Infusing efficiency into healthcare
Susheela Venkataraman, MD, Internet Business Solutions Group, Cisco India
Globally, changing lifestyles, increasing incidence of chronic diseases and the rise of new diseases is demanding the need for a specialized workforce to deliver healthcare services - often across geographically dispersed areas. Simultaneously, there is also an increasing need for accessible, affordable, and responsive healthcare solutions that meet specific, constantly changing medical and clinical needs of patients. For governments across the world, disease prevention is a huge priority. At the same time, there is a visible shift in the way healthcare is delivered, as patients are demanding greater participation in the healthcare process. Information and communications technology (ICT) presents several possible solutions to address the various challenges in healthcare delivery.
There are several trends that any discussion on technology support for healthcare must take cognizance of. The move from 'Care' to 'Health' is increasing focus on early diagnosis and treatment as well as avoiding disease. Patients today seek modern practices which instill a sense of well being by reducing hospital stay and helping to manage the health condition from the comfort of their home. Both patients and their caregivers seek information about their condition, treatment alternatives and disease management, which would empower them to take charge of their health condition. No longer are patients satisfied with merely following the doctor's prescription. Participation in the process of getting well is seen as necessary, both by patients and doctors. Healthcare is becoming more experience-centric, making the 'Patient' a 'Customer' and their satisfaction, a key success indicator.
The health ecosystem is complex and involves the coming together of various stakeholders like public health organizations, private hospitals, clinicians, emergency/ first responders, laboratories, pharmacies, social services, suppliers, insurers, home and caregivers - all of who must work collaboratively to meet the new expectations and needs of their patients. While collaboration as a way of working is not new to the health system, it is becoming more of an imperative as the priorities of the industry, its customers and society change. Better efficiencies and effectiveness could be achieved only through closer collaboration within the ecosystem.
Globally, the clinician - patient ratio is rather skewed, with very few qualified clinicians wanting to work in remote and rural areas. At the same time, there are just not enough specialists available to deliver the level of care required. Therefore healthcare organizations today are looking for innovative ways to simultaneously increase productivity and improve quality of care. Healthcare providers around the world are looking to ICT to help them collaborate, improve patient experience and deliver better outcomes. The shift to 'information age healthcare' (see diagram) has firmly taken root.
The Role of Technology
As they continue to take charge of their health, patients in an increasingly connected world where people, devices and applications are becoming more integrated, are beginning to demand access to information anytime, anywhere and on any device of their choice. Increasingly seeking greater transparency within the healthcare system, patients today look for information regarding early warning of their health condition and demand a quick connect with their physician, from wherever they happen to be. Preference for knowledge based treatment is resulting from the ease of access to information, through social media tools like Facebook, Twitter, Wikis and Blogs, along with powerful search engines and video, which provide innovative ways of gathering information, learning and sharing.
It is not just patients; healthcare providers too stand to benefit from these tools. Today's hospital staff, like the patient base they serve, are increasingly using Web 2.0 tools to stay connected with their peers, patients, families and friends. The ability to break through geographical and time boundaries means that health experts have a much larger, more global audience, whilst staff in the hospital can have access to global expertise. Use of always-on collaboration breaks down silos and improves communication between departments and organizations, while rich media conferencing solutions with web-based meeting capabilities enhance learning.
Enterprise-level interconnectivity helps provide better care for patients, whether they are being treated at an urban emergency room or a rural doctor's office. Integrated clinical systems, accounting, personnel, inventory and logistics management systems support the core activities of a hospital and help to drive greater efficiencies. The availability of hospital Information systems, medical records, imaging systems and technology tools for access is enabling care providers to overcome the limitations of time and location and connect so that the required person can be reached wherever they are, whenever required.
With integrated systems, caregivers can be alerted automatically via sms or email, when lab results are available, whilst enabling the hospital to provide support services to in-home caregivers such as family members. Availability of dependable, standards based devices that can be remotely read and interfaced to the various applications add to the speed and accuracy of diagnosis.
Collaboration solutions enable referring physicians to connect and share knowledge. Combined with video and voice interaction, e-learning and remote education makes it easy to share understanding and experience rapidly, as well as to undertake on-going skill upgrade and mentoring by senior professionals. Such programs help clinicians tap into experience, understand facts and gain knowledge which they can then use in their profession. The benefit of all this would ultimately flow to the patients.
With the help of data mining tools, data generated and collected through an integrated health system can provide insights to policy makers as well as the entire healthcare ecosystem. In-built alerts coupled with workflows can make this massive data store actionable by highlighting exceptions and trends and prioritizing actions in a pointed and specific way. With remotely managed display systems, it is possible to broadcast to multiple devices, taking into account differences in language, sensitivities and literacy levels, thus enabling rapid and effective dissemination of health information.
Driving healthcare ICT Adoption in India
While the possibilities are immense, adoption of ICT in hospitals is easier described than achieved. Clearly, high-quality data is central. The focus must shift to stitching together all the information residing in several silos, to help people interact and work together closely. Application of technology helps to achieve the desired levels of efficiency and effectiveness with the healthcare system. Quick adoption is the key to success and helps meet the expectations of current and new customers.
With Electronic Health Records (EHR) at the centre, at a minimum, the integration of PACS/RIS, Hospital Information Systems, lab and administration systems, is required. This implies that open standards must be followed, not just within the boundaries of a single healthcare provider, but the entire eco-system. High quality infrastructure, focused on those in need, for the identification of disease, and its containment must enable rapid dissemination of information, provide for emergency response and empower patients and their families to take charge.
Essential to countries such as India, is an integrated health system, which addresses both the response and preventive aspects of health. A good response system must allow for early detection of health conditions. With increasing emphasis being placed on prevention and health, there will have to be a radical change in processes so as to optimize delivery of services, avoid medical errors and control costs. These processes must be centered on patients, who play an active role in deciding the most appropriate course of action for them. Ongoing education must become an integral part of the agenda for the medical workforce.
Healthcare organizations will need an integrated network to help various departments to collaborate, learn and communicate effectively. Using collaboration solutions to quickly gain access to people, resources and information while reducing the cost of care and time to treat, is helping to create an efficient system that contributes to better health outcomes.
As organizations align technology and operational needs to support and streamline information flows, the ability to combine or integrate all of them in a manner that is relevant to the specific situation and issues to be addressed, would determine their successful adoption. In order to make all of this a reality, there is a pressing need to collect, record, tabulate and disseminate data related to patients, health conditions and treatments, relevant to India.
Going forward, as patient needs determine pathways through care, services would have to be provided in an integrated way whereby caregivers and patients connect, communicate and collaborate across boundaries of care and geography. Using technology to share vital health information enables healthcare organizations worldwide to improve the safety, cost-effectiveness, and accessibility of care.
Improving information and knowledge flow helps to make healthcare more responsive and resilient because clinicians and the entire ecosystem spend more time on care outcomes. By embedding ICT into the way the healthcare ecosystem operates, the healthcare industry in India has the opportunity to leapfrog to 'information age healthcare', even as the industry grows and matures.