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Technology requirements are easy when they are spelled out in regulatory requirements or contractual agreements. Just make sure the technology has the features you need to meet the requirements. But when there are no hard requirements, then its more difficult. How can technology help me or my customers? Will it pay for itself? What are the risks of adopting a new technology? How will we keep up with evolving evidence-based practices? Can I train my staff and customers to use it? Will it be worth the effort? The answers to these questions aren’t easy. But without knowing the answers to these and other questions, it is risky to invest in new technologies and workflows.
To help our clients understand if and how technology can be of value, and to inform our own technology design, we developed a method for analyzing any set of health interests, which we call the “Care Unit Method.” The origin of the phrase “Care Unit” comes from the hospital setting, were departments are often referred to as care units, such as the “labor and delivery care unit” or the “intensive care unit.” Care Units can represent any set of health interests, such as a health or social condition, therapy or program. Care Units can represent health conditions such as diabetes, COPD, hypertension, substance use disorder or pregnancy. Or Care Units can represent a treatment or program, whether for physical health, behavioral health or social determinants of health. Examples of Care Units include substance use disorder, depression, pain management. Care Units also address social determinants of health like employment, food and nutrition, supportive housing and criminal justice re-entry.
The Care Unit Method is our model for evaluating any potential Care Unit. For the past 12 years, we have worked with teams of graduate students at Indiana University Purdue University at Indianapolis (IUPUI) to apply the Care Unit Method to a wide range of Care Units. Following is a partial list of Care Unit Analyses that have been conducted:
We have found that some Care Units represent tremendous opportunities to improve health outcomes and lower cost while contributing to an organization’s financial sustainability. For other Care Units, the opportunity may not be very compelling. Sometimes the evidence-based practice supporting a Care Unit is not particularly enhanced by technology, and in others, the financial models simply cannot justify the investment in either technology or labor for a technology-enabled configuration. On the other hand, it is often the case that a combination of Care Units presents a compelling value proposition where no individual Care Unit within that combination presents a compelling value proposition on its own.
The Care Unit Method revolves around a flexible inquiry process using the following inquiry framework:
For each Care Unit, we begin with from one to three primary use case organizations or communities. We look for consistency or variations in how the EBP workflow is implemented. In some Care Units, the EBP is clearly defined and consistently applied. In other Care Units, the EBP is more of a philosophy providing vague suggestions than a prescriptive model for treatment. In these cases, we may add a survey to the Care Unit Analysis to understand the range of disparity among the broader community of organizations. Ultimately, every organization is different, but understanding the broad landscape of how organizations implement each specific EBP is critical to success.
The Care Unit Analysis acts like a tool box for a wide range of purposes. The Care Unit Analysis is critical to evaluating the value proposition for whether or not to implement new technology or workflows. It provides core components for grant applications or contract negotiations with payers. It helps to set staffing requirements and anticipates how the relationship with customers could evolve. Ultimately it serves as a roadmap for functional requirements and for technology configuration and evaluation.
In short, everything we do flows from the understanding we gain, with our clients, through these Care Unit Analyses.
