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Overcoming Entropy: Cultivating Care Coordination at eHealth Week

doctors having friendly discussion around a table

There’s usually a single phrase or concept that stands out for me at every event. The European eHealth Week 2017, held recently in Malta, is no exception.

The formal theme of the conference was “Data for Health: The Key to Personalised Sustainable Care,” and it is well aligned with the patient-centered, connected care InterSystems facilitates. But the phrase that caught both my eye, and my imagination, appears in a blueprint document published by the European Innovation Partnership for Active and Healthy Aging (EIP for AHA).

“Better care coordination, or ‘integrated care,’ does not evolve naturally” (emphasis is mine).

While I switched from physics to medieval studies after my first year of college (yes, there is probably a metaphor there), I haven’t forgotten the rudiments of the second law of thermodynamics. Basically, the law states that, on their own, systems naturally become increasingly disordered. To prevent disorder requires energy, that is, work. To reverse disorder, to create and maintain order, requires the continuous application of even more energy. Which is essentially what the report goes on to say:

“Better care coordination or ‘integrated care’ does not evolve naturally and still requires a fundamental transformation of care delivery mechanisms: a shift in focus from acute, hospital-based care to early prevention, population management, community and home-based care; a much stronger participation of citizens in their own care process; more recognition, support and participation of carers and healthcare professionals; new roles, skills and responsibilities for care professionals; new patient pathways ensuring the cooperation among care actors and timely follow up of patients; new governance models between payers, providers and consumers of care that incentivise co-delivery of care and results (including performance-based payment models), supported by innovative technologies (emphasis also mine).”

While the conference focused on the progress made across Europe in all of these areas, it also made evident the challenges. One of the biggest of these is the one that plagues every nation – getting the incentives right. One delegate described his home country as the “home of the perverse incentive.” I’m deliberately not naming the country, because I’m convinced we could all claim it as our own!

Beyond the problem of incentives is the tendency to think that we can overcome the entropy in our healthcare systems just by building or buying technology solutions. This is why I highlighted that second phrase, “supported by innovative technologies.” We can’t fundamentally transform health and care without innovative health IT. But we can’t lead with it either.

Successful transformation requires technology, led by vision. And yes, it requires a whole lot of work.