HealthManagement, Volume 18 - Issue 1, 2018

Let's change before we have to

The race is on to implement technology effectively for improved liaising and better health outcomes
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Theraceisontoimplementtechnologyeffectivelyfor improvedliaisingandbetterhealthoutcomes.

Healthtechnologycanchangehealthcarebutonlywithimplementationofbasicssuchascollaboration,communicationandeasyexchange,combinedwithtransformationofsometraditionalworkflows.

AirBNB, TripAdvisor, Uber, OpenTable, WhatsApp and many others have appeared in a disrupting manner and have changed the market and theapproachtoit.Theyeachhavetwoveryimportant things incommon: theyareglobal conceptapplied locallyandareledbyuserswho arethemainbeneficiariesof thesplatforms.Theuserisnotonlyinthe centre butis,infact,thecentre.Itistheuserwho directs,decidesandvalues.


N
otonlyhaveprocesses changedbuteachofthe abovehasalsohelpedimprovecompetition.Iremember howdifficultitwastogetanairporttaxifiveyearsago inNewYork.butonarecenttripthere, Icould seehow theofficialtaxishadnewregulationssuchastheobligationtotakeapassengerandprohibitionoftalkingon thephonewhiledriving. IthinkthisisthankstoUber.

 

HealthInformationSystems:thebasis that shouldexist

Andwhatis happening inhealthcare?The sector continues tobemysteriously immobile. The system still controls processes andinformation withpaternalisticexcusesbut,inspiteof this,thetrendthat supportspatientownershipofmedicalhistoryisalready well underway.

Anotherobstacleisthatthereisnosolid foundation onwhichtobuild.Informationsystemsandelectronic medical recordsaremoderately implemented within andbetweenhealthcare facilities butit is notarobust, solid andinterconnected basis onwhichnewmodels canbebuilt. Inothersectors, suchasbanking,travel andhospitality, therearemoresolid computersystems thatallow othersystems tobebuilt uponthem.innovationandcompetitionispromoted.

Inhealthcare weusually cannotconsider making anappointmenreservationsystem withthemedical centreofacity(private,insurerorpublic)without startingfrom thebase.Eachentitymanagesitina controlledwaythroughitswebsite.Norcanweeasily access aspecialist.Itisthesystem  thatwilldirectus tothespecialistthatisconsideredmostappropriate.

 

New online processes, activator of Health 2.0
Yesitistruethattherehavebeenadvances.Thereare platformsandportalsthatallowthesearchof,appointmentwithandassessmentfromadoctor.Thereare clearprocessesforasecondopinion.Patientswhowant anotherdoctortoreviewwhattheirassigneddoctorhas toldthemcannowdosoonline.I hadtheopportunityto workfouryearsinaglobalcompany,BestDoctors,that offeredsecondopinionmedicalservices.Theexperienceandthelearningwereformidable.We designed apowerfulsystethatallowedthecollectionofclinicalinformation,evaluationandanalysistoselectthe expertinthefieldandalltheexchangeofinformation, reportsand imagessothatthespecialistcouldevaluate andgivetheiropinion.Thissawexchangeofinformationandservicesamongstpatientsanddoctorsinthe UK,HollandandNewZealand,theUnitedstatesand othercountries,makingaglobalandaccessiblesystem. Newwebplatformshaveappeared  (TopDoctors, Doximity,Grandroundswherethewholeprocessis onlineandmanagedbytheuser.Thepatientiscentral.

 

Communication, collaboration and coordination
After20yearsworkingpassionatelyineHealthprojects, Ihavebeenabletoparticipateinprojectsof allkinds: digitalisationof electronichealthrecords(EHRs)in hospitals andhealth services, corporatehealth history projects andcitizen clinical protocols, global platforms of collaborationandexchangeof clinicalcaseand globalinitiatives ofsecondmedicalopinion,etc.Inthe end,therehasalways beenacommonelement identifiedasafundamentalproblem:lackof communicationandcoordination.

Users havealways demandedanadequatecommunicationsystem  that  allowsmultidisciplinarycare teamstocommunicateeasilyandefficiently.

