Rush care providers prescribe and track non-medical services using high tech
Rush University Medical Center is among the first hospitals in the country to use its electronic medical record to “prescribe” non-clinical resources and social services that can be crucial to patients successfully managing chronic medical conditions, and then electronically monitor whether patients are receiving the recommended support.
Rush physicians, nurses and social workers have been using a web-based messaging system developed in partnership with the Chicago technology firm NowPow that securely connects patients with resources and services available in their neighborhoods. Rush began using this new technology in January.
A screening tool built into Rush’s electronic medical record — or EMR — prompts providers, including physicians, advanced practice providers, nurses and social workers to ask patients a series of non-medical questions as they also collect standard medical history data. Asking patients whether they have adequate housing, food or access to transportation, for example, provides a more complete picture of patient needs and the barriers they may face to staying healthy.
After the provider completes the patient intake process, the Rush EMR combines the social data with the medical history into a patient profile that it sends to NowPow instantly and securely. Within seconds, NowPow’s software queries the company’s database of local community resources to identify where patients can receive needed services. NowPow then draws on its national database of clinical evidence to find how the most commonly diagnosed chronic conditions have been managed successfully in areas demographically similar to Chicago’s West Side.
NowPow then provides a curated list of resources and services — called a HealtheRx, a combination of a tech pun and the Rx symbol for prescriptions — that matches the patient’s needs. The technology enters the HealtheRx in the patient’s EMR, sends it to the identified community-based providers, and emails and/or texts it to the patient.
For example, outcomes data shows that people are more likely to manage diabetes successfully if they have sufficient access to fruits and vegetables, get frequent blood sugar screenings and receive foot care. So in addition to a prescription for a medication to regulate blood sugar, a patient with diabetes might also be referred to a Federally Qualified Health Center for free blood sugar screenings and foot care, and to a Greater Chicago Food Depository partner site for free healthy food.
‘Food and housing are medicine’
“This is a real breakthrough in acknowledging that social needs are medicine: Housing is medicine. Food is medicine,” says Robyn Golden, associate vice president of population health and aging at Rush. “Having all these partners at the table together, around the same mission and vision, is critical, particularly when there are far fewer resources available than there were a decade ago. We have to use what we have more efficiently and effectively, and connecting our organizations is the best way to do that.”
“Rush is pioneering the work in the social determinant space by leveraging technologies such as NowPow that systematically connect patients to local resources near them that help them address their individual health needs," says Stacy Lindau, MD, NowPow’s chief innovation officer.
“As a physician, I know that medicine is important to people’s health, but vast majority of what determines a person’s health is not medicine, it’s the ability to take care of themselves, live well, manage disease, give care to others outside the doctor’s office.”
Because NowPow makes these prescriptions for services part of a patient’s EMR and sends them to the service providers, both clinicians at Rush and staff at the community resources can send reminders to nudge patients into action and reduce the incidence of patient failing to show up for their appointments with care givers. For example, in the first few months since tracked referrals have been sent to West Side-based CommunityHealth, the nation’s largest free clinic for uninsured or uninsurable patients, the attendance rate of appointments has increased by over 20 percent.
Putting a FHIR under care coordination
The messaging system that enables this flow of information connecting care providers, patients and community resources is based on a modern API based interoperability standard called Fast Healthcare Interoperability Resources. FHIR, as it's known for short, allows encrypted patient data to be exchanged between organizations and devices with any system in a standard plug and play fashion. It provides the right information to the right individual in the right format at the right time in order to make the right decision. It does this all to the highest security standards, greatly expanding the possibilities of care coordination among separate organizations.
Shafiq Rab, MBBS, MPH, Rush’s senior vice president and chief information officer, adds that in addition to being secure and convenient, this two-way flow of data between the EMR and social work should be seen in historical context. Less than a century ago, thousands of people would die every year due to water-borne infectious diseases.
“Those diseases didn't go away by themselves,” Rab says. “They were eliminated by social change — making clean water and sanitation available.We don't have typhoid or cholera here because we eliminated the causes, and we are now going after the reasons that diseases like heart diseases, cancer and diabetes cut thousands of lives short in Chicago."