Innovation in healthcare IT
Delivering healthcare is one of the most complex human activities. In recent decades, major transitions have taken place in diagnostics, pharmaceuticals and treatments resulting in shorter length of stay in healthcare facilities. The current transition to more personalised care and to longer term managed care pathways means that healthcare IT systems are changing direction. But this change may not happen smoothly.
Health service delivery has massive variety. It entails mixing important short term acts such as conversations and care tasks with hugely complex interventions and long term services. Then there are the processes that run in the background. Policies, standards, measurement, analysis and highly specific research activities - all of which demand attention. And as society undergoes change, there is a public agenda that debates both value for money and measurement of both statistics and reputation, the balance of risk moves. So is there more risk in change or are we better off without implementing the change?
Change is never easy. Especially when there are tough decisions to be made, clinical services to be delivered and normal business to be run. All the stakeholders have a case for attention, and there are many decision points about new projects in a naturally risk averse environment – although healthcare often delivers rapid responses and excellent results under pressure.
Typically, efficiency and productivity within the hospital boundaries are measured by waiting lists and length of stay. This now needs more diverse measures of longer term resource allocation and outcomes on patient pathways. A typical patient experience now includes multiple service providers in geographically dispersed settings and shared care models between clinician, hospital, community services, social services and private providers.
The organisational change massively increases complexity especially in the use of information to support health and care delivery.
Three major influences are likely to impact in the short to medium term:
Patient communications and security:
Broad consumerisation of technology is dramatically increasing the speed of IT adoption. For instance, more and more individuals are using iPad, smartphones and social networking to browse, purchase and make shopping decisions online. So usage and the procurement landscape have to respond appropriately. Typically, the suitable technology is selected, bought and paid for on a shorter depreciation cycle. Further, the products and services have to be more flexible and adaptable even visually. They should especially be able to share data with open, yet secure standards.
Health providers have to consider how patients and carers want to develop and sustain communication with specialists, link into their records and become part of the important population cohort that is able to contribute to self-care. This moves all aspects of ‘tele-health’ into normal use – e-consultations, where captured data and plans are jointly shared by patient and clinical teams. The aim is to involve patients as partners in their own care and avoid re-hospitalisation.
While nothing replaces the value of personal contact between clinicians, patients and carers, there is now a new dimension to important relationships. Several clinicians now show the patient information on a computer screen such as graphed results over time and X-ray images. The next step is sharing information in more than one way. This works both ways. The patients expect regular feedback about their condition and self-service apps. And if they are able to use their own gadget for accessing information then the staff can also use their own preferred hardware through ‘bring-your-own-techto- work’. This will ultimately lead to saving budgets and increasing usage. And it is important to monitor relative success in pathways, developing insights and training and rapid reaction about deploying what works well and stopping poor processes. This approach, called Applied Customer Insight, is already used by other businesses.
The benefits are clear:
- improve patient experience by saving time and travel
- better manage the clinical workload
- improve monitoring of post discharge and chronic conditions
- transfer some basic responsibilities to patients
- reduce health provider direct costs through using common services such as email/web services/video conferencing or Skype.
Meanwhile, patient groups are already campaigning for free wifi in hospitals. Health services have to be able to manage patients who are comfortable with email, social media and online shopping.
Re-use of technology:
The maturity of the information held in health systems means there is high process compliance and research value. It is quite common to see successful services get roadblocks because they do whatever it was that makes them leaders a little too long. It is better to use pre-emptive selfdestruction and renewal. Fortune Magazine in 1994 quotes the then HP CEO Lewis Platt: “We have to be willing to cannibalise what we’re doing today in order to ensure our leadership in the future. It’s counter to human nature, but you have to kill your business while it is still working. Or as they say in Silicon Valley, it’s better to eat your lunch before someone else eats it for you.”
Focusing innovation on re-using and applying existing resources (cannibalising existing investments) means a focus on the real value of what is being done. Re-using data in a new service architecture means decisions are taken about duplicate data.
New large scale views of all the information about a patient means that process conflicts are removed and redundant supporting processes are stopped or replaced. Thereby using more standardised common processes so both staff and patients see systems as useful and not as a hindrance.
If clinicians have a ‘single view’ of the patient, they can see all the details pertaining to that patient, including demographics and all professional contacts, all diagnostics and events, documents and consents, alerts, allergies and medications. Most health systems have clear governance rules and such integrated services actually improve security.
And by moving away from a ‘systems focused’ to ‘services focused’ plan, the policy of re-using saves scarce capital and makes better use of revenues.
Are we big enough to maintain in-house services:
Healthcare computing and the digital storage of patient records started half a century ago. Providers rightly continue to worry about the return on investment, managing the cost curves between revenue and capital, the demands of a modern infrastructure and the introduction and sustainability of new systems.
Information systems are usually allotted a small budget in most health environments, but can be mission critical. And typically most healthcare services favour serving specific responsibilities and a focus on managing current services and situations.
But the true value of in-house services is not to drive to the lowest cost or lowest percentage of revenues and so create the cheapest mediocre provision. Or to delay investment to the last possible moment. It is to be able to ‘leverage’ technologies whilst not being responsible for their creation. And to apply readily available bought-in services not duplicate them. The economics of the ICT industry means in-house services can now focus on supporting clinical informatics. Working with health professionals on specifications, project delivery and support to enable patient and clinical services, to address whole processes and the important touch-points, and reduce the cost but maintain the quality of interactions.
So the challenge is to blend in-house services with outsourcing services and enjoy economies of scale. For example, by merging help desks, virtualising servers, or managing systems and desktops remotely. This is now almost the norm for most sectors with mission critical systems. Supplier management is important and needs specific service management thinking.
By concentrating on service management and using external providers wisely, in-house staff can develop roles focused on processes and patients with clinical and health process design, rapid deployment and improving quality of patient services.
Download PDF (1.1mb) Go to eBook