Health Transformation

A "Future Vision"

Working with the generic process models in healthcare I see a trend in preparing for more services oriented thinking and more demand for centralized functions like patient overview, security infrastructure and patient centric portals, drugs etc. in a national perspective. Sweden is moving strong on this path and I can see similar trends in the other Nordic countries.
Future vision.JPG In the other hand I see a strong technical potential coming in parallel. Take a look at Microsoft future vision video by clicking on the picture at the end of the linked webpage on the left side.

Do we have an upcoming dispute between a more centralized landscape with fewer actors in the market and strong regulations vs. a marketplace containing a lot of actors in all sizes on a services oriented framework? What are your visions?

Perfection kills Progress

Recently, in a publication in the well-circulated magazine for medical professionals in The Netherlands "Medisch Contact", the Dutch Ministry of Health, Welfare and Sports was criticized on their plans for the national Electronic Health Record. The authors accuse the Ministry of restricting innovation "whilst Web 3.0 is forthcoming".

National programs for the introduction and use of Electronic Health Records are usually at the center of attention for professionals and politicians alike. The nature of these programs makes them vulnerable to a diversity of criticisms. The fact that a long-term perspective is taken, with high ambitions and serious impacts, often calls for lengthy procedures in terms of policy setting, stakeholder buy-in, open tendering, and specific legislation. One of the major trade-offs to be made is on the technological dimension: how to balance between state-of-the-art and the current installed base of systems and their legacy technology. The fact that the architecture is usually designed at the beginning of the long-running program makes it an easy target for arguments that it doesn't keep up with current technology.

Communication is key to refuting these arguments and keeping the program in perspective. It helps when clear governing mechanisms are in place for architecture development and the renewal of parts of the specifications. Such mechanisms can be designed to achieve the necessary balance between proven technology and current innovations, and to keep that balance in place over the lifetime of the EHR infrastructure. Leaning too much towards innovation will call for major redesign during a project that is already hard to really get off the ground. The old adagium - Perfection kills Progress - is applicable here as well. We would like to hear your experiences in coping with this dilemma.

The ‘business viability’ of HIE/EHR?

Another viewpoint of the work around generic process models in healthcare is what value will it provide and to whom!
“Knowing is not enough; we must apply. Willing is not enough; we must do.”—Goethe
The National Board of Health and Welfare in Sweden have formulated these bullets in the context of “Good care” inspired of the report from Institute of Medicine.

• Goals:
Safety, effectiveness,
patient-centeredness,
timeliness, efficiency, quality and equity
• Three guiding strategies:
Patient-centred, knowledge-based and care-flow based systems
• Quality as a system feature

Is quality a kind of “silver bullet” in this context? Making the care providers able to estimate result, measure result and do a follow up compared to quality index perhaps stimulate the willingness to enter data even for others to see. A kind of quality process inspiring the academic talent and competition. In Israel, Clalit Kaplan Medical Center , I saw a quality process like this but with quality index instead of estimates starting the process. The results were astonishing! If the process and information models integrate estimates, measures, follow up and show the gaps to quality indexes in an as automated way as possible it will heavily improve the cost – benefit ratio as I see it. What do you think?

The dangers and benefits of RFID in healthcare

Recently the Dutch national newspapers featured headlines like "Chips disrupt medical equipment", referring to an article in the Journal of the American Medical Association of June 25th. Before applying RFID technology in a clinical setting, tests revealed that standard RFID technology can cause serious interference with medical equipment, resulting in serious malfunction and danger to patients. These tests had to be carried out, because no literature or standards were available that could rule out any such dangerous interference.

Knowing the dangers involved, the team designed a combined technological and organizational solution that effectively circumvented the dangers and delivered promising results for improving the quality, efficiency, and safety of care. One of the authors comments on these outcomes in a short video featured on YouTube. So, in the future we could see the following headlines in the national press much more often: "Chips save lives in hospitals". What could help in achieving these results?

Healthcare Transformation: A Mandate for Collaboration

The healthcare communities around the world are under significant pressures due to well documented challenges (i.e., aging populations and decreasing wellness; poor patient safety results; increasing patient/consumer expectations; spiraling healthcare costs; and poor integration of care. HIT for healthcare information sharing (e.g., HIE, EHR, PHR, EMR) is still an empty promise.

In our entry for ‘Semantic Interoperability’ Robert Stegwee asks the question “if semantic interoperability is equally important to the healthcare professional, why is it still unknown territory to the majority?”.

