Leading in real timeAn investigation of the impact of real-time business on strategy and management.

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Towards predictive medicine2. HEALTHCARE

Futurists, describing the healthcare of tomorrow, often present a vision of the connected patient

in the connected home—healthcare provision that is remote and pre-emptive, powered by Internet-connected weighing scales, telemedical nurse visits and smart pills that report back to the hospital to record when you’ve taken them. This vision is partly enabled by new connected and wearable devices—but ultimately it is data that will bring it to life.

At the Beth Israel Deaconess Medical Center (BIDMC), the Harvard Medical School teaching hospital renowned for its innovation, this vision is already a reality.

“We have wired the bathroom scales, blood pressure cups, glucometers and other devices in the home,” says John Halamka, BIDMC’s chief information officer. These devices relay information to a central electronic health record via individuals’ smartphones. “We’re

getting real-time data: you step on the scale, and within one second we know how much you weigh.”The system allows caregivers to set up alert thresholds in such a way that within a few minutes of a patient recording a metric that is out of the ordinary, doctors can conduct a telemedicine visit or dispatch a home nurse. Doses can even be adjusted remotely, if needs be.

This real-time, data-enabled approach to health, whether at home or in the hospital, promises a more efficient, pre-emptive care system.

So far, however, the use of real-time information among healthcare providers is limited and scattershot. In a recent global survey of executives across industries, conducted by The Economist Intelligence Unit and sponsored by Cisco, over one-third (35%;

The adoption of real-time data in healthcare is lim-ited and scattershot, but providers are building the skills they need for the systems of tomorrow

Written by The Economist Intelligence Unit

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

% of healthcare respondents

Improve decision-making across the business

Enhance customer service, satisfaction and retention

Improve organisational agility

Maintain or achieve market leadership in our industry

Better integrate functions through the real-time exchange ofinformation

Improve executive oversight of the organisation

Launch new products and services

46%

40%

38%

37%

37%

33%

31%

What are the primary goals for your organisation's use /planned use of real-time information?

% of healthcare respondents

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Decision support

The most common goal of using real-time data among healthcare executives is to “improve decision-making across the business”, as identified by 46% of respondents in the sector.

petabytes of data,” he says, describing his IT infrastructure.

Ensuring that data are effectively converted into useful information often requires an organisational shift. At US hospital and clinic operator ThedaCare, for example, it required the integration of its analytics capabilities into operations.” As we began to really understand the power of information flow and to understand clinical business intelligence, we were able to begin to marry the analytics side of the organisation with the operations side,” explains John Toussaint, CEO of the ThedaCare Center of Healthcare Value, the company’s research division.

the most common answer) of respondents from the healthcare sector said: “We make limited use of real-time information, but we have no overarching strategy.”

Across all industries, four in ten (41%) companies have incorporated real-time information in up to half of their business processes or more. Among healthcare companies, this proportion is just 27%.

The key challenge, healthcare executives reveal, is designing processes that incorporate real-time data—40% identify “incorporating real-time information into existing business processes” and “designing new business processes around real-time information”, respectively, as the greatest challenges to their use of such information.

It is vital, Mr Halamka points out, that doctors are not overwhelmed by data overload. “I have four

“It is impossible for my doctors to look at those data. What they actually need is information, knowledge and wisdom.”

Nowhere is the potential value of real-time information more apparent than in clinical decision support (CDS) systems, which provide up-to-the-minute data to help doctors decide which course of action to take. The more up-to-date these data are, the better the decisions can become. At Beth Israel Deaconess Medical Center’s intensive care unit (ICU) such a system provides real-time monitoring of patients’ vital signs and constantly evaluates the level of risk for each one. “This application is really looking at the beat-to-beat variation, all the data coming in from the monitors from the ICU,” says Mr Halamka. “You could call it ‘situational awareness’.”

Such systems make doctors’ lives easier by automating decisions—to a degree. BIDMC’s system applies around 2,000 rules to the CDS data. For example, if a patient is taking one medication, it will alert the doctor not to prescribe a drug that might clash.

But there is limited appetite within the profession for fully automated decision-making. For one thing, doctors are prone to “alert” fatigue, says Mr Halamka, when they are overloaded with automated instructions. A study published in June 2015 found that CDS systems fail to yield recommendations two-thirds of the time, due in part to the difficulty of writing effective rules.

Clearly, there is much room for improvement in the use of real-time data in healthcare. But there are also signs that organisations in the sector are making the investments required to make that improvement happen. For example, 49% of healthcare executives say they have hired experts in real-time information. This compares with an average of just 38% across all industries.

Meanwhile, 44% of respondents say they expect their organisation to acquire one or more companies in order to boost its real-time capabilities in the next three years. This is slightly ahead of the cross-industry average of 39% and bodes well for real-time data one day leading to predictive medicine. “We ought to be able to predict what’s going to happen,” says Mr Toussaint. He foresees a future scenario in which automated systems could spot the emergence of antibiotic resistance within a community in time to warn doctors off prescribing them.

“It’s early days,” says Mr Halamka. “We have these streams of data, but at the moment we lack a lot of the sophistication to really understand these data and act on them appropriately.”

- Written by The Economist Intelligence Unit

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This article, written by The Economist Intelligence Unit and sponsored by Cisco, examines global organisations’ use of real-time information and its impact on strategy and management. It is based on a global survey of 268 executives, just under one-third of whom hold positions in the IT department, while 47% are members of the C-suite. Respondents were drawn from companies in the healthcare, transport, retail, healthcare, manufacturing and energy sectors, 49% of which have annual revenue over US$500m.