Digitisation vs. Healthcare – Round 2

Surly the title should read "Digitisation for Healthcare", but somehow this process tends to feels like a struggle in this environment.

For the last 20 to 30 years we were going through the first wave(s) of software support for the functioning of hospitals. Results were very mixed, to say at least. With huge efforts and costs, a good portion of western healthcare is now covered with electronic medical record (EMR) systems, although a good number of healthcare providers are still resisting. Paper is still out there, and so are fax machines and pagers, long forgotten everywhere else in the relentless march of technology progress.

Some systems, like National Health Service (NHS) in the United Kingdom, have struggled with adoption, despite billions of pounds spent on large centralised projects (1). The United States has fared somewhat better, as they opted to subsidised projects and not centrally imposed solutions. It did take some 35 billion of incentives (2), and many more billions from providers, but progress has been made.

However, the outcome in the form of large complex EMR systems is not much loved by the nurses or physicians. There is a feeling that these are administrative and billing focused systems, with limited support in clinical care. Also, they are often perceived as difficult to use (3) and an obstacle between clinicians and patients.

In this battle-scared environment, a new wave of technology is coming, backed by a surge in cloud and mobile computing, artificial intelligence, internet of things, as well as with huge strides made in the biotechnology, especially genome sequencing and analysis. The stakes are even higher this time around. Current healthcare systems are obviously not sustainable in the long run and the promise of technology to improve outcomes for the patients and efficiency of healthcare systems is greater than ever. Those large EMR system that were implemented with so much effort and cost, simply cannot keep up with these new technology trends. They still have their place of course, but platforms with far greater capabilities for data handling and analytics are also needed.

How do we transform this highly complex environment to benefit from technology, in the way that other industries have and how we do in our personal lives?

We ran a survey, together with Oxford Economics to feel the pulse of the 400+ executives in healthcare and understand their thinking and priorities.

Although a large majority of executives agrees that this process of using technology to transform their organisations is critically important for the very survival of their organisation, only 2% believe that they have all pieces in place today. Major obstacles are lack of right skills and leadership, but also lack of mature, proven technology. Of course, there is no lack of bold claims and promises in this field, but these executives want to see repeatable success at scale, before committing to certain direction.

There are examples out there of organisations which already made large strides in this direction. Some of them have been making quiet progress for a long time and perhaps they should be better known for it.

I’ll mention a couple which are closest to my heart, through the work in SAP. I think they can offer some very important lessons:

• Catalonia is known for great weather, culture and food, but it should also be known for a very well organised and efficient public health system. They got there by having a clear vision and strategic thinking to make it reality. They realised they need a single version of truth and to link what’s happening in the clinical world with hospital operations. They have almost all of Catalonia residents in a single environment which coordinates care between the largest hospitals and in the same time they have full operational control of quality and cost.
• Estonia, a small, ex-Soviet Republic, is not an obvious candidate for posterchild of digital transformation. However, with the clear vision and commitment to deliver on it, they have transformed their country in a just few years to what is considered the most digitally mature one (4). Their Health Insurance Fund, key payer of care across country, has been doing some excellent work in automating and accelerating their processes, as did most of the local public sector.

What these places have in common is clear vision and leadership, right organisational structures and authority to introduce changes at scale. Of course, I think they made some excellent technology choices as well, but I may be a bit biased there. What they didn’t do is try to impose technology as a Band-Aid over broken processes and siloed organisations.

To truly benefit from this booming technology potential, we need environments which support integrated care, and are organised around patients’ needs, not around the types of services. Biggest opportunities for improvement are not within hospitals or physician practices, but in the hands of patients which can finally take ownership and control of their care, if we let them.

Patients are the largest unused resource in healthcare and they cannot remain just passive subjects of care in the hands of medical experts. This starts by providing access to and control of their medical history, personalise care to their unique characteristics and history, but also enable them to do more for themselves. 

We also need to standardise and automate parts of health delivery which are routine and predictable, as we know from many other industries that this leads to better quality and greater efficiency.

It may sound like a contradiction - personalise care and automate processes at the same time, but these are not mutually exclusive. Decisions regarding the care and engagement need to be tailored to the individual, both through highly trained professional and use of advanced decision support. But once we have decided on a course of action, delivery can and must to be standardised where possible as it will be safer and more efficient.

Full engagement and personalised support is an opportunity to help patients live longer and healthier lives and eliminate a lot of waste and harm which we know is happening even in the best of our current health organisations.

1 Campion-Awwad, O., Hayton, A., Smith, L. and Vuaran, M., 2014. The National Programme for IT in the NHS. A case history.

2 Landi H (2016) Report: Meaningful Use Payments Total $34.7 Billion. Healthcare Informatics. [online] https://www.healthcare-informatics.com/news-item/report-meaningful-use-payments-total-347-billion

3 Moacdieh, N.M., Ganje, T. and Sarter, N., 2017, September. Physician perceptions of clutter in electronic medical records. In Proceedings of the Human Factors and Ergonomics Society Annual Meeting (Vol. 61, No. 1, pp. 572-572). Sage CA: Los Angeles, CA: SAGE Publications.

4 Heller, N (2017) Estonia, The Digital Republic. The New Yorker [online] https://www.newyorker.com/magazine/2017/12/18/estonia-the-digital-republic