Similarly, how do we account for individual expectations for the use of information technology to facilitate better care for individuals? They are getting older. They are becoming more likely to suffer from a long term chronic condition. They are educated consumers with expectations of getting what they want/need whenever they desire. They have been using technology in every other part of their life and see HIT as a reasonable approach.

How will care communities deal with these expectations and demands? There are many transformational ideas and programs underway including:
• Payment for results
• Proactive care services (see example Telehealth & Telecare entry by Jason Crellin)
• Restructuring of reimbursement models
• Increasing transparency of care costs and quality of care
• Introduction of competition into national care services
• And of course, national/regional HIE, EHR, PHR, EMR implementation programs

We see that these pressures and forms of response are appearing in virtually every nation, region, and care community, demanding specific responses suited to individual needs and expectations of the players. There is a clear need to balance the expectations and the complex value network that spans these players (i.e., hospitals, general practices, clinics, diagnostic service providers, payers, government, pharmacies, volunteer organizations, and patients). There are many examples, but consider the perverse incentives that exist when attempting to implement a proactive care service or share patient information through HIT. How do we get everyone to participate? How do we realign the value proposition incorporated into the reimbursement models?

Our experience indicates that healthcare transformation will require new levels of collaboration. The collaboration needs to actively engage all parties at the same time. The collaborative process needs to be sustained beyond the onetime instances. Collaboration needs to be supported by strong communications, agreed standards, and shared views of the community’s health economy (the value network).

That’s how we approach this global challenge. What are you seeing in your care community? Is collaboration working? Are the “players” working together with new levels of connectedness and cooperation? What are the key incentives that have made this happen? We welcome your contributions, be they positive or more skeptical.

Telehealth & Telecare on a "long term" road to mainstream adoption?

Over the last few weeks I’ve been talking to some of the bright young things from our graduate programme. They’re working on a challenge themed around healthcare transformation, and one of the common threads they’ve been picking up on (and rightly so) is around the value of “remote patient monitoring”. Falling under the “Telehealth” “Telecare” and “Assistive Technology” banners; it’s an area with a lot of interest, but with a few notable exceptions is still relatively low-key in terms of adoption and utilisation.

Americans are using some of the basic online tools for health information

As part of National Health IT Week 2008 held in Washington, DC June 9-13, Kaiser Permanente, through independent market research company StrategyOne, released the results of a nationwide survey conducted between May 8-11, 2008 to gauge Americans awareness and perceptions of electronic health records (http://xnet.kp.org/newscenter/pressreleases/nat/nat_080612_healthit.html). Key findings indicate that Americans are using some of the basic online tools for health information. The results are interesting:

65 percent of respondents have gone online to learn about a medical condition, and 38 percent have used their insurance company's online tools to learn more about their care, up from 29 percent in 2007.

The research also revealed that Americans continue to have concerns about privacy and thus require assurances from all parties that store personal data that information is secure.

47 percent had a preference for doctors who use EHRs and 61 percent had a preference for insurance companies who employed EHRs.

51 percent agreed that health IT should be a top priority for the next president to ensure that all Americans have access to their own personal medical records electronically. Kaiser Permanente is leading the way to make this vision a reality.

It would appear that the general population is willing to utilize EHRs/internet for care information. Has anyone seen additional surveys that re-enforce or conflict with that trend?

Is it possible to have a generic process model in Healthcare?

In Sweden, the National Board of Health and Welfare, commissioned by the Government according to the National Strategy for e-Health , has the task of defining a generic process model in Healthcare. The 3 year project, started 2007-01-01, will deliver guidance for content, structure and patient centric documentation. The starting point is the profession and the citizens demand of information.
This is a way to lay the foundations for the information needed in the complete chain of care involving different care providers. “The steps before IT”.
Now half-way in the project different stakeholders contribute, from their viewpoint, in producing semantic models, information models and process models. All with the same goal: make a common regulatory framework.
From the supplier side, care system providers, there are doubts if the mission is possible.
What do you think? Is it a too academic approach and the expected result reside “above the clouds”? Inventing the wheel again (HL7v3, openEHR...)? Any other nations have done it? I am eager hearing from YOU!

Semantic What?

In the last week of May, international standards organizations in healthcare held their meetings in Gothenburg, Sweden. Several times a year, hundreds and hundreds of people working in healthcare, or at least having a keen interest in healthcare, gather together to discuss "semantic interoperability". There are quite a number of doctors and nurses involved, who are fervent contributors to and supporters of semantic interoperability. However, if you ask a random doctor how semantic interoperability is helping his or her patients get better, you are very likely to get startled or puzzled looks. Semantic what?

