Healthcare Lessons from Beyond our Borders

By Kirsten Meisinger, M.D. | June 5, 2018

2018 Alliance sponsor article courtesy of athenahealth

Why does the rest of the world spend less on healthcare than the U.S. and have better health outcomes? Because other countries have done what we in the United States have repeatedly declined to do: Align the public health sector with the healthcare delivery system.

I work on a project in Nepal to reduce maternal and infant mortality. We knew that mothers and babies were dying because midwives in remote mountain areas lacked necessary medical supplies: Antiseptic for babies and misoprostol to prevent hemorrhage in mothers. The government gives these supplies away for free because its data show that mortality rates go down when they do.

But keeping those supplies on hand was a challenge. So we gave all the midwives in our project cell phones and had them text central supply when their stock levels ran low. Within three months, all the rural health posts were fully stocked, and maternal and infant mortality decreased dramatically.

This kind of rapid response is only possible in a decentralized healthcare system in which public health data directs and informs healthcare delivery.

In the U.S., we created a centralized, hospital-based system, believing better outcomes would result. We were wrong. We do emergency and tertiary care very well, but the rest of the world has shown that for primary care, a decentralized delivery system is far more effective.

The key to decentralized systems is health promotion via community health workers, trained laypeople who know their communities and can translate medical recommendations in a way that patients – their neighbors – understand and follow. And that leads to better outcomes.

In centralized systems, normal events like pregnancy and pediatric care tend to be medicalized. We moved all our pediatric care into medical offices, for example, and our vaccination rates plummeted. The reason? It’s really hard for parents to take off work, particularly for an appointment where their child is measured and someone says, “Good job, Mom and Dad.”

In France, Australia, and over much of the rest of the world, children often go to the doctor only when sick. Their vaccinations and well-child care are largely managed by a nurse, often one who works at their school, because that is more efficient and, therefore, more effective.

The resource-poor world has developed efficiencies in care delivery through necessity. And most rely on community health workers. In Brazil, community health workers reduce the risk of falling among elderly by teaching patients exercises to do while holding on to a chair. Driven by necessity, their decentralized, community-based strategy yields results any health system in the U.S. would be proud of, and shows precisely why harnessing the power of community to get widespread results is an area of such intense interest right now.

In Rwanda, the Ministry of Health provides most of its citizens access to primary care consultations via a telehealth app on their mobile phones. These are incredibly efficient and effective interventions. Our health system is rich enough that we don’t demand these kinds of simple efficiencies, and then we blame patients when our inefficient systems don’t meet their needs. Rwanda shows us a perfect example of how to make crisis an opportunity by investing in a technology solution that empowers patients to direct their care.

Consumers in the U.S. are using similar technology for everything other than healthcare. Now is the time for us to learn from our neighbors and make the leap.

To achieve efficiency in healthcare delivery, we need to trust our patients to a much higher degree and give them recommendations they can easily follow. The resources we need are already in our communities, our patients, and our public health data. It is our job, our mission, to connect them. And we can learn to do so from our global neighbors and colleagues.

Kirsten Meisinger, M.D., is president of the medical staff at Cambridge Health Alliance.

When data drives the bus to better health

By Gale Pryor | May 24, 2018

2018 Alliance sponsor article provided courtesy of athenahealth

How can data visibility improve population health?

Consider the state of West Virginia, where more than 11,000 residents are diagnosed with cancer each year, and almost 5,000 die from cancer-related diseases, according to the CDC. And one in eight adults has diabetes, and the state spends $2 billion each year on diabetes care.

What’s needed in the heart of Appalachia is early detection and intervention to treat disease. Yet for patients living in isolated communities with inadequate transportation, routine screenings for treatable diseases may fall by the wayside until it’s too late.

“If you don’t think you have breast cancer, driving to the city to get a mammogram is a tough sell,” says Sarah Chouinard, chief medical officer of Community Care of West Virginia, a federally qualified health center with a network of 49 primary care and school-based clinics, pharmacies, and dental offices across nine counties.


Bonnie’s Bus is named for Bonnie Wells Wilson, who lived in a region without access to mammography and died of breast cancer.

So Community Care found a way to take healthcare screenings directly to patients — by bus. In a partnership with West Virginia University School of Medicine, the organization operates two mobile health buses to provide breast cancer and diabetic retinopathy screenings where patients live and work in the hollows and hills of the region.


When data from Community Care’s EHR indicates that mammogram screening rates are low in one of its clinics, Bonnie’s Bus, the mobile mammography unit, sets up in the parking lot to expand capacity. When the rate of use plateaus — from 15 patients per day to one or two — the team knows it has addressed the need at that location for the time being and moves the bus on to the next site.

The results, so far, have been dramatic: Since first hitting the road in 2009, Bonnie’s Bus has provided more than 11,000 mammograms to women over 40 throughout West Virginia and has led to the detection of over 48 cases of breast cancer.

Data to the rescue

Leaders of Community Care, a high performer on the athenahealth network, say data visibility — the ability to track quality measures for patients and performance — ensures the buses show up where they’re needed most. Every provider “has that data at their fingertips,” says Chouinard. “If they have a pause in their day, they can go in [to the EHR] and say, ‘Hey, let’s take a look at our cancer screening lists and see who’s due for services.'”

And, through its patient record sharing service supported by the CommonWell Health and Carequality alliance, Community Care receives results of mobile screenings in near real time. “Now we can access records if a patient has had testing outside our facility,” says Genevieve Larimer, nurse practitioner and EHR project manager for Community Care.

“Patient record sharing gives us the ability to very quickly access that information,” she says, “usually the same or next day after the patient has been seen.”

Even if the patient was seen in a bus on a mountain hours away.

Gale Pryor is senior editor of athenaInsight. This article is an update to content originally published October 20, 2016. Additional reporting by Alison Pereto, staff writer.