A dynamic, holistic, personalized care plan that follows an individual over their lifetime can help drive quality care and overall well-being. In this ideal state, care plans can support a connected, collaborative and patient-centered experience. However, fragmentation, duplication, and lack of patient engagement can be some of the most pressing challenges in the world of care planning.
The Future of Connected Care Planning
A dynamic, holistic, personalized care plan that follows an individual over their lifetime can help drive quality care and overall well-being. In this ideal state, care plans can support a connected, collaborative and patientcentered experience. However, fragmentation, duplication, and lack of patient engagement can be some of the most pressing challenges in the world of care planning
Characteristics of an Effective Care Plan Care
Care planning is an essential piece of care coordination that can foster continuous improvement throughout a healthcare organization. An effective care plan:
Organizes patient health and care activities and promotes seamless information exchange from outside sources across the clinical and personal care team
Establishes focus to improve communication and clarity of the patient story across all members that interact with the patient with the aim to reduce duplicate documentation, enhance clinician efficiency, and improve overall care
Enables the person to be an active participant in managing their healthcare to improve collaboration and communication
- Advances value-based care strategies around preventative care, collaborative decision-making, and managing the total cost of care
The Real-World Impact of Care Planning
A person-centric approach allows health systems to provide more competent and robust patient care. For example, let’s say the patient, “Jen,” was born prematurely, so her parents and pediatrician worked together to develop a care plan to ensure Jen’s healthcare needs were always met. As Jen transitioned from childhood into adolescence, her care team expanded to include an ENT, a gynecologist, and other added specialists as plan contributors. Even though Jen’s data spanned multiple electronic health records from childhood into her adult years, all relevant reports were captured and made available to Jen and her care team. When Jen turned 40, her gynecologist recommended she start getting annual mammograms. The radiologist’s interpretation of her exam was included in Jen’s care plan, allowing her gynecologist easy access to related goals and activities and current status even though the providers were at different health systems. If an unplanned event occured and Jen was admitted to the hospital, data captured for this acute event related to her care plan was also documented in her records. In addition, long-term goals and activities were evaluated and paused as appropriate and then resumed when Jen’s health issues were resolved
As the amount of digital data grows and the ability to connect to outside sources evolves, it’s crucial for you to be able to use available data to help drive organizational decisions. Cerner’s analytics solutions use aggregated and normalized data from multiple, disparate sources across the health continuum to help drive decision-making and perform advanced analysis tailored to your organization-specific needs and goals.
