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Healthcare in the digital agePutting the patient at the center

Introduction

This paper provides a rationale for a reinvention of healthcare. It also provides a set of recommendations as to how this can be achieved in a managed way.

Observations

Increased digitization is affecting all aspects of society. Citizens are more empowered and there is growing intolerance to delay or inconvenience in the services they consume. Healthcare is no different. Citizens want to take charge of their health. As all general practitioners (GPs) know, there has never been a more informed generation of patients. However, this is only the start. Citizens do not want to place their health in the hands of an indifferent medical practice receptionist. They have had enough of the “account-manager–free” engagement model.

At every step of the citizen’s life, healthcare needs to put the citizen at the center. This is not to imply that healthcare professionals are not caring; they often work within a system that is overstretched and where the dice is loaded against the citizen when the system fails. People need to be treated, rather than just their sickness.

Wellness has been identified as a cure for sickness, both from quality of life and economic perspective. People are living long enough now to acquire conditions that were unheard of a century ago. Longer lives under the current healthcare “sickness” paradigm equates to exponential cost increase.

Our new digital accessories are turning us from average citizens into high performing athletes, at least from a self-analytics point of view. We are fast moving to a situation whereby “intensive-care-unit–grade” data feeds are part and parcel of our daily lives. So we need to integrate healthcare systems with popular “quantified self” or wearable providers so that the data can be woven into their medical records.

Like everything else, healthcare needs to be a mobile glance away. Care is no longer something that only happens in a healthcare physical location. Thus, healthcare conceptually must become a platform on which citizen, practitioner, and administrator services are built. As some futurists believe, the administrators will eventually become algorithms, as will some of the practitioners.

The term citizen rather than patient is used throughout this paper, as the latter has a restrictive, illness orientation. Of course, illness is responsible for a very significant proportion of today’s healthcare spend. However, smart societies recognize that the way to reduce the illness spend is to invest in wellness. Thus, we do not want to dismiss this increasingly important aspect of healthcare by inappropriate labelling.

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The current state of healthcare

Firstly, we must acknowledge that healthcare is a very complex business. Given the variety of ailments that can arise, coupled with the variables associated with each patient, it is amazing that healthcare has been industrialized to the extent it has been. Many of us, including our friends and family, would not be here today but for healthcare services.

Many healthcare services were not engineered to cope with today’s rapidly growing populations. Social behavior changes in respect of diet and exercise are giving rise to new challenges for healthcare service providers. Obesity significantly increases the patient’s chances of developing cancer, heart disease, and type 2 diabetes. These illnesses consume substantial healthcare resources. An almost exponential growth in materialism is giving rise to mental illness. It appears that it is not about how much you have, but the fact that others have more than you. The fact that citizens are not living up to the fantasy expectations crafted by the media is another source of depression, which, in the extreme, leads to suicide.

The sector appears to be developing a two-tier system. Tier 1 is for the wealthy. Not only is your illness addressed, but also it is done so in an unhurried manner with options provided to suit the patient as opposed to the practitioner. The concept of health tourism has evolved to enable countries to encourage the wealthy to visit and thus leave some of their wealth there in the process.

Tier 2 is for the less fortunate. They are reliant on the strained public healthcare services, which driven by numeric targets, and cost pressure, focus primarily on disease management, with the experience being a secondary concern. Invariably the citizen has to fit in with the provider’s packed agenda.

However, there are significant opportunities to raise the bar in respect of healthcare. As citizens become increasingly mobile, healthcare will be a major factor in their choice of destination country.

Here are some of the most pressing issues requiring improvement.

•Poor integration between GPs and hospitals: Often critical data is transported between these two parties by the patient, not all of whom have perfect memories.

•Location based medicine: The need for treatments to take place at a location to suit the hospital is both inconvenient to the patient, and a real estate cost for the provider. We need to embrace tele-healthcare.

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•Poor integration of IT systems: It is impossible to build a holistic picture of an individual if their data is scattered across incompatible systems.