If you ask the same doctor on possible treatments for influenza or how to handle anaphylaxis in case of peanut allergy, the answers will come directly. This is true wherever you are in the world. If a doctor wouldn't know, many patients would probably suffer or die needlessly. A number of reports and testimonials have been published on the number of patients suffering or dying from a lack of semantic interoperability. So, if semantic interoperability is equally important to the healthcare professional, why is it still unknown territory to the majority?

The key to saving lives with semantic interoperability is to take into account any patient information that is already known and available. This availability of patient information is often the main driver behind intiatives to introduce an Electronic Health Record (EHR) in healthcare organizations, regions, or even countries. However, research shows that availability of information is not a key motivator for healthcare professionals to adopt an EHR. Their motivation lies in saving time and improving medical decision making and that is where semantic interoperability of healthcare information comes into play. If we can clearly show how saving lives translates into making money, many others might embrace the concept of semantic interoperability as well. For now, I'll focus on saving lives and leave the translation to making money for future discussion.

In order to be able to take more information into account in medical decision making, while at the same time reducing the effort to process this information, we need computers to assist the healthcare professional. The vision is to combine the vast amounts of patient information and to present them to the healthcare professionals in a form that is actually helping them to care for the patient. Some of the possible forms are medical alerts, probability distributions for specific diagnoses, suggested treatment options (including personalized medication dosage) according to guidelines, or full 3D rendering of affected parts of the body.

If we are to provide a meaningful presentation of data for the healthcare professional, the available patient information has to be interpreted by the computer system. It has to "understand" the meaning of the information (i.e. the semantics of the data). This is of even more importance when the information is coming from different healthcare organizations (and usually different computer systems). Many lives are lost because vital prior information from previous visits or other professionals was not taken into account when deciding on the proper treatment for the patient. Hence, information from different computer systems need to be shared, and therefore these systems need to work together (i.e. they need to be able to interoperate).

Given the breadth and depth of healthcare information, many years have already gone into specifying the ways in which to meaningfully share this information between computer systems. A lot has been achieved, but much more work still needs to be done. That is why meetings like the one in Gothenburg are so important. However, if we keep talking about semantic interoperability, no doctor will ever spend an extra euro or dollar on systems that support these features. Rather we should talk about meaningful ways to let information help saving lives.

Welcome to Transforming Health

Welcome to Capgemini’s health blog ‘Transforming Health’. Our objective is to create a place where we can host a collaborative dialog on subjects related to the transformation of how individuals receive care, how the care is paid for, and how the exchange of information will propel the industry to make broad changes…changes that are needed to deal with the wellness and care cost of aging populations and populations that face more chronic illnesses.

Below we have identified some discussion topics that we anticipate covering in this blog, but we would like to start the dialog by exploring the topics that have the greatest interest to you – our customers and our friends in the industry.

So, what do you think of these idea? Where would you like to start the dialog?

Will “health information infrastructure” (EHR/EMR/PHR/HIE) improve the wellness of the population?

Shouldn’t individuals/patients have a say in their privacy risk management (e.g., “if sharing means I might get better, let’s make it happen”)?

Many say that providers gain no value from the use of health information infrastructure yet they must enter all the data for the benefit of others. Are there really opportunities for these providers?

How will care services delivered over the health information infrastructure be transacted for reimbursement? How will services be monitored?

What is the role of health information infrastructures in supporting the transactions of “payment for results”?

Beyond the “spin”, have we really learned how to implement a successful “health information infrastructure”?

What do you think about growing investment in creating clinics within retail shops (e.g., CVS, Boots, Walgreens, WalMart)? Better care for patient? More effective access to care? Better value?

Affordability of care is directly related to the costs that care providers are facing and ultimately their financial stability. Numerous hospitals are running in deficit. What are some of the important changes hospitals can make to improve their financial position? Success stories?

What options, like “pay for performance” do governments have to curb the increase in healthcare costs? How do payers and providers react to changes in these regulations? How does it empower patients?

How can multidisciplinary care for the chronically ill be streamlined, taking into account the possibilities and preferences of the patient? How can a social non-professional network be established to support this care?

Preventing illness is the best way to cut health care costs. However, some prevention solutions lead to a steep increase in diagnostic procedures and even an increase in possibly unnecessary surgical procedures? Do we need different players in the field to approach prevention from a behavioral rather than medical angle?

Hopefully that gives you a feel for where we would like to take this blog conversation.

Now its your turn. We want and need to hear your points of view and stories of success. There are two starting points for the dialog.

First, our intial entry provides a different perspective on semantic interoperability. What are your views?

Second, the topic list above is a starting point, but we need to know the topics YOU would like (us) to cover.

About the authors