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In the Upper Connecticut River valley, an unprecedented effort is underway that could revolutionize the U.S. healthcare system. At Dartmouth-Hitchcock Health System, an unlikely team of experts from a broad swath of industries — from medicine to retail, entertainment, publishing and hospitality — is fearlessly and persistently challenging the status quo of modern healthcare. They’re piloting a highly coordinated, intensely personalized solution that encompasses physical, mental and emotional health. It’s called ImagineCare, and it’s built on Microsoft’s leading technology for machine learning, big data storage and processing, and perceptual intelligence — including the just-announced Cortana Analytics Suite. Dartmouth’s goal is to provide this technology platform to health organizations across the country, changing the way people interact with the healthcare system by putting them at the center — and ultimately changing the way we all think about our health.
The potential upsides are enormous: healthier people who are more in control of their own well-being, receiving proactive care at home where they’re most comfortable. Physicians with actionable data that help them provide personal, optimal care. And a sustainable system that delivers the best possible care at the best possible cost, informed by massive amounts of real-time data — all while remaining laser-focused on the individual.
“What’s wrong with healthcare today is that people aren’t willing to think differently,” says Dr. Jim Weinstein, Dartmouth-Hitchcock’s CEO and the driving force behind ImagineCare. “We imagined what could happen if we gathered the best and the brightest — experts from all kinds of industries — and allowed them to invent an entirely different way.”
Fueled by a passion for change, and using lessons learned from the retail and hospitality industries, the team created a system that upends the usual process of care by focusing first on customer service. “The current healthcare system asks a patient to come to us when it’s convenient for us,” says Dr. Ethan Berke, medical director for Clinical Design and Innovation at Dartmouth-Hitchcock. “We asked, ‘how can we meet a patient where they are? Instead of being a reactive health system, how can we become a proactive health system?’”
The team’s answer is ever-present healthcare, a cloud-based system in which nurses and health coaches track and respond to an individual’s health status in real time. Data from sensors and devices such as blood-pressure cuffs, pulse oximeter devices and activity trackers like Microsoft Band are transmitted via smartphone to the Azure cloud. From there, it’s pulled into a Cortana Analytics Suite dashboard at a “contact center” staffed 24/7 by registered nurses who have a singular view of each customer’s personalized care plan. When a person’s data exceeds a custom-prescribed threshold, an alert is sent to the nurse, who then reaches out to the customer via phone call, video chat or secure text — often before the person even knows there’s a problem.
“Imagine you get a high blood-pressure reading. The nurse pops up within seconds, welcomes you by name, and helps you understand what it means, and what you might need to do next,” says Nathan Larson, director of Remote Medical Sensing at Dartmouth-Hitchcock. The system provides a dashboard for the patient, too, and sends reminders to take medicine and measurements, or get exercise. Loved ones can be looped in with real-time alerts to health or plan changes.
“It amazes people,” says Larson. “This level of proactive personal care and customer service really blows the clinical world away. It really feels like someone’s got your back.”
Where ImagineCare really takes flight — breaking into uncharted territory in healthcare — is its ability to track mental and emotional health. Using the perceptual intelligence capabilities of the Cortana Analytics Suite, the system can detect a person’s emotional state — an extraordinarily valuable index. By monitoring Twitter feeds and other social media, the system performs a sentiment analysis, looking for troublesome trends. It can also perform speech and tone analysis during interactions with ImagineCare nurses — a boon for early intervention. A mobile app that invites timely mood check-ins completes the picture, vastly increasing the chances of catching and treating depression before it becomes a life-changing issue.
“We’re truly looking at the whole health of the individual,” says Larson. “It’s a completely new way to deliver care.”
Each patient’s personal care plan is continually updated in the secure, HIPAA-compliant system, using Cortana Analytics Suite to evolve based not only on the person’s own data from Microsoft Dynamics CRM but on near-real-time data from similar people, based on location, age, disease, biometrics and more.
“Imagine if you had a system that is looking at each person’s data — hundreds of data points over time,” says Dr. Robert Greene, executive vice president and chief population health management officer at Dartmouth-Hitchcock. “Now imagine that we have 10,000 patients. Machine learning gives us an opportunity to continuously improve our care plans based on a deep understanding of all that data, so that when patient number 10,001 comes along, we can do exactly what’s best for them.
“It’s almost a paradox,” says Greene. “We want to look at the whole population, because that’s what we’re accountable for, but we’re going to do it one individual at a time, because we want each patient to have the best possible experience.”
What results is a dynamic and contextual care plan that is infinitely more customized — and definitively more accurate — than traditional plans, which are often based on decades-old data and population averages. In the future, external data sources, such as pollen data by ZIP code or CDC flu epidemic data, could be factored in for even greater context.
“It’s a seamless technology solution,” says Larson. “That’s what makes ImagineCare possible — Cortana Analytics Suite, Dynamics CRM and Azure enabling big-data integration, predictive analytics and machine learning on a seamless cloud-based platform. It’s allowing us to make a big difference in people’s lives. It’s exciting to be a part of it.”
A double win
All of this personalized care doesn’t have to cost more; in fact, it’s expected to translate into cost savings across the healthcare system. With U.S. healthcare spending expected to reach $4.8 trillion in 2021 — accounting for one-fifth of the U.S. economy — getting costs under control is critical.
“With this system, we can proactively reach out and prevent emergency room visits, unnecessary primary care visits, hospital admissions and readmissions,” says Berke. “If you have congestive heart failure and your weight starts to trend up, rather than letting that get worse — potentially landing you in the emergency room — your practitioner can start to monitor and help you change some lifestyle issues to prevent that trip to the ER.”
This not only benefits patients but also payers such as employers and insurance companies, because better outcomes translate to lower costs of care. Larson says that could eventually result in lower patient premiums, a “double win.” And physicians stand to gain, too. “Many of the solutions currently on the market give physicians access to raw data; that’s not as useful as actionable intelligence to help them make a diagnosis,” says Berke. “When you start looking at tools such as ImagineCare that have intelligence built in, I think that’s a big deal for providers.”
ImagineCare rolls out to 6,000 patients this October; Dartmouth-Hitchcock is already lining up health organizations across the country for the technology platform they hope will soon become table stakes for high-quality care in the U.S. (and, intriguingly, Berke suggests, potentially the world, via Skype Translator).
“We’ve created a system that focuses on health instead of healthcare,” says Berke. “As more and more people are responsible for their own cost of healthcare, they need to make smarter and more informed decisions. This tool empowers them to take control of things that for the longest time have been out of their control.”
With so much at stake, and with pressures mounting on a critical industry, the ImagineCare team hopes to rewrite the book on healthcare — one patient at a time.
“I’m dedicated to creating a different world,” says Weinstein. “A world in which healthcare takes place outside clinic and hospital walls, in the places where people live. That’s the right answer.”