Editor’s Note: A big welcome to David Chou, the newest member of the Healthcare Scene family of bloggers. David has a great background as a hospital CIO and will bring a wealth of knowledge to Hospital EMR and EHR readers. We’re calling David’s series of blog posts the Healthcare CXO Scene. You can receive the CXO Scene blogs by email as well. Welcome David!
Healthcare is finally evolving towards utilizing data in our decision-making. The landscape has changed dramatically with the adoption of Electronic Medical Record across the nation. Healthcare use to be a predominately paper based vertical and there are still lots of areas where it is dominated by paper. The fax is also still alive as a communication channel, but the industry has transformed dramatically in the last few years.
According to the Office Of The National Coordinator in 2013, nearly six in ten (59%) hospitals had adopted at least a Basic EHR system. This represents an increase of 34% from 2012 to 2013 and a five-fold increase since 2008. I am sure that percentage is even higher in 2015 in our journey towards an electronic world.
The workflow for the clinician and physician documentation does take a little longer now that they have to type instead of write their notes, but the advantages of having discrete data elements to run analytics will transform the decision making of every organization. If you Google the definition of “big data” the consensus definition is the wealth of structured, semi-structured and unstructured data that has the potential to be mined for information.
Unfortunately the healthcare vertical is still playing catch up and the majority of the organizations still only have Electronic Medical Record (EMR) data being used for decision-making. The healthcare vertical use to be similar to the airline industry where the key to success was keeping the hospital beds occupied similar to how the airline industry wanted to keep every seat on the airplane filled. The new model of care is figuring out a mechanism to keep patients out of the hospital beds and focus on keeping them healthy through preventative measures. We have to do all of this while figuring out the right financial model to be profitable.
As we move down the journey where we transition from a fee for service payment model to a value based payment model it is critical for every organization to transform their business process. Analytics will be key in making that change. Now let’s focus on the 2 key challenges that will force healthcare providers to focus on data to drive their decisions impacting their operations internally and externally.
Challenge #1: Healthcare reimbursements from Medicare and Medicaid have reduced year after year
This has a huge financial impact on health care since the Medicare expenditures have been growing as the baby boomer population ages. There has also been a steady increase of Medicaid expenditures, so the trend of lower reimbursements for taking care of a growing population will be what lies ahead for us in health care. Effective, quality delivery of care while reducing waste will be the main driver of success in the future.
Healthcare providers must understand the cost of delivering care down to the unit level. You will be surprised by the variation of cost for various procedures. The same procedure cost can vary by as much as 15-25% based on the products used. So one of the key elements of cost containment is standardization. As we transition to a value based payment model there will also be value based contracts which will be structured towards a shared savings model. The contractual terms will vary but the general theme will be to incentivize the providers to reduce cost for providing quality care to a population by offering a percentage of the net savings. We are seeing this trend in the Medicare shared saving program and leveraging data analytics will be the key-driving tool for this to be successful.
Challenge #2: The Move Towards Personalized Care
Consumers/patients have different expectations now. We are living in an on-demand personalized world where every industry vertical is moving towards a predictive environment including healthcare. The ideal scenario would be to consume data from the social platforms, wearables/sensors, mobile, public data, and other sources so that we can really understand in real time the current state of the consumer/patient.
Let’s assume the scenario of a digital consumer who is currently a diabetic patient that has been prescribed to be on a low calorie diet. The patient wears a fitbit and also has their smartphone app that tracks her heart rate. The heart rate is a bit higher than normal and the patient feels a little bit off. This wearable and mobile app is integrated with a central monitoring system at the hospital and an alarm triggers a clinician who checks the patient profile and history and takes the proactive measure of making a video call to the patient.
The patient answers the video call with the clinician and they have a video interaction where the clinician can see the facial color of the patient and asks a few questions. Fortunately the patient finished an intense workout about a hour ago so things are fine with the irregular heart rate at the moment and this video interaction also alleviates any anxiety for the patient. It is about 7pm so the patient decides to get something to eat and he is craving a burger so he pulls in to the drive through. The patient has his GPS turned on from his smartphone and also posts on Facebook that he is at a fast food chain’s drive through. This data element is picked up by the hospital’s CRM app and then an automated text is sent to the patient reminding him of the low calorie diet and makes a few recommendation from the menu. The patient can now make an inform decision and instead of ordering a burger he orders a grilled chicken sandwich.
The technology that I have described is already in place and it is similar to the retail sector when you walk in to the store and they already know your behavior. There is a trigger to create an action which hopefully equates to a sale.
Healthcare must move towards this culture of living in an on demand world where we can predict or persuade a behavior by the patient. The challenge that I see is that the majority of healthcare providers are still focused on their internal operations leveraging EMR data and we have not focused on the digital consumer yet. There are a lot of great work being put together by enterprise vendors and healthcare providers, but as we move down the journey of managing population health we can really learn from the other verticals and how they leverage the big data technology to improve consumer/patient engagement. All of this will ultimately lead to a healthier population.
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