Ness Point of View
As all industries become more digital, a vision for the future within a technologically-advanced healthcare sector must challenge the very essence of what a “digital hospital” should be. From product vendors keen to showcase how their technology or reference architecture can improve outcomes, to avant-garde hospitals using technologies like HoloLens, RFID or 3D Printing, there is definitely a move towards the world Star Trek imagined where a Tricorder (hand-held scanning device) could diagnose all ills in seconds.
This note lays out a specific point of view based on our experience of what matters to all stakeholders, and our expectation that disruption will drive change in unexpected ways. We have not focused on the surgical side of the hospital where numerous innovative developments are already having a significant impact; instead we address the changing needs of the key medical professionals.
Of course patients are clearly a key stakeholder category. However medical professionals – doctors, nurses and other trained medical staff – are equally important in terms of the design of a digital hospital and how technology can be used to improve the efficacy of the hospital itself. We know that the medical profession is something of a global phenomenon, able to morph and relocate according to economic realities, so the medical professionals who practise and exercise their skills in the Digital Hospital have to be attracted, trained, retained and motivated. Their actions heavily influence patient satisfaction and quality of care, and they are the people who will drive the adoption of digital transformation.
There are specific areas that don’t immediately open themselves up to the digital revolution. One key part of the clinical diagnosis process relies on touch. Traditionally, a medical professional expects to be able to touch and feel the patient’s body and use a series of physical interactions to derive key information that influences their diagnosis or prognosis. Even with the latest virtual reality technology, we are not yet at the point where this can be fully digitised. But, digital is already helping the early stages of remote diagnosis, even with simple approaches like consultations via Facetime, which can be used to optimise medical professionals’ time and improve patient access.
Medical professionals work in a professional services environment. Like accountancy and law firms, the economic model is based around the time available to do things, so there is always a desire to be more efficient with time. A simple truth to illustrate this model is how the most valuable resource (a surgeon for example) is not required to perform data collection on a particular patient, but reviews the data collected by less expensive resources within the hospital supply chain. It makes sense that as there are fewer surgeons, so they need to have as much help as possible to be the best most effective surgeon they can be. However, this need for the hospital to exercise careful financial resource management is balanced by the time that patients expect to spend with their consultant. Over-efficiency in time management can lead to a reduction in patient satisfaction if they don’t feel “looked after” by the expert. And, not everyone (consultant or patient) responds in the same way to a more digital engagement, for various reasons relating to age, familiarity with digital channels, and suspicion that a machine is not as understanding as a human. So, while there are innumerable ways to improve hospitals, these have to be carefully considered, and change needs to be weighed against the effort and cost of the current ways of working (which may already be optimal). The challenge is in identifying the opportunities for digitisation that will add value rather than improving one metric at the expense of another – and in areas where there is universal agreement that change is required.
One of those key areas, where everyone can agree that efficiencies must be found, is around patient identity and access to historical medical notes. There is a significant amount of paperwork that could and should be digitised to improve accuracy, transparency and efficiency. Basic facts such as the patient’s name, address, contact details, next of kin, General Practitioner (GP), NHS (National Health Service)/Social security number, relevant insurance details, and so on should be easily accessible from one quick search and integrated with notes from the patient’s GP and notes from previous hospital interactions. If you provide your name upon arrival at the hospital (and potentially confirm it with some identification which may include a biometric scan of your thumbprint or iris), that should be enough for the hospital to have “all your data”. And, if there are updates to be made, the patient should able to make these in advance or while at the hospital waiting to see someone, rather than in a dialogue with a hospital receptionist, who can instead focus on validating your identity and the reason for your visit.
The healthcare industry is still commonly powered by the paper fuel from anachronistic form filling. This is now a historical quirk of embedded behaviour, regulation and self-imposed policies which have become the unquestioned accepted norm. The benefits and efficiencies of digital data gathering are many. One example from India is the national biometric identification program; hundreds of millions of people were quickly assigned a unique 12-digit number and able to have an official “identity” for the very first time. Decades of paper-based inefficiency were swept away in a couple of years, and identity can now be established and verified in seconds. The benchmark has been set for all governments and national health infrastructures.
In the UK there have been significant failures in previous efforts in this area, as individual solution providers have attempted to address the entire problem in a very expensive, all-encompassing big-bang digital solution, (something which has failed several times now), rather than to run trials and then roll-out improvements gradually.
Another area ripe for digitisation is a hospital’s playbook of standard practices and policies. Anything which has to be explained repetitively by medical professionals to patients – or by the hospital to medical professionals – can be captured and made accessible to everyone. It can be updated and improved in real time and become the very best version of the explanation which would be given by the very best professional. It would also help ensure that medical professionals have the very latest information and best practice guidance available, rather than relying on their own knowledge, which will probably not have been updated in real-time.
