The COVID-19 pandemic brought into stark relief glaring weaknesses in the global healthcare system over the past year. Naturally, the focus of our collective attention has largely centered on gaps and failures in the clinical side of the system — from understaffing of emergency rooms to the lack of proper reserve stockpiles for essential safety supplies.
At the same time, we all recognize that digital transformation (DX) has been forced into a rapid acceleration phase across the world of work. Now that employers worldwide have had to maintain operational continuity with workforces largely required to stay at home, it is clear that digital systems and networks are as mission-critical to society as water, heat and power have been for over a century.
What is equally important, however, is how the pandemic informs the digital side of healthcare delivery — and specifically, what lessons we have learned (and are still learning) about how digital transformation can, should, and must be at the center of healthcare going forward.
Despite the rapid pace of clinical research and innovation, healthcare systems and institutions have been relatively slow to adopt new digital technologies or embrace change systematically. This is, in part, due to the unique structure of the healthcare ecosystem. Accurately identifying each participant in the healthcare system will allow us to better evaluate the ways in which DX can, and does, offer transformative potential.
Expanding our Understanding of Healthcare’s Key Players
At its heart, healthcare as a system can be divided into six component parts. These “Six Ps” include:
- Professional associations
Most of us gravitate toward a natural focus on the first two, since we collectively recognize that the patient-provider relationship is at the very heart of healthcare delivery. And we tend to spend considerable energy debating how to deal with the next two — the payers and policymakers.
What is often forgotten entirely (e.g., see the recent survey on DX in healthcare) is the producers (those who engineer and manufacture the physical components of healthcare delivery — from pharmaceutical companies and biotech firms to medical device manufacturers and healthcare suppliers) and the professional associations (who provide peer engagement, education and credentialing to the professions that collectively make up the provider framework).
Now that we see all participants as integrated players in healthcare delivery, we can view them collectively as the Six Pillars of the healthcare ecosystem.
Returning to Patient-Centered Healthcare
One of the most essential goals for digital transformation in any sector is to achieve efficiency and improve accuracy in ways that enable a more human element to emerge. We experience this when we check in at a hotel and the guest services representative is prompted to greet us by name, accurately summarize our guest preferences, and deftly send us on our way in a highly personalized manner.
The difference for healthcare is that patient-centered delivery isn’t just a courtesy, it’s a critical factor in improving actual health outcomes. Clinicians today are overwhelmed with high workloads and the challenge of serving hundreds, if not thousands, of patients. Improved digital platforms can reduce the risk of medical errors, catch potential prescription contra-indications, and help practitioners serve patients asynchronously in real time (rather than only when an appointment can be scheduled) — and therefore drive better outcomes while deepening the patient-provider connection.
Fixing Healthcare Interoperability (Finally!)
Most patients see many physicians, some within a single hospital system and some at other hospitals or clinics. Due to lack of interoperability among electronic medical record systems (EMR systems) at different providers, it is impossible to have a holistic view of a patient’s health. This problem is exacerbated in emergency and acute care when a physician needs to quickly understand a patient’s complete medical history. Today, such a capability does not exist for most patients.
During the COVID-19 pandemic, patients often did not have an option to choose a hospital. Emergency vehicles/ambulances took patients to the nearest hospital where there was available intensive-care-unit capacity. The lack of interoperability among EMR systems meant that physicians often lacked awareness of patients’ pre-existing conditions and risk factors. This resulted in life-or-death situations. During the height of the pandemic’s first wave, hospital EMR systems became so overloaded that clinicians documented cases of patients ‘getting lost’ due to rapid data-entry errors or lack of ability to connect with the EMR platforms at other institutions in the region.
These disastrous outcomes are unacceptable professionally, untenable clinically, and unconscionable ethically. The solutions of course are right in front of us: unified national and global standards for portable health records, incentives or mandates for interoperability, and universal incorporation of secure wearable wireless technology so that a patient’s ability to receive timely and appropriate treatment is not predicated upon the interoperability challenges or the typing speed or accuracy of an intake coordinator.
It seems senseless that a person wearing a digital, wireless computing device with detailed identifying information contained therein cannot be instantly admitted into a provider’s care delivery platform. It’s easier to access a transit system through contactless entry than it is an emergency room. Today, you and your financial adviser have instant access to your complete financial picture across multiple financial institutions – banking, investing, insurance, etc. – but your medical records are siloed across multiple providers where different medical transactions took place. Consequently, your physician does not have a complete picture of your health.
Healthcare leaders are under enormous pressure to fix these glaring problems, and this will require three major changes, all likely to come from the policymaker side of the ecosystem if they are not voluntarily addressed in the near-term by provider systems and payers. The first requirement will be broad, unambiguous acceptance of a single standard for portable health records. Fast Healthcare Interoperability Resources (FHIR) is the defacto standard today but it has many modules, each with its own version history, and different EMRs conform to different versions of these modules. The second will be an incentive framework and/or regulatory mandates requiring providers to incorporate interoperability in their EMR systems. The interoperability rules recently issued by Health and Human Services (HHS)/Center for Medicare and Medicaid Services (CMS)/Office of the National Coordinator for Health Information Technology (ONC) are a step in the right direction but the implementation of these rules is yet to materialize. The third will be the incorporation of wearable tech and wireless near-field communication (NFC) into the digital side of the ecosystem.
This means opening up EMRs to patient-side input and breaking down competitive walls erected in the interests of self-preservation by individual networks and EMR vendors. Nonetheless, interoperability must happen. We know it is digitally possible, but the pandemic has made the price of the longstanding interoperability breakdown plain to see.
Serving More Patients, More Effectively
Finally, digital transformation enables a more holistic approach to the healthcare ecosystem from end to end. The pandemic taught us that our static and inflexible forecasting models for predicting patient populations, staffing requirements, and resource utilization were woefully inadequate.
Post-incident reviews following the first wave of the pandemic demonstrated that hospitals and health systems in many cases had multiple months of early warning signs that could have resulted in rapid ramp-up efforts prior to the coming onslaught.
However, the data points were largely unmonitored, uncoordinated, and unmanaged. It was largely anecdotal qualitative communication between on-the-ground practitioners that led to large scale awareness in the early days of the pandemic. In simple terms, word-of-mouth did what disconnected and poorly monitored tech “solutions” could not: spot a new trend.
Which is why DX needs to sit at the center of the healthcare planning process, taking inputs (down to the patient level) and aggregating them for overall strategy and decision support, while also turning around and feeding new precision healthcare data back to the patient-provider relationship.
Challenges and Opportunities Ahead
Many practitioners still feel highly distrusting of DX in healthcare, and their frustrations are not invalid. Most enterprise EMR and related HIT implementations have been unbendingly top-down projects, imposed by office-based managers and IT leaders with little to no input or guidance from clinical professionals. Data aggregation and decision-support has historically become a toolset used primarily to push costs (i.e. beds, personnel, and supply reserves) out of the system on the basis that ‘just-in-time’ data can allow for a thinning of any cushion without risking loss of life.
We now know that these assumptions and top-down approaches are largely fool’s gold (and the evidence backs that point up overwhelmingly). We also know that in order for DX to truly transform healthcare it needs to be unlocked from the administrative and managerial class and placed squarely in the places where it is most needed: clinical acceleration, patient education, provider decision support, and seamless interoperability.
The pandemic has clearly demonstrated that digital transformation is a critical and central ingredient in healthcare delivery. The key now is to take the lessons learned about *how* it should be implemented and apply them post-haste, in order to achieve the ultimate goal that all six members of the healthcare ecosystem share: improving patient outcomes and enhancing both the length and quality of life for patients.