Healthcare dips a toe into the digital age

Healthcare dips a toe into the digital age
By Geoff Nairn

Published: March 22 2010 16:51 | Last updated: March 22 2010 16:51

Healthcare is beginning to shake off its Cinderella image after lagging behind other sectors both in levels of IT investment and in its perception of IT as a strategic tool.

Governments are now looking to IT to rein in their soaring healthcare costs and improve care quality as healthcare decision makers belatedly realise that technology is one of the few weapons that can make an impact on the sector’s chronic problems.

Healthcare has always suffered from limited resources and conflicting demands and that is especially true for technology, with IT managers having to counter the view that money would be better spent on ”front-line” medical technology such as CAT scanners – particularly if the latter generate new revenue.

In addition, a risk-averse culture is deeply ingrained. While pockets of innovation exist, usually at well-funded university medical centres, healthcare providers are reluctant to allocate scarce funds for improvements. This leaves IT staff spending more time maintaining old systems than developing new ones.

According to Forrester Research, healthcare enterprises in North America spend just 22 per cent of their IT budgets on new IT initiatives, compared to 28 per cent for businesses in other sector.

But in spite of this unpromising diagnosis, the outlook for healthcare IT is looking brighter. ”Across the OECD, there is a universal acceptance that we should be investing more to digitalise healthcare,” says Andy Mullins, head of health at PA Consulting.

Decision-makers also now recognise that IT investments must be co-ordinated and focused on key technologies that can be deployed across a whole healthcare system.

That is good news for IT vendors, who have long complained how the limited investment available for healthcare IT is spread across a patchwork of unco-ordinated pilot programmes.

”We often joke that healthcare IT suffers from ’pilotitis’,” says Neil Jordan, managing director of Microsoft’s worldwide health group. ”Historically, there has been very little industrialisation and a lack of long-termism so it has been very hard to get technology to work at scale.”

He says the key to creating a modern information-based healthcare system is to break down the barriers that have traditionally separated IT systems. Data integration technologies play an important if unglamorous role in making ”joined-up” healthcare a reality.

During the Sars respiratory disease epidemic in Hong Kong in 2003, for example, data integration technology from Informatica was used to bring together data on 6m patients from 43 hospitals and 121 outpatient clinics.

Microsoft is also pursuing the data integration opportunity with Amalga, a data aggregation platform that integrates clinical, administrative and financial data from disparate systems.

The issues of scalability and integration are now coming to the fore as more governments set national or regional targets for care outcomes and cost savings.

For example, President Barack Obama has identified nationwide electronic healthcare records as one of the key technologies to help contain the staggering cost of healthcare in the US. This one initiative, if adopted by 90 per cent of doctors and hospitals, could save $77bn a year, according to a study by Rand Corporation.

The target is for most Americans to have electronic health records by 2014. But in 2009 only 5 per cent had an advanced EHR system capable of looking up medical histories and ordering tests electronically.

Fearing that many physicians will drag their feet on the EHR issue, there are federal funds to subsidise the cost of equipping practices with EHR systems. And those who still refuse to buy an EHR system will see their Medicare and Medicaid payments reduced from 2015.

Other countries have embarked on initiatives to create an information-based healthcare system but several have been hit by delays, cost overruns and political bickering.

In 2006, Germany began to field test a nationwide eHealth card scheme which would ultimately embrace 80m users, 300 health insurance companies, 2,200 hospitals and 188,000 physicians and dentists.

As well as containing patient data and insurance details, the smartcard can hold electronic prescriptions and, more controversially, be used to access a patient’s health history online.

The project was meant to be running nationwide in 2009 but ran into opposition from many GPs who could not see any advantage in this new way of working. Security concerns were also raised.

After spending €1.7bn on the initiative, the German government has now decided to put the project on hold. The cards will only be used in a few pilot areas as a simple identification card.