•Poor processes: Paper and human memory still make up a significant element of modern day healthcare processes. Within a tightly knit ward team, this is less of an issue, but as more and more outsiders get involved, this is a recipe for disaster. Leaving untreated patients in corridors or failing to have clear-cut mechanisms for keeping loved one’s informed suggests that there is much to be done in respect of patient centricity.

•Poor governance: There is a culture of “burying mistakes,” rather than learning from them.

•Unsecure: Hospitals in particular are more like hotels than fortresses. Anybody can come in. White coats and stethoscopes are easy to acquire, so impersonating a doctor requires minimal effort. Treatment plans, available for all to see, at the foot of the patient’s bed, might appear to a millennial as some sort of crowdsourcing approach to helping the patient recover. Poor integration between IT systems creates fault lines that hackers can exploit.

•Overly focused on cure rather than prevention: The healthcare sector typically does not mobilize until there is a problem. Then, it sets about fixing that problem, rather than focusing on the wider needs of the citizen. Getting to the root of the problem takes time and effort, but it likely leads to greater cost savings.

•Too costly, and thus unsustainable: The concept of a national health service might be considered a social contract between the government and the people. Unless a radical rethink is undertaken, the contract is going to become increasingly worthless.

•No concept of account management: Citizens can feel like a “hot potato” when they are being handled by healthcare professionals. A GP cannot be expected to account manage all their patients and their current projects. During the days of help desk GPs, doctors would have developed relationships with whole families across several generations, and so would be able to make inferences that wouldn’t be picked up by the “standalone” professionals further down the supply chain.

•Poor integration in respect of physical and mental health: Physical health seems to dominate healthcare. Maybe this is because the apparent cost of treatment is higher. However, the overall cost of mental illness is high when one considers the lost economic costs of people being unable to work, and the associated unemployment costs. In any case, there is a clear link between some physical illnesses and the mental state of the citizen. A better integration of these two domains would lead to preventative action that would avert costly (both socially and financially) interventions down the line.

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Three steps to wellness

There are three natural phases on the path to wellness from where we are today. Let’s take a look at each step:

Step 1: Digital healthcareIn this phase, we focus on better integration and increased digitization of the clinical processes and data. The aim is a single view of the patient. Improved connectivity between GPs and the hospital, in the form of a “caregiver exchange,” reduces both errors and delay. Automation needs to be incorporated wherever possible to relieve overburdened practitioners from having to rely on memory.

Step 2: Integrated careOnce step 1 is in place, integrating the digital hospital with other stakeholders in citizen health can be the priority. Care can be coordinated at community level. Being able to pool citizen data from healthcare providers and providers of self-analytics services provides a richer picture and thus make healthcare provision more personal and accurate. Incorporation of telehealth technologies, coupled with home care, can reinvent the concept of hospital from a physical to a virtual entity.

Step 3: Personalized wellnessAt this stage, the big focus is on insight. In the last two stages, the infrastructure has been put in place to collect the data and provide a single view. This data can now be applied to wellness, and not just illness. Wearable devices become part of the wellness armory. Actions can be inferred from the crowd (GPs can, for example, anticipate a surge in the flu complaints and so prepare accordingly.) and from research that is being added to the data pool. At this level, the citizen can have access to a raft of wellness apps that will provide alerts when the patient’s attention is required in respect of their health, ranging from “Your eye test has been booked” through to “Your signals suggest you must get to the hospital in the next four hours.”

Recommendations

Here are some high-level considerations, which if woven into your initiatives from the outset can increase your chances of pleasing all stakeholders:

•Create a plan that accelerates the journey to citizen centricity. However, structure it with the intention of delivering incremental and frequent improvements. Big bang deliveries do not work in a world where requirements change in real time. Think Silicon Valley startup rather than multigenerational cathedral construction.

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•Re-engineer the clinical pathway processes before investing further in new technology. Digitizing a dinosaur is not progress. In fact, it can accelerate organizational collapse.

•Ensure the business architecture puts the citizen at the center understanding their need to consume some health-related services whilst on the move.

•Ensure the citizen’s family is considered in this architecture. Using mobile technologies, they can also form part of the service delivery team, at no extra cost.