TheAmerican InstituteofMedicine (IOM)in its ImprovingDiagnosisin Healthcarereportpublished intheautumnof201concluded thatimprovingthe diagnostic process requiredgreater levelsofcollaborationandimprovement  ofcommunication. The IOMreportshowedthatoaddresproblemssuch asdiagnostic  andtreatmenterrorsitisalsonecessarytousenewapproachestotheproblem andtools thataredifferentfromthetraditionalones. Thereport concluded thatthediagnostic processis acollaborative process and,intheimmediate future,willrequire collaborationtoolsthat  integratandpromote the communicationofallthepeoplewhocontributetothe process.  Thiswouldmeaninvolvingfamilymembers andthepatient, aswell ascaregivers, doctors, nurses andsocialagents.


Nobody disputes usingInformation andCommunicationstechnology(ICT)toimprovenotificationsystems. It isnolonger aboutboostingtheelectronic medical record,buttotakeastepfurther: promoteexchange, collaborationandcommunication.

Thehealthsystemboastsoffocusingonthepatient asthemainaxis,butthepatiengoes beyondthe health systemandmaynotneedasystemasprotectionistor paternalistic.Thepatienmoves,travels, changes  thesystemcityorcountry,seeks asecond opinionortheopinionofanexpertorfriendandhasan environmentaroundhimthatsupportshimin hiscare (caregivers athome, residences, rehabilitation centers, etc.)orin theirday-to-daylife(exercise,food,etc.). Therearenewservices,likeIdonia.com,that  provide afree-to-use exchange platform wherehospitals can deliver themedical images andtests  topatients using theinternet andavoidingthepainful CD/DVD burning anddeliveringprocess.Patientscanalsomanageand

sharetheirmedicalimagesandinformationinasecure environment.

Takeintoaccount  thesurveyamong95health professionalsconducted  by HarrisPollforPerfect- Serve4 inU.S. (Perfect Serve 2015)wheretheyrepresent  alargemajorityofactors inthecosystem: specialiseddoctors,primarycarephysicians,nurses, casmanagersandadministrators.

The vast majority (98 percent) considered it necessary to improve communication and assistance toreducereadmissionsandimprovepopulationmanagement.


Some interestingresultsincluded:

Communication

  • 69  percent  of professionals considered  that patient care was delayed while waiting for important information about the patient
  • More than  half of the  professionals admitted that they did not always know the member of the healthcare team to contact in a given situation
  • 71 percent  of doctors  said they had lost time trying to communicate with the healthcare team
  • Only 25  percent  considered  that they could contact  colleagues to collaborate or consult in an effective way.

Technology
  • Telephone (83 percent) and patient  portals (74 percent) were the  two most  commonly used forms of communication
  • Among the clinicians, when it was necessary  to contact a specialist doctor about a complex case, the EHR was used only 12 percent of the time
  • Most nurses  and managers did not believe that the EHR was adequate  for effective communication with doctors

Lackoftime,difficultyinfindingotherdoctors, lack ofpersonalrelationship withotherdoctors,lackof informationfeedback,discrepancyinmedicalprescriptionandlack ofclarityinpendingtestandhomecare arefurtherproblemsidentifiedamongprofessionals. Studiesidentifydifferentwaysinwhichthecoordinationofthehealthcareteamcouldbeimproved.Many timesthoseinvolvedwerenotawareoftheproblems encounteredbytheircolleagues-forexample,thatthe primarycarephysicianorcareteam  wasadmitted  to emergency.There werealsocoordinationproblemsin thefollow-upof apatientatdischarge,pendingtests orhomecare.


It seems clear, therefore that improving the coordinationandcommunicatioof thecareteam couldpreventreadmissionsandlossoftestswiththe resultingunnecessaryrepetition.

Communicationandclinical collaboration arekey toimprovingthediagnosticprocessaswellasforthe efficientmonitoringofapatient andareapplicable andnecessarin differentclinicalscenariosuchas homecare,healthcare partner,primary/specialised carecoordination, non-physical careandmulticentre collaboration.

Big data, Artificial Intelligence (AI) andChatbotare trendingtopicsand,althoughitmaynotbepossible toobtainthesame valueasapplyingthemtoother moremature sectorstechnologically,theycanhelp thedigitaltransformationinhealthcare.