In UK, the National Programme for IT has run into a barrage of criticism not just for its huge cost – £12.7bn since 2002 – but for the delays and the lack of consultation with suppliers and medical professionals. Some IT suppliers have abandoned their involvement.

One of the key planks of NPfIT is the summary care record, a simplified EHR, which is supposed to be running nationwide by early 2011. But as of December 2009, only 152 GP practices and two of the 168 hospital trusts were using summary care records.

”The summary care record is a good idea, but I am not sure that having all medical records online at all times is really necessary. A lot of physicians are not qualified to interpret specialist data and there is a risk that the GPs get information overload,” says Robin Hughes, founder of Ascensus, a UK-based vendor of practice management software..

This highlights a new area of opportunity for healthcare IT, namely using business intelligence and other analytical technologies to help clinical staff and other decision-makers extract useful information from vast quantities of health-related data.

”I would say that business intelligence is a more critical technology than electronic patient records, which are nothing more than a very expensive way of replacing patient notes,” says Adrian Downing, healthcare director at Concentra, a UK-based BI and consulting firm.

One of the welcome side effects of the introduction of nationwide EHR systems is that it will allow decision makers to tap into a rich source of aggregated population data to support operational and clinical research.

This would, for example, allow researchers to look at longitudinal patient data in the search for early indicators of those in the population most at risk of developing serious medical conditions.

That not only saves the health system money – fewer emergency admissions – but spares the patient the stress and risk of an operation.

”If you can spot people with hypertension before it becomes a stroke, you can actually improve the life of the patient and knock a zero off the cost of treatment,” says Mr Hughes.

Data analysis technologies are also playing an increasingly important role in improving the operational efficiency of healthcare systems.

”We need to give clinicians more information about how to spend resources more effectively,” says Mr Mullins of PA Consulting.

Healthcare providers have embarked on initiatives to cut the spiralling cost by boosting efficiency, benchmarking performance and generally making practitioners more accountable. But these initiatives need to be monitored and analysed to ensure they are achieving their goals.

Mr Downing gives the example of a UK private hospital which wanted to reduce the high cost of hip operations by reducing the average hospital stay from 10 to seven nights. The reduction in stays was achieved but not the expected cost savings.

Deeper analysis of the data with business intelligence software revealed why: patients who were sent home early needed much more physiotherapy and that offset the money saved on beds.

Another critical application for data analysis technologies, at least in the private sector, is in fraud detection. Healthcare fraud costs the US more than $140bn a year but only 10 per cent of fraudulent claims are detected and only 10 per cent of the frauds detected ever get recovered.

Some fraud is blatant – submitting claims from dead doctors, for example – but other forms are more subtle, such as a physician misrepresenting a patient’s condition to obtain higher reimbursments.

”The problem is that you cannot just look at claims data to spot fraud, you have to also look at demographics, the age and sex of the patients, the kind of hospital and so on,” says Richard Ingraham, head of healthcare marketing at Teradata, the data warehousing company.

”Traditionally, this data would be kept in silos so you have to bring it together to get the complete picture.”

The final big challenge is developing new cost-effective ways of delivering healthcare. Telecare technologies make it possible for many elderly or chronically ill patients to stay in their homes while being regularly monitored for warning signs.

Telemedicine has long been used to bring healthcare to people in remote areas. Today its use is expanding to allow more people to access scarce skills.

At first sight, San Diego might not seem to be an obvious choice for a telemedicine project. ”Irrespective of whether it’s an urban or rural area, you have access issues with healthcare,” says Kaveh Safavi, vice president of Cisco’s Global Healthcare Practice.

Cisco’s system, which is a variant of its TelePresence high-definition video-conferencing technology, is being used to deliver primary and speciality care to two community health centres in San Diego.

The HealthPresence system has already been tested in a pilot project in Scotland, where it is used to provide remote consultations for patients in outlying community hospitals rather than requiring them to travel to the main accident and emergency hospital in Aberdeen.

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