•Ensure the architecture supports the healthcare practitioners such that they can focus on health rather than administration.

•Ensure that security is woven into the fabric of the business model rather than an afterthought. It would be a mistake to think of this as an IT issue. Everything from surveillance through to theatre equipment and culture needs to be factored in.

•Develop a citizen’s journey that extends from cradle to grave. Early interventions in respect of dietary guidance, mental wellness, and exercise can result in happier citizens and lower costs in respect of fixing self-induced illness.

•Anticipate the rising interest in self-analytics and wearables, and look to where you can both add value and deepen the relationship with the citizen. Explore how this data can be aggregated for use in tackling pandemics.

•Consider partnerships with wellness and insurance providers to incentivize citizen’s responsibility in respect of health.

•Create procedures similar to the airline industry in respect of learning from mistakes. Build operational post mortems into the processes.

•Learn from initiatives taken in other countries. This might well be a key criterion for choosing your digital partner.

Creating next generation healthcare is much more than a technology matter.

Conclusion

Whilst we are striving for a humane healthcare service, technology will be critical in respect of personalizing the experience. Technology can help institutions keep cost under control. It can help practitioner’s make better decisions and likely accelerate their “time to wisdom.” Again, technology is the enabler, not the driver. Associated solutions need to put the citizen at the center, and recognize the role of wellness from both an experience and cost management perspective. Increasingly, people want to consume health services whilst on the move.

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Healthcare reform is an opportunity to both improve the quality of life for your citizens and attract, and retain the most talented people. Such people, when in good health, are the engine behind your economic growth.

Looking a little further ahead, there are many advances that likely has a dramatic impact on the ratio of wellness to illness spend. These include:

•Nootropics

•Genomics

•Nanomedicine

•Internet of Things (IoT), wearables, and embeddables (e.g., IP-enabled pacemakers)

•Stem cell therapy

•Bionics

•Bioinformatics

All of these are underpinned by information technology. So getting the infrastructure right today is paramount to capitalizing on these inevitable trends. And by “right,” we mean that you have the ability to scale up, and down, your IT requirements, in a safe and timely manner.

Given the dynamic nature of healthcare, it is important that any solution should support the mobile healthcare professional’s ability to make the right decisions at the time and place where the decision has to be made. Similarly, the mobile needs of the citizen, and their family, must be given at least equal attention in a post-industrial healthcare model. Any solution needs to adhere to open standards in order to future-proof the investment. The ability to embrace new developments with minimal side effects on the overall infrastructure must be a primary consideration.

About the authors

Pierre MirlessePierre Mirlesse leads HPE Mobility business in the EMEA region. Mirlesse joined HPE (now known as Hewlett Packard Enterprise) over 20 years ago, advising industries and government organizations in their digital experience transformation. He has held a number of executive positions around the globe including Middle East-Africa VP, Worldwide SMB VP based in Palo Alto, Asia-Pacific VP for HPE Managed Print Services, and distribution director in Middle East, Africa, and Eastern Europe.

Pierre is a recognized industry keynote speaker. He now lives in the UK with his family. Find out more about Pierre on LinkedIn: ch.linkedin.com/in/pierremirlesse

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Ade McCormackAde McCormack is a near futurist, digital strategist, keynote speaker, and author. He is a columnist with CIO magazine, and a former columnist with the Financial Times, focusing on digital leadership. His experience extends over three decades and almost 30 countries across many sectors. He has written a number of books, including one on the future of work (Beyond Nine to Five—Your career guide to the digital age). He has also lectured at MIT Sloan School of Management on digital leadership. For more information on Ade, visit ademccormack.com.

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© Copyright 2016 Hewlett Packard Enterprise Development LP. The information contained herein is subject to change without notice. The only warranties for Hewlett Packard Enterprise products and services are set forth in the express warranty statements accompanying such products and services. Nothing herein should be construed as constituting an additional warranty. Hewlett Packard Enterprise shall not be liable for technical or editorial errors or omissions contained herein.

4AA6-5189ENW, April 2016

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