5. Telehealth, social determinants of health (SDOH) and communities of care
In addition to evolving technology, reimbursement, and regulatory requirements, non-medical societal factors influence the development of systems to support healthcare delivery.

The pandemic has accelerated adoption of telehealth as a primary method of contact for patients. A new focus on SDOH shows promise for engaging community resources to help patients who may not otherwise be able to access needed services. With patients and their families or other caregivers having access to their own information, and the framework being established for the sharing of that information across all points of contact, it will enable a “community of care” to be established for each patient.
This scenario will necessitate all participants in each patient’s personal community of care having access to information at the point of need. That point of need can be the time of registration or screening, either in-person or through the much touted “digital front door,” at the time of patient-clinician encounter (virtual or otherwise), during a home care visit, during pre-visit planning by a care team, a visit with a school nurse, and all other settings where care is delivered or managed. The 21st Century Cures Act, TEFCA, and FHIR provide the basic building blocks for sharing patient medical information. Combined with new innovations for cloud-based deployment, enterprises now have both the motivation and the tools to transition from transaction-based reimbursement to true value-based care.

Patient-centric, community-based care
Holy Name Medical Center in Teaneck, New Jersey, decided to put all of this together and build a community health record for each patient. The record ties together every interaction with a patient, with any healthcare provider or other point of contact, into a single patient medical record. Implementing this new patient-centric, community-based system required Holy Name to build a new type of clinical management platform––with all the factors mentioned earlier.

Incredibly, Holy Name accomplished this during the pandemic. The new system has now been live for a full year, after being deployed first in the emergency department. It is now being built out to the rest of the health system. This new way of using the latest technologies to link patients with all members of their care community, isn’t just a “nice to have,” but a glimpse into the future of healthcare delivery.

About the author: David Lareau is CEO of Medicomp Systems where he is responsible for operations and product management, including customer relations and marketing.

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