What modern care models can learn from traditional project management

A traditional Care Model assumes:

  • Scheduled appointments in exam rooms
  • Documented oral conversations in the form of notes in an EMR that patients do not have access to
  • 85% of the content in oral conversations in exam rooms are forgotten by patients
  • Radio silence in between visits

The traditional care model is inconvenient for patients and highly ineffective at managing care. A clinician’s job is to strategize, educate, and inspire. If they only have 15 minutes every quarter to learn about you, teach you about your condition, and inspire you to change your everyday habits, and 85% of what clinicians say is forgotten, traditional clinicians are 15% good at educating and inspiring you. And let’s face it, for chronic conditions, the patients are the ones doing the hard work every single day of their lives to change their health for the better. If you got only one hour a year to meet with your work colleagues to deliver on a life or death project at work, you simply wouldn’t be able to deliver anything. Yet, this is how healthcare is set up all around the world.

Traditional care models are powered by traditional EMRs. The core architecture and technology of those EMRs were born in the last century prior to the invention of cloud computing and online collaboration. The core assumptions of traditional EMRs are:

  • Care will be delivered in-person via 1:1 oral conversations in exam rooms
  • Care must be documented in traditional SOAP note formats to document “here’s what happened today” and any activity that happens outside of today requires another note.
  • Patients will have no significant access to information beyond the basics.
  • Patients are not core members of the project team. The tools are designed exclusively for clinical staff.
  • Beyond basic 20th century email-like messaging, patients cannot significantly contribute to the source of truth despite being the most important human in the project.
  • The clinical notes inside them have major duplication issues as the “stories” are templated to speed up each visit’s documentation.
  • The data inside EMRs should be taken with a grain of salt because they are designed to maximize revenue, creating truthiness issues.

Other industries have figured out how to deliver on very complicated projects that take years to develop with multiple teammates scattered throughout the world across many different time zones and cultures. The ridiculously complicated platform you’re reading this on was very likely developed in this manner. That’s because those teams have:

  • Team leaders setting the vision and plan
  • Purpose-built collaborative project management platforms
  • Individuals who embrace that way of working
  • Easy online communication within the projects

Project management principles and the software to enable them are now ubiquitous in the world. They’ve got a few decades of development under their belt. If healthcare adopted these principles and treated every condition as “projects to be managed,” managing chronic diseases over time via novel care models could drastically improve our nation’s health. Managing chronic conditions needs a fundamental rethink. So, let’s analyze the features of today’s project management (see Basecamp or Jira if you need a good overview)

  • It’s team-based and collaborative
  • There is a team leader building the outline of the project
  • Asynchronous, online communication is the main form of communication.
  • Every moving part is scheduled, tracked, and organized by stage of development
  • Tasks are assigned to the appropriate team member
  • Birds eye view of the progress of the entire project
  • Integrates with hundreds of external services/apps
  • Single source of truth for all team members
Jira’s board

The features of the technology that powers modern care models must be based on these project management principles. This means that modern care models have:

  • A team-lead (typically a clinician setting strategy and goalposts)
  • A collaborative team that augments all roles
  • A patient who can easily contribute to the single source of truth
  • Easy, primarily asynchronous communication and “meetings” when necessary
  • Assigned tasks with statuses
  • Birds eye view of the entire condition being managed
  • Securely integrating with other online platforms

By far, the biggest difference between traditional project management and health condition project management is the number of projects being managed. For traditional teams building, say, a new feature at twitter, they are members of 2 or 3 projects in their project management tools. But, for a provider serving as “team lead” for 1,500 patients, each with a few conditions that need to be managed, it’s easy to imagine being overwhelmed. That’s why the secret sauce of modern care model platforms needs to be a set of features that help all members of the care team manage 1,500 projects at once. It’s a firehose of activity that needs insane amounts of structure and intelligence. And traditional EMRs are by no means set up to manage this kind of activity. More to come about that secret sauce…

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