Healthcare Economy

Hi Gary,
I've been working with health service providers for over 10 years - trying to bring a holistic approach to the need for cost reduction / service improvement to be delivered. I've worked in and / or visited acute hospitals in over 20 (mostly 1st world) countries in the course of this activity.

Almost eight years ago I wrote a paper identifying the changes needed - which, if not addressed holistically...(people, politics, technology, structure etc.)...in my view will not work in a robust and sustainable manner. Definitely technology is a tool, not the answer - and past experience shows that, if technology is tackled in isolation, it will not work.

Part of that paper also identified the 'blockers' to real, sustainable, effective change actually happening - and, as far as I can see, these have not changed, a few of the key ones:
- vested interest in maintaining the status quo (from those in a position of power)
- short-termism by politicians (measuring the wrong things, therefore creating the wrong behaviours)
- change exhaustion (health care workers)

Gary, the bottom line for me is that only long-term projects, addressing things from a people and process perspective first - led by the boss, championed by people at every level and engaging change experts who - as a result of matching technology to process - can make it happen together will have any chance of success.
Bleak, but - from everything I've seen - true.

I agree, this is more about standards, regulations and laws than technology.
Technology could also run amok with this, especially if the political and legal standards are not first in place.

All that said, technology can introduce efficiencies in record keeping and information transfer. Of course, it can ruin privacy, create an automated process for insurance to deny claims. Like I said, the legal and poltical work has to be done.

I think the most important thing is that the US has to have the political will to break the backs of special interest groups in the health care industry that have made the US the most expensive and least effective of all well developed countries. For example: R&D is done inefficiently on a company by company basis. Then the companies get all sorts of price fixing deals to cover their costs (or so they say). If R&D were done more as it once was, by government funded researchers, putting the results in the public domain, costs would be reduced.

I especially love the special interest / conservative pac TV ads that are running, that show the few bad cases in places like Great Britain. They don't show the thousands of people who die for lack of insurance in the US system.

I agree with some of the points made in prior answers, esp. that a big part of the issue is in the political.

However, consider straight, (science fiction) technology, the computerized autodoc, robotic surgery. It is possible to imagine all the components for such a system in mid term time lines, 10 to 60 years. Expert systems for diagnosis and prognosis, prototypes were demonstrated in the 1980's, chemical, photo and other sensors to perform tests, many already deployed in normal testing labs, massive but diffuse research covering many aspects underway, records doable with current technology,
aspects of UI/interation/robots again massive diffuse research happening.
Genetic screening, massive focused research targeting dropping the price for a personal sequencing from 100's of thousands or million dollars to 1000 USD per. Wearable and implantable sensor systems for patient monitoring.
Also in the area of much focused research, but likely to be forbidden or proclaimed cost prohibitive at deployment are therapy synthetic organisms, including one treatment "sustaining" cures for Metabolic syndrome, autoimmune diseases....

In putting time frames out to 2 generations, 60 years, I do include a factor of +20 years for patent spans, but I doubt fully taking into account the FDA political, too risk adverse practices dominating treatment and device deployment.

It may be too early for a "Automatic doctor" platform, but this might be an approach where pre-planned technology generations, with subsidy of version transitions might work.

From a technology thinking towards fixing healthcare comes a personal experience with electronic records while receiving care through the VA medical system. Electronic records made a move from Oregon to Maine and back to Oregon a lot easier because I did not have to lug copies of the records back and forth. My record since 2003 probably is around 3000 to 5000 pages. That is a lot of paper.

This is a complex issue, and while there is no silver bullet, there are some considerations that are offered herein. Healthcare is a business, and as such, it should be analyzed in terms of its stakeholders, internal and external environment, Porter's Five Forces, relevant corporate and business strategies, SWAT and TOWS analysis, and any other standard methodologies. Moreover, the scope of healthcare needs to be undestood, as it involves hospitals, HMOs, tertiary care operations, medical tourism, and a list of agencies and businesses that easily exceeds 50 different types of entities.
No matter what entity is in question, there is a need to ensure that the technology strategy is aligned with the business strategies. Where there are gaps and problems, as identified through analysis, there must be effective projects implemented and problem solving methods (eg. six sigma) applied for resolution. And while it may seem basic, it is so important to define and resolve the correct problem.
While there may be temptation to immediately role out technological solutions, care must be taken to ensure that the expense is justified. In other words does it enhance the patient care process, increase revenues, decrease expenses, increase reliability? Does it provide a competitive edge? Remember, healthcare is competitive; for customers (patients), exclusive apparatus, etc.
Finally, there must be accountability and measureable progress in meeting strategic goals. The Balanced Scorecard is a great method for this, as it tracks projects and processes to the fulfillment of the strategic goals, while allowing personal accountability; or a defined neck to grab.

