of a system, instead of a set of silos.