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Designing for the Whole Patient Journey: Lumeon Enters the US Health Provider Market

Posted on April 23, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Lots of companies strive to unshackle health IT’s potential to make the health care industry more engaging, more adaptable, and more efficient. Lumeon intrigues me in this space because they have a holistic approach that seems to be producing good results in the UK and Europe–and recently they have entered the US market.

Superficially, the elements of the Lumeon platform echo advances made by many other health IT applications. Alerts and reminders? Check. Workflow automation? Check. Integration with a variety of EHRs? Of course! But there is something more to Lumeon’s approach to design that makes it a significant player. I had the opportunity to talk to Andrew Wyatt, Chief Operating Officer, to hear what he felt were Lumeon’s unique strengths.

Before discussing the platform itself, we have to understand Lumeon’s devotion to understanding the patient’s end-to-end experience, also sometimes known as the patient journey. Lumeon is not so idealistic as to ask providers to consider a patient’s needs from womb to tomb–although that would certainly help. But they ask such questions as: can the patient physically get to appointments? Can she navigate her apartment building’s stairs and her apartment after discharge from surgery? Can she get her medication?

Lumeon workflow view

*Lumeon workflow view

Such questions are the beginning of good user experience design (UX), and are critical to successful treatment. This is why I covered the HxRefactored conference in Boston in 2016 and 2017. Such questions were central to the conference.

It’s also intriguing that criminal justice reformers focus attention on the whole sequence of punishment and rehabilitation, including reentry into mainstream society.

Thinking about every step of the patient experience, before and after treatments as well as when she enters the office, is called a longitudinal view. Even in countries with national health care systems, less than half the institutions take such a view, and adoption of the view is growing only slowly.

Another trait of longitudinal thinking Wyatt looks for is coordinated care with strong involvement from the family. The main problem he ascribed to current health IT systems is that they serve the clinician. (I think many doctors would dispute this, saying that the systems serve only administrators and payers–not the clinician or the patient.)

Here are a couple success stories from Wyatt. After summarizing them, I’ll look at the platform that made them possible.

Alliance Medical, a major provider of MRI scans and other imaging services, used Lumeon to streamline the entire patient journey, from initial referral to delivery of final image and report. For instance, an online form asks patients during the intake process whether the patient has metal in his body, which would indicate the use of an alternative test instead of an MRI. The next question then becomes what test would meet the current diagnostic needs and be reimbursed by the payer. Lumeon automates these logistical tasks. After the test, automation provided by the Lumeon platform can make sure that a clinician reviews the image within the required time and that the image gets to the people who need it.

Another large provider in ophthalmology looked for a way to improve efficiency and outcomes in the common disease of glaucoma, by putting images of the eye in a cloud and providing a preliminary, automated diagnosis that the doctor would check. None of the cloud and telemedicine solutions covered ophthalmology, so the practice used the Lumeon platform to create one. The design process functioned as a discipline allowing them to put a robust process for processing patients in place, leading to better outcomes. From the patient’s point of view, the change was even more dramatic: they could come in to the office just once instead of four times to get their diagnosis.

An imaging provider found that they wasted 5 to 10 minutes each time they moved a machine between an upper body position and a lower body position. They saved many hours–and therefore millions of dollars–simply by scheduling all the upper body scans for one part of the day and all lower body scans for another. Lumeon made this planning possible.

In most of the US, value-based care is still in its infancy. The longitudinal view is not found widely in health care. But Wyatt says his service can help businesses stuck in the fee-for-service model too. For example, one surgical practice suffered lots of delays and cancellations because the necessary paperwork wasn’t complete the day before surgery. Lumeon helped them build a system that knew what tests were needed before each surgery and that prompted staff to get them done on time. The system required coordination of many physicians and labs.

Another example of a solution that is valuable in fee-for-service contexts is creating a reminder for calling colonoscopy patients when they need to repeat the procedure. Each patient has to be called at a different time interval, which can be years in the future.

Lumeon has been in business 12 years and serves about 60 providers in the UK and Europe, some very large. They provide the service on a SaaS basis, running on a HIPAA-compliant AWS cloud except in the UK, where they run their own data center in order to interact with legacy National Health Service systems.

The company has encountered along the way an enormous range of health care disciplines, with organizations ranging from small to huge in size, and some needing only a simple alerting service while others re-imagined the whole patient journey. Wyatt says that their design process helps the care provider articulate the care pathway they want to support and then automate it. Certainly, a powerful and flexible platform is needed to support so many services. As Wyatt said, “Health care is not linear.” He describes three key parts to the Lumeon system:

  1. Integration engine. This is what allows them to interact with the EHR, as well as with other IT systems such as Salesforce. Often, the unique workflow system developed by Lumeon for the site can pop up inside the EHR interface, which is important because doctors hate to exit a workflow and start up another.

    Any new system they encounter–for instance, some institutions have unique IT systems they created in-house–can be plugged in by developing a driver for it. Wyatt made this seem like a small job, which underscores that a lack of data exchange among hospitals is due to business and organizational factors, not technical EHR problems. Web services and a growing support for FHIR make integration easier

  2. Communications. Like the integration engine, this has a common substrate and a multiplicity of interfaces so doctors, patients, and all those involved in the health care journey can use text, email, web forms, and mobile apps as they choose.