Medical technology solution providers promote digital technology to knowledge-enable patients in advance of spending time with their consultant, but this perhaps doesn’t take full account of the underlying human approach to health issues. If people start to self-diagnose or make assumptions about a course of action based on what they are presented with digitally, they may well start to feel worse and suffer distress through the sub-conscious or irrational assumption that “I’ve got that.” Web-based hypochondria is one of the main reasons patients should continue to see their consultant before opening up a digital deluge of possibilities. Doctors are still best placed to deliver reassurance and guidance on the likely severity of any condition.
There is a strong argument within the hospital that the time and money spent ensuring and measuring that each consultant is operating at the top of his or her game is the one of their most important investment strategies. This is especially true in the private sector, where medical professionals are free to choose where they work and will of course, work for a hospital that gives them a good experience (over one where inefficiency makes them less effective). A successful implementation of digital technology should remove a lot of the frustration in a consultant’s typical work day. From simple things, like finding a place to park, to receiving an advance set of detailed surgical briefing notes with links to the other medical professionals involved, and a reminder and summary of the procedure to be performed in relation to the individual patient. Digital should improve efficacy if designed, tested and monitored properly.
It is also important to remember that cost-cutting/efficiency drives have diminishing returns. It’s a common mistake in this sector to go too far too fast and consume too much precious budget without validating the returns through constant monitoring and taking the temperature of patient satisfaction. Lessons must be absorbed from previously abandoned efforts before repeating the same mistakes in a healthcare Groundhog Day.
If we look at disruption in other industries, success is most often delivered when providing a new way to do something that has previously been done differently, and/or enabling people to do something better that they couldn’t do at all (or very easily) before. And, in the case of replacing paper-based form filling, other heavily regulated (and previously reluctant) industries such as banking have made it across the digital Rubicon.
Three easy to identify disruptive trends gaining momentum within healthcare are:
- Networks of patients sharing their views and experiences, and giving some familiarity and reassurance to patients who are facing a medical procedure that they are worried about. A crowdsourced approach to spreading knowledge from “previous people who bought this product.” Although as noted above, the risk of web-based hypochondria can worsen someone’s condition in advance of their being seen by a medical professional.
- The rise of online information and limited diagnosis by medical professionals on their own specialist websites, which while purporting to be educational in nature, are really trying to promote the author and their business. This is still in its infancy and could be evolved such that senior medical professionals share their knowledge with their juniors this way, as well as prospective patients.
- How drugs are prescribed, administered and monitored. This is already changing as modern medical devices can augment or in some cases replace medical professionals. Drug performance monitoring and tracking is already available remotely, especially around lifestyle choices such as sugar/glucose intake, cholesterol, or quality of oxygen processing in the lungs.
Overall, the biggest benefit delivered by a digital hospital is around data. The positive exploitation of data is likely to deliver the most improvement to patient outcomes and the industry as a whole. As more things are digitised, they start to leave a digital footprint. Over time these digital records and events can be analysed to find patterns and derive useful insights. Data should reveal which of two approaches resulted in the best outcome and what were the crucial steps taken to reduce the risk of exceptions.
The real future of the digital hospital lies in a data strategy which tracks and then shapes the quality of the interactions between patients, medical professionals and hospitals. At some point statistically significant insights can be derived that help all stakeholders; that suggest the optimum course of treatment; that help identify less productive approaches and treatments (and inappropriate ones which have resulted in unforeseen consequences that had life threatening outcomes); and which create a body of knowledge to help continually improve the efficiency and quality of health benefits delivered by the digital hospital of the (near) future.
- If you want to pursue a transformation agenda in the digital hospital environment, think about what areas are crying out for improvement. Usually it’s obvious. However, sometimes people will have put in work-arounds as a temporary measure that get accepted as the norm, when they are not the optimum way to achieve something. And think about it in terms of the needs of all stakeholders. Try to include some outside-in perspectives into this exercise.
- If you’ve tried to do this in the past and it’s failed, make a conscious decision to do it differently this time around. Engage with a different partner from whom you’ve always used in the past. Select a partner who will help implement small but important things, rather than trying to boil the ocean. Small steps are a good way to start, and the positive feedback and improved experience will help garner senior management support to do more of the same.
- Recognise the nature of the partnership you need. You probably understand your domain better than any third party, so focus on leveraging this as a strength. The right partner will bring an array of expertise and experience of having done similar things in other areas. Marry the two together. Don’t tell your partner what to do, and vice-versa, don’t let them tell you what you should do. True partnership is about an exchange of ideas and collectively driving towards an outcome based on both parties’ strengths and capabilities.