This new data-driven model is revolutionizing healthcare funding. What are the first steps to consider?

In their efforts to be efficient, patient-centric and to offer seamless services, healthcare companies are starting to use clinical pathways: a data-driven model with a high potential to modernize the industry.

A clinical pathway is defined as a tool for guiding evidence-based medicine. It is a multidisciplinary plan that involves patient care guidelines and step-by-step treatments.

It is multi-targeted. On the one hand, it standardizes care for certain clinical problems or specific procedures for a particular population. In this way, all the bureaucracy surrounding treatment is accelerated, since many of the studies or practices that must be carried out in a particular context are automatically “pre-approved”, and automatically updated in the case of long-term or chronic conditions.

Patient-centeredness

Not only does this approach exponentially improve the patient’s experience, who no longer has to endure long waiting, cumbersome paperwork, and misleading explanations (or, worse still, need not deal with poorly decided denials of service), but it significantly reduces the administrative costs and enhances planning for healthcare companies. As a consequence, the equipment and infrastructure utilization is enhanced.

Moreover, the process is focused on the patient: the “pathway” referred to is none other than the person’s life cycle from the start of the treatment process to discharge or chronification. Each time the pathway is activated, all the exchanges involved take place automatically: payments, medical prescriptions, calendar openings, etc.

Another objective is to bring transparency to the system. All parties involved collaborate on the same clinical pathway, including medical professionals, administrative staff of the healthcare provider, pharmacies, treatment centers, and insurance companies. In a segment characterized by funding restrictions, having a tool that helps to ensure that each authorized service is correct and provided in time, form and scope represents a true revolution.

An interoperable future

The adoption of a clinical pathway is slow, even though its characteristics have been defined for almost a decade, with limitations in its field of application to oncological patients, for example.

Some of the barriers that hinder its scalation are the system interoperability problems, the existence of complex interfaces that, ironically, end up overloading administrators and doctors in the data loading processes, and the presence of weak control mechanisms that do not ensure transparency, while endangering the patient´s privacy.

Given our experience in the sector, Making Sense understands that for clinical pathways -which are ultimately nothing more than a model based on data and leveraged on digital platforms- to be successful, it is necessary to implement an approach that tears down all obstacles.

Creating UX-enabled applications designed around user interaction – the clinician, the administrator, the patient – enables intuitive and simple data loading and greater engagement of the parties.

The next key step is using technologies that support open standards and integration processes. And, of course, data governance models ensure that system data is of good quality.

By addressing these challenges, we may be looking at one of the highways that will lead the healthcare industry into the future.