  3. Workflow or content engine. Once they learn the system, clinicians can develop pathways without going back to Lumeon for support. The body scan solution mentioned earlier is an example of a solution designed and implemented entirely by the clinical service on its own.

  4. Transparency is another benefit of a good workflow design. In most environments, staff must remember complex sequences of events that vary from patient to patient (ordering labs, making referrals, etc.). The sequence is usually opaque to the patient herself. A typical Lumeon design will show the milestones in a visual form so everybody knows what steps took place and what remain to be done.

Wyatt describes Lumeon as a big step beyond most current workflow and messaging solutions. It will be interesting to watch the company’s growth, and to see which of its traits are adopted by other health IT firms.

How to Enhance the Patient Journey and Patient Experience Using Digital Health Solutions – #HITsm Chat Topic

Posted on April 4, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 4/7 at Noon ET (9 AM PT). This week’s chat will be hosted by Michael Joseph (@HealthData4All) from @PrimeDimensions on the topic of “How to Enhance the Patient Journey and Patient Experience Using Digital Health Solutions”.

The healthcare industry is now immersed in digital transformation — connected devices and solutions which allow for the rapid exchange of information among patients, providers, payers and caregivers. As value-based care models become more pervasive, care delivery will become less episodic and more continuous, compunding the unprecedented proliferation of digital health solutions. Today’s digital health solutions are centered around apps for smartphones and tablets that facilitate and automate more frequent and appropriate interactions to keep patients connected in the ambulatory setting. Common features include:

(1) Connection with remote sensors and monitoring devices for disease management
(2) Integration with patient clinical and demographic data to deliver contextually and clinically relevant information to patients, including reminders, notifications and alerts, to avoid adverse events and eliminate care gaps
(3) On-demand, seamless access to the proper healthcare professionals via text, phone and/or virtual visits
(4) Information to patients on disease prevention, healthy lifestyles and wellness
(5) Recommendations and guidance for at-risk patients to appropriate clinical, ancillary or public health services

As the trend for digital tools is moving toward mobile platforms and cloud-based services, innovators and designers must also consider how to enhance and enrich features and capabilities, so that the tools remain adaptive, flexible, simple and convenient. Through IT modernization, next-generation database solutions and analytic platforms enhance our ability to extract actionable clinical intelligence from ever-increasing volumes of health data and move toward systems for cognitive computing, simultaneously running on millions of connected devices. We’re just at the dawn of a digital transformation in which mobile and wearable devices are commonplace. But gaining traction are implantable devices, cyber pills and smart tattoos that can send constant streams of physiological data for near real time analyses.

Digital health requires a dedicated, highly skilled, multi-disciplinary teams of clinicians, researchers, technologists, data scientists, IT architects, solution designer and developers to guide, build and deploy solutions that yield measurable, impactful results. It requires making investment decisions based on the business case and a well-defined, complete set of evaluation criteria that align with strategic goals and objectives. It requires visionary leaders who champion innovation, make the tough decisions to execute, and persevere, often amidst adversity from conflicting stakeholder interests, with a sense of purpose, accountability and transparency.

The purported benefits of digital health are improved patient interactions and care coordination, increased provider productivity and efficiency, and encouraging behavior change for healthy lifestyles. The key to success is knowing how to appropriately engage users, based on necessity, urgency and personal preferences. i.e how, when and where to maximize frequency and depth of engagement so that digital health becomes ubiquitous to the patient experience.

For today’s #HITsm, we will discuss the path toward digital health transformation and how to enhance the patient journey and patient experience.

The Questions
T1: What are the barriers to user adoption of digital health solutions? (“User” can be patient, clinician or caregiver.) #HITsm

T2: Notwithstanding specific purpose and function, what essential factors must be considered during the planning and design phase of any digital health solution? And who must be involved? #HITsm

T3: Given the explosion of digital health solutions, how do decision-makers determine which ones are most effective for their patient population and/or chronic condition, based on the features described above? #HITsm

T4: What information is necessary to establish credibility and validity of the conveyed value proposition and promises of a digital health solution?  #HITsm

T5: Upon implementing a digital health solution, how do you evaluate its impact with respect to the patient journey and patient experience? Is it possible to correlate better health outcomes as well? (Otherwise, why would anyone pay for it?) #HITsm

Bonus: Can you name a digital health solution that you’d use today if it were available? #HITsm

Upcoming #HITsm Chat Schedule
4/14 – Healthcare Content Creation for the Audience Economy
Hosted by Jess Clifton (@jslentzclifton), Sarah Bennight (@sarahbennight), and Steve Sisko (@shimcode)

4/21 – Innovation vs Incremental
Hosted by @Colin_Hung

4/28 – TBD

5/5 – TBD
Hosted by @IntelHealth

We look forward to learning from the #HITsm community! As always let us know if you have ideas for how to make #HITsm better.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.