 

ArtificialIntelligence

Inimaginganalysis,forexample,there aretoolsof artificialintelligence thatcanbetrainedinaspecific pathologytosupportadiagnostic process.Googleis promotingaprojectfocusedondiabeticretinopathy intheUK.

An innovativeandtotallydisruptiveinitiativein which Ihavebeenabletocollaboraterecentlyisparticularlyrelevant.ItisaboutcombiningAIwithautomated communicationmechanisms(Chatbots)toimprovethe monitoringandcommunication  of chronicpatients. Forthisprojecttherehasbeenaninterestingalliance between  twoentities. On theonehandahomecare companyintheBalearicIslandsfor thepersonalised monitoringofchronicpatientsathomehasmanaged toretainpatientsthroughconstant communication. On theotherhand,atechnologycompany,specialised ineHealth, medical imaging, artificial intelligence andtransactionalchatbotsapplied todifferenthealth processesandscenariohasalsobeenactive.

Through this alliance, theyhavemanagedtocreate thefirstvirtual brain tomonitorandcontrol chronic patients athomeintheformofavirtualassistantwho controlsandmonitorspatientsbycommunicatingwith them  inasimpleanddirectway.Thevirtualassistantremindspatient  totakemedication  andrecords dataperiodically throughanautomaticconversational system  based  onAIconcepts. Acontrolsystem  (the brain)helpstoprioritiseactions, controlandclassifypatientsandautomatescertaintaskthat  are repetitive.It also distributes taskstodoctors,nurses, caregivers,rehabilitatorsand,if applicable,family members. Thisallowsthesupportteam  tofocuson patientswho requireimmediatactionasidentified bythevirtualassistantandtheintelligencesystem.

Technology,inthiscase,isadifferentialchange.The mainefforthasbeentocreateasolutionaspowerfulin its actionasit is simple inits presentation. The focus hasbeenongivingvalue totheprocess.Without the needforacomplexandconfusingappfortheuser, avirtual assistant controls everything thathappens, coordinatesandestablishescommunication  links. Anybodyfromthehealthcareteamcanbeinconstant contact  andavoidtraditional misunderstandings and miscommunicationissues.

Promotingcommunication andcollaborationin parallel toimprovinginformation systems is essential. Integrating all thecare, clinical andsocial teams thatinteract withthepatient inside andoutside the system  (residences,hospices,rehabilitationcentres, caregivers,nurses,etc.)isabasicstep  forwardfor digitaltransformation.


WithdifferentexperiencesandprojectsIbelievethat solvingabasicproblemsuchaslackof communicationwould beafirst step.It is afundamental aspectin thechangethathastooccurinthehealthcare sector. Changeisnotonlydigital.Ihopethat  thechange occursbeforeweareforcedtomakeit.


Key Points

  • Technological disruption has improved competition in a range of sectors  while healthcare is lagging
  • In healthcare there is not a solid and interconnected basis on which robust communication models can be built
  • There are some encouraging examples in healthcare where the patient is central
  • ICT can promote exchange, collaboration and communication as well as boosting EHR use
  • Studies show better coordination amongst healthcare personnel is needed for improved overall efficiency
  • It is essential to promote communication and collaboration in parallel to improving information systems in healthcare



References:

Institute of Medicine (2015) Improving Diagnosis in Health Care [Accessed 4 January 2018]. Available at: http://www.nationalacademies.org/hmd/~/ media/Files/Report%20Files/2015/Improving-Diagnosis/DiagnosticError_ ReportBrief.pdf

 

Perfect Serve (2015) Efforts to improve population health hampered by lack of communication among healthcare professionals [Accessed 2 January 2018]. Available at: http://www.per fectser ve.com/press-releases/effor ts-to-improve- population-health-hampered-by-lack-of-communication-among-healthcare- professionals/




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eHealth, Healthcare, Patient, Hospitals, health system, collaboration, electronic health records, Information and Communications Technology, EHRs, Artificial Intelligence, future of healthcare, better health, health outcomes, Health Information Systems, healthcare workflows, Miguel Cabrer, eHealth 2.0, chatbots Health technology can change healthcare but only with implementation of basics such as collaboration, communication and easy exchange, combined with transformation of some traditional workflows.

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