Gen;
I want to thank you for this very informative answer. I understand the consensus building effort you are referring to. My background includes healthcare technology for 25+ years working for organizations at the forefront of these issues including First Consulting Group, Anderson Consulting, Perot Systems and CSC. Currently I am developing a Healthcare Provider Practice at Infosys. We have launched a new blog from our site with questions posed by experts within our organization who are proactively developing these solutions for the Top provider and plan organizations in the world and U S.

I would appreciate your input and participation to our blog postings and any other information you can provide. This will give our group deeper insight into the issues facing us in the U S based on the healthcare leaders we know who are considering ARRA HIT Stimulus funding and how to best take advantage of that. Proactive -vs- waiting is the topic of another posting I have on the Infosys blog.

Robert;
Thank you for this addition. We are working with the largest healthcare providers and payers in the U S. We have views from all sides on healthcare reform and in some cases, CEOs with polar opposite opinions. The politics between the stakeholders in the Executive Suites and inter departmental competition for funds in today’s economy is a challenge. Take that to the national level and consider those politics if the government manages this and the outlook can be bleak unless the controls are designed appropriately.

From a technology perspective the information needs are similar if we really want to provide high quality and safety standards while controlling costs.

Les;
I appreciate your input to this question. Robotics and Telehealth play a big role already in what organizations are asking us to provide. Already, the virtual physician is becoming a reality. United Health has partnered with Cisco and has a virtual clinic on the Cisco campus as a pilot.

Infosys has been involved with major telehealth initiatives as well and it is coming to the forefront of client interests.
Thank you for originally posting this answer on LinkedIn and allowing its posting on Infosys' Healthcare blog.

Katherine;

This is certainly a compelling and real story and a testament for the quality already deployed in healthcare for the Electronic Medical Record. The VA has been working on this for 20 years and your story is obviously a testament to its quality. The next step now is for the Physicians and Patients to access these and for organizations to track costs and utilization of services that provide higher quality and increase patient safety (EHR, PHR & P4P).

Thank you for this posting.

It is very true that it resonates and is the story for an increasing amount of veterans needing to use the VA medical system. Think about this that if through the VA the government could cover uninsured veterans and their family members then a lot of uninsured could be covered under the VA budget.

Technology is not the problem nor the solution - the technology is relatively easy (in comparison).

Data and the regulation thereof is the problem. HIPAA regulations about the transportability of patient data is a restrictive regulation. There are currently limited/no regulatory structures in place that allow data to be easily transferred between institutions.

In addition, if regulation becomes available to allow patient data to be transferred easily; another issue arises: data hoarding. Hospitals are businesses too. The hoarding of patient data allows the hospital to maintain a strangehold on the patient by not allowing the information that they have collected to be transferred out. In addition, a hospital could even declare intellectual property over the writings/materials produced when evaluating a patient. Imagine a world where content created by and about *you* is owned by someone else -- you don't have to look far - I'm assuming LinkedIn owns the IP to these forums and the content we just created.

Michael;

Thank you for your comments. You raise some points that we see daily in our profession. If the Personal Health record becomes available then the patient can get records at their fingertips.

The politicians however are slow to adopt these methods.

Gary,

Perfect timing for the question. What is missing from the system is power in hands of patients. Today Patients are at mercy of Health Insurance companies and Doctors.

Medical Tourism industry while still in nascent stage is one option.

Technology can certainly bring transparency. I'm building a portal where Hospitals/Doctors will have to put their best show and participate in health communities giving solutions for free to patient queries to improve their ratings. Patients can choose to remain anonymous while sharing stored medical records across the border.

Cost of complex surgeries in Thailand, India, Singapore, etc is almost 1/10th of what is there in US. In 2007, 750000 patients traveled outside US for their surgeries.

Ever thought how much you need to wait outside when visiting a doctor? And why do you have to go again to see a doctor if you don't have adverse medical reports ? Doctors want you to visit often. It not only costs you time but also $$$. Getting free advise, and getting paid second opinions online with scheduling phone conversation with best doctor without traveling out from your home is something technology can easily offer today. Access to High Speed Internet and VOIP has made this possible for patients to take this option.

What is challenging is to train doctors, hospitals as well as patients to use technology for their health care needs. You will probably see "Health TechnoClinics" that are online brick and mortar shops in every city that have no Doctors but Certified facilitators who help patients in using the web for their health care needs.

Maybe I am thinking too far but I don't see other options. Here in Indian villages where they have limited access to high quality health care, patients are not aware where to get the best treatment for a particular disease. Just because they are staying in suburb or village, they have limited choices. Their local doctors also are not tech savvy and even if they refer the case to a nearest hospital, it may not have best doctors and facilities. Also Doctors in villages and suburbs may not have knowledge of who is best doctor worldwide, nationwide, statewide, citywide for a particular ailment.

Technology gives various options. It does require lot of training. Government and Private Partners must invest in such ventures as it gives more choices to patients. This will break the current medical system gradually. But don't we need to do it?

Tie in accountability in the system with transparency and rating and voila, you already see lot of productivity gains, reduced costs and quality of health care improved for everyone.