The Demand for Value-Based Health Care

One of the hallmarks of the twenty-first century is the explosion of technological devices and systems that touch every part of our lives. Nowhere is this more apparent than in health care. As a result, an enormous strain has been placed on the shoulders of those who make business decisions for health care organizations. Capital budgets are already at the breaking point, even though there is an amazing number of emerging technologies to consider purchasing (e.g., imaging, monitoring, communication devices, information management systems, pharmacological products, and implants)—all of which promise improved therapies, care delivery processes, and patient safety. Sorting these out can be quite time-consuming and often requires a level of knowledge that many executives simply do not possess. Moreover, consideration of this vast array is frequently complicated by the many disappointments that have accompanied the introduction of earlier versions of the technologies under consideration.

As a result, it has become increasingly important that each institution have its own means of confronting decisions related to technology, and that these questions always be addressed within a clear framework of policies and procedures. In fact, a helpful approach is one that represents a combination of evidence-based practice (something demanded of all clinicians but seldom expected of administrators) and informed consumer behavior. Value analysis and technology assessment are parts of the process, but the techniques to do this can be imprecise, and other business imperatives (e.g., maintaining a competitive edge and retaining physicians) may take precedence. Nonetheless, careful and deliberate consideration of technology purchases has become essential because of the magnitude of both the cost and potential impact, whether good or bad. In the future, robust comparative effectiveness research may shed more light on the effectiveness and efficiency of the most expensive technologies.

There is an urgency to understand the benefits of health care investments. In a 2009 Institute of Medicine report, “Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation,” health information technology was noted to be a prerequisite for attaining greater value in health care. The benefits were improved quality, ability to monitor outcomes, clinical decision support, collecting and developing evidence, tracking costs, streamlining paperwork, improving care coordination, and facilitating patient engagement. Although perspectives on the value of care differ for each stakeholder (i.e., the consumer, provider, and payer), the lack of uniform definition of value does not diminish the belief that outcomes can improve while reducing costs. Value-based payment approaches by payers such as Medicare link payment to performance in order to stimulate improvements in systems of care and, thus, better care coordination and reduction of unnecessary costs.

Use of technology is a key strategy for harnessing the power of data at the point of care and using these data for managing disease, identifying patient trends, and intervening on health problems earlier. Transforming technologies such as telehome care and telemonitoring are already showing reduced hospital admissions and lengths of stay, as well as decreased unplanned visits to health care providers. Devices that eliminate redundant nursing tasks can increase the nurse’s time spent in direct care of patients, improving safety through direct observation and early interventions.

Technology Enhanced Nursing Practice

Health care organizations are making significant investments in technology to improve clinical care and slash error rates. Technology has been used extensively in the hospital for decades, but now it provides new capabilities for remote monitoring in homes, offering connectivity to portable devices such as cell phones and personal digital assistive devices. In this way, technology is becoming an effective tool for chronic disease management, prevention of hospitalization, and keeping people in their homes.

Nurses have begun to embrace the use of technology in all aspects of their practice. They perceive it as a means to improve the accuracy of care delivery, reduce redundancy of activities such as data collection and documentation, reduce physical strain from moving patients, and improve workflow efficiencies. Nurses may also find that some technologies present barriers to efficient care if not developed to complement the nurse’s workflow and human behavior. As a result, nurses may develop “workarounds” that circumvent the correct use of devices. Early bedside barcode medication administration scanners and complicated intravenous pumps with safety software required redesign and testing to ensure that nurses could use the technologies easily and efficiently.

The Effect of Technology on Nursing Practice: The TD2 Study

In 2000, the Workforce Commission of the American Academy of Nursing (AAN) focused on ways to decrease the demand on registered nurses’ time as a solution to the impending workforce shortage. Facing a different kind of shortage characterized by the aging population of nurses, a dwindling supply pipeline, an increase in demand for nurses, and a paucity of individuals prepared to fill the ranks of nursing faculty jobs, the Commission focused its attention on how the demands of patient care could be met in part by technology. It was thought that the growing availability of technology—devices, instruments, appliances, and information systems—offered important opportunities for reducing the demand on nurses’ direct and non-direct care time. Likewise, technology was thought to have the potential for easing the physical burden of nurses’ work through a variety of devices such as those used for moving patients. In short, the AAN Workforce Commission believed that innovative technology could be used to enhance patient care, improve efficiency, and make care safer for patient and provider.

To that end, the Commission convened an invitational conference in 2002 that was attended by nurses, physicians, pharmacists, health care provider organizations, government agencies, equipment suppliers, engineers, architects, futurists, and medical record system vendors to consider how technology might be deployed in an ideal care delivery system within the next decade. They proposed a redesigned future nursing work environment that effectively used technology to improve practice and patient care outcomes.