The atomic elements of care

When you think about the process of delivering care, you realize that care can be broken down into very consistent and predictable elements. I call these the “atomic elements of care.” Almost every element is involved in managing any kind of condition, whether acute or chronic. They are:

• Gathering a history

• Making assessments

• Confirming an assessment

• Determining a plan

• Defining and communicating what success looks like

• Educating the value of the plan

• Ordering interventions

• Fulfilling interventions

• Interfacing with external specialists/facilities

• Tracking progress

• Continuing standarized education

• Proactive ongoing clinical support and question answering

• Determining resolution or ongoing management

• Maintenance or prevention

When you break the care process down into these atomic elements, you can easily see that the only difference between managing different diagnoses is the content found in each element. For example, standardizing gathering a history via the “20 magic questions” you need to ask anyone presenting with a diagnosis or symptom means creating those 20 magic questions for every symptom and diagnosis you tackle. With Sherpaa, we created ~400 of those question sets because, surprisingly, there’s a very finite list of symptoms in primary care. But standardizing those questions so that a doctor can find them within seconds and send them off all at once saved thousands and thousands of hours a year. It was a phenomenal investment of our finite resources. First, it standardizes how you take a history (which ensures consistency, quality, and reduces risk) and, second, it saves tons of time/money in the care model. 

But what’s interesting here is gathering a history is just one of the 14 atomic elements. Each atomic element can be standardized and mostly automated. And, adding that all up in the end, this means the vast majority of care can be standardized, and therefore, become meaningful data points. 

But do you know what’s even more interesting? If you’re thinking of building your own technology, you can easily see what you need to build or how you need to assess a traditional EMR to see if that thing can standardize and automate your care model’s atomic elements. There’s a lot of debate about whether or not care model companies should build their own tech vs outsource it to a cobbled-together suite of traditional tools. The best way to think about this is:

Can off the shelf technology structure these atomic elements across all of your care teams so it can standardize and automate the atomic elements of care you deliver and ultimately drastically save care team time? 

Because, in the end, the biggest expense you’ll have is care team payroll. If you can build the suite of atomic elements in house and double the patient panel for 500 providers because of these standardizations and efficiencies, it’s a shockingly worthy investment. And if you find that traditional EMRs cannot do this for you, you really need to question the belief that traditional EMRs are the right tools to power modern care models. 

And this brings up the next question, what components of an EMR do modern care models need? Here’s a teaser. It’s a tiny, tiny sliver of what they offer. The best way to think about this is you need a very skinny “EMR” which means you hardly need an EMR at all. That will be covered next. Stay tuned!