Could Physicians e-Prescribe Community Services?

Nov. 7, 2018
What if helpful community services could be e-prescribed from the EHR in much the same way that an antibiotic or statin is today?

What if helpful community services could be e-prescribed from the EHR in much the same way that an antibiotic or statin is today? That is the vision of Stacy Lindau, M.D., a professor of obstetrics/gynecology and geriatrics at the University of Chicago who has helped launch a startup community coordination system called NowPow.

In August I wrote about 2-1-1 San Diego’s Community Information Exchange and noted that their Community Information Exchange (CIE) platform seems to be on the cutting edge of tech-supported projects to connect social service agencies and health providers in closed-loop referrals and in sharing client-level data. Its participating organizations even use a common risk rating tool. The CIE also facilitates community case planning, and care team communications to better address the social determinants of health.

Yesterday I heard another thought-provoking presentation touching on community information exchange from Dr. Lindau, chief innovation officer of NowPow, a Chicago-based company that uses a digital platform to link patients or people with chronic health and social problems to community-based organizations. She was taking part in a discussion hosted by Nemours Children’s Health System on community care coordination systems and the role of technology applications that are emerging to “close the loop” between clinical and community services.

Her organization had already been involved in a youth-focused training program called MapsCorps designed to have students gather and curate data about community businesses and organizations that serve the public. With an innovation grant from the Center for Medicare and Medicaid Innovation, they took advantage of that MapCorps data. “We had the idea that our jobs in the caring community would be better if we had the MapsCorps data about those assets in our work flow,” she explained. This is where she drew the connection to e-prescribing drugs. “That model is what drove doctors and the whole health system from paper to digital a few years ago,” Lindau said. “We proposed to CMS the idea of e-prescribing community.”

NowPow emerged as a sustainable business model together with MapCorps for the innovation called communityRx that was supported with that healthcare innovation award. The technology company NowPow grew out of that effort. “We think of it like a utility company,” she said. “Every community needs one. We provide the highest-quality data about all the resources of community people need to live well and manage with chronic conditions and to care for others.”

During the 30 months of the grant-funded project, they were able to integrate new software into the EMRs at 33 health sites, mostly community health centers but also some emergency departments and generate more than 250,000 community resource referral prescriptions, which they call HealtheRXs. NowPow has closed-loop functionality, which allows a person in the caring community to generate a referral digitally from their own work flow. It allows a referral receiver to receive the information, take action on it, and communicate that action back to the person who made the referral.

As an example of how they work, NextLevel Health Partners Inc., a Medicaid managed care company, recently partnered with NowPow to better manage and address the social determinants that impact the health and wellness of residents across Cook County. NextLevel Health coordinators will use NowPow e-prescription methods as a way to deliver personalized community resources based on factors such as patient conditions, address, age, gender and preferred language.

During the webinar, Lindau was asked what are some critical readiness factors that are indicators of success in implementing a digital infrastructure to enable matching and tracking of people to and from community resources. One critical factor is policy alignment, she responded. Communities and ecosystems adopting value-based payments are more likely to be ready than those still in fee-for-service mode, she said. “Strong cross-sector relationships are key. It is important to see people across the caring community are capable of speaking a common language and know each other,” she added. They usually have codified relationships that might be Business Associate relationships or other contractual relationships that allow sharing of information with integrity, and they have a shared interest in quality improvement and in making data-driven investments in the communities they serve.

One key element that is crucial and not always available is affordable broadband. “It may be shocking to imagine, but even some of the communities we serve in the City of Chicago are working with dialup Internet service,” Lindau said. “They are in areas where there is a monopoly or at best an oligopoly on Internet service provision, so they have high-cost, poor-quality Internet access. Internet access is like plumbing. Communities that have a large number of their community-based organizations operating off the grid because of poor broadband access are probably not fully ready.”

Lindau ended her talk with an anecdote involving the Apollo 13 mission. When an oxygen tank exploded in space, the astronauts and NASA engineers on the ground had to use their imaginations to determine how to return the spaceship to Earth safely. They made the decision to focus only on what was working rather than on what was broken. They knew every working part and used an “asset-based” approach to problem solving.

That asset-based approach undergirds the work her team does in Chicago. “My vision for the future is that we regard the resources of the communities as assets and treat them with respect,” she said.

Lindau noted that when physicians treat patients with drugs, they have perfect information about every drug available on the market — what it does, side effects, costs and how to connect patients to the drug. “Drugs can be life-saving, but we know that what really determines the long-term health of individuals is not medicine, it is everything each of us does every day to stay well, manage with disease, and take care of others. My vision of the health system is one where the caring community, including the growing population of informal, unpaid caregivers, has what they need to operate in their sector, just like every other 21st century economic sector.”

For her, that means that participants have access to the highest-speed communication capabilities, and that the caring community fully leverages the assets of the geographic communities they serve. “We must treat every program and service, most of which are funded with our tax dollars and charitable dollars, like a critical asset, she stressed. “The resources are accessible to everyone; the people who need them can get them; and those of us who have signed up to be members of the caring community can devote our energies to healing people rather than scrounging around looking for critical assets.”

All in all, a powerful vision of the role technology can play in bridging the chasm between health systems and the communities in which they operate.

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