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Health care, like many industries, places great emphasis on innovation. In just the past decade, we have moved rapidly from paper medical records to electronic ones and web portals that let information pass seamlessly between health systems and patients at the touch of a finger. Smartphone apps, wearables, medical devices, and other gadgets that promise to improve health are being developed at an ever faster pace. These developments often come from companies and startups that are relatively new to health care.

Although it is essential to welcome ideas and creative solutions from diverse sources, many of these “innovations” aren’t solving well-defined problems in health care or they don’t easily fit into current systems that deliver care to patients. Take, for example, Bluetooth devices that sync patients’ fitness trackers to their primary care physicians’ offices. While that may sound like helpful communication, it actually overwhelms primary care providers with data that is difficult to act on. The proliferation of monitors and sensors can make elderly individuals feel spied upon rather than making them feel safer.

More important, this outside-in approach does not usually drive a deeper dialogue between patients and their health care organizations on the challenges we face and the disruptions or innovations that can help meet these needs.


Here’s an example of how that kind of dialogue can improve health care. An elderly woman who visits our Braintree, Mass., practice for care called after feeling ill for several days. Unable to travel to the doctor’s office, she thought that taking an ambulance to the emergency department was her only option to get the care she needed. Emergency room visits are a reality for many individuals who clearly need medical care but have no way of getting to the doctor’s office. But they are stressful and costly.

One year ago, my health care organization, Atrius Health, launched an Innovation Center to help solve problems like the one affecting this patient. Our team met with patients in their homes to learn more about how we could best serve them. Those conversations catalyzed the development of our Care in Place program. It sends nurses from Atrius Health’s staff and its home health subsidiary to the homes of elderly patients who require home-based urgent care.


Our patient in Braintree and her family were surprised and delighted that we could visit her where she lived, evaluate her health, begin treatment under the direction of a geriatric practitioner, and arrange for a follow-up home visit. One of her family members called it a “back to the future approach” to her care that they hadn’t believed was available. In addition to being convenient for the patient, it saved her from an expensive emergency room visit, unnecessary worry, and worse — potentially putting off care that she needed.

Patients continue to coproduce solutions with us, keeping us grounded in real problems and real opportunities. Another example of this from-within collaboration is our teledermatology program. It lets primary care providers take pictures of a rash or lesion using a smartphone or tablet and send the photo to one of our dermatologists via the patient’s electronic medical record.

The dermatologist documents a diagnosis and recommendations for treatment, then sends the updated chart to a dermatology nurse who closes the loop with the patient by teaching him or her about the diagnosis, exploring potential medications or therapies, and arranging an in-office dermatology appointment if needed. Instead of requiring patients to wait 30 to 60 days for an in-person consult, they can now get a medical recommendation within 72 hours. This process also frees up office time and improves access for those who must be seen in person.

Thanks to the success of this program, we have also rolled out e-consults for other specialties such as infectious disease, nephrology, and cardiology, and are developing others. Other innovations in progress include testing video visits and looking at better ways to connect patients with their Atrius Health care team when they are at a hospital or have recently been discharged from one.

Medicine is a collaboration between patients and providers. Innovation should be no different. We are at our best and are most effective in continuously improving care when innovation comes from within the patient-provider community. That means leveraging the relationships we develop with patients, investing in people who are eager to learn how to serve them better, and giving them the time to do that. The best solutions will come from partnerships between patients and the health care systems that know them best.

Karen DaSilva, MD, is vice president of innovation at Atrius Health and leads the organization’s Innovation Center in Needham, Mass.

  • I do hear a lot about new health technology. Sounds like Atrius specializes in ‘last mile’ services that connect to patients where they are. This is getting easier but there are still terrific barriers. How do they handle data security over that last mile? can my neighbor hack my dermatology videos? It would be great if we could get this figured out soon, as my loved ones could use it today.

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