Recently I came across a video from one of the conferences on Healthcare IT. The panelists were talking about how technology can enhance patient care and delivery of Healthcare services. A specific point of discussion was implementation of Hospital Information Systems (HIS or HIMS) within the hospitals. Its been well established the need for IT systems in Healthcare which has traditionally lagged the other industries in the scale of Automation. We know now for instance, having a patient record for administrative, clinical and financial aspects does provide benefits to the patient care process flow within the hospital.
World over IT implementations have focused on the need to implement solutions that bring efficiencies to the Hospitals process flow.
But Does implementing an 'ONLY' HIS in an hospital truly provide for an enhanced patient experience?
In my review of Healthcare IT Implementations at various hospitals I have seen, the HIS implementations have their own unique issues and I am sure we in our own experiences have "lessons learnt" scenarios to make IT work better.
But the purpose of this post is to discuss the "Fringes", the solutions in the periphery of the Healthcare organization's processes that are woefully left out of the purview of a traditional HIS or are treated as "customisations" to the HIS solution. Or are perhaps considered to be traditionally not part of the IT strategy for the management. I believe these solutions on the "Fringes" are specialised and are equally important to provide fillip to an efficient care delivery in a Hospital. And that was also one of the points made during the discussion.
I list below 10 Fringe solutions which in my opinion should be also included within the IT Strategy of a hospital and product strategy of a Startup or an Healthcare IT Vendor.
- Patient Engagement: Patient Engagement is a framework by which hospitals provide their patients with tools (read as "apps") and resources (read as social media engagement, etc) to strengthen their patient engagement activities. A great resource that provides various levels of patient engagement can be found here. There needs to be a concerted effort from the Hospitals to understand what level of engagement they want to enable for their customers. Patient Engagement has been termed as the "blockbuster drug of the century"
- mHealth Apps for Patients: It became quite evident by the end of 2013 that mHealth was here to stay and a 'mobile-first" approach is one which has shown to provide some really innovative solutions being "prescribed" now by the doctors. But as is the case with every new idea, care must be taken to enable the mHealth App strategy with the patient engagement framework.
- Cloud Telephony for Hospitals: I recall when we used to talk about the "future of healthcare" in our pitch to various customers, we used to mention the "Dominos" example. Wherein as soon as a patient calls up the hospital she is greeted with a "Hello Ms. Doe, what can I do for you?" Today this kind of a scenario is available on our mobiles with the Truecaller app, but we are yet to achieve this within our hospitals. Even if you have called the hospital a number of times, are such solutions available right now? Therefore, with the availability of Cloud Telephony solutions each customer touch point with the hospital can now be integrated with a CRM solution and enable your customer facing staff to more effectively track customers and offer a superior customer experience to your patients - existing and new. For instance, a patient calling for a followup appointment need not be routed through the IVR options, instead she could be directly taken to the department with she already has an appointment scheduled or has had a visit in the past 10 days.
- Unified Communications for Care Coordination: Recently was reading an article on the "EHR and Paper record Usage" by young and old physicians. It spoke about what each type of patient record was used by these two types of users. It mentioned that the "older physicians use it to get information, and the younger docs do activities on it". Now with this kind of a scenario it becomes important to provide the right information at the right time to the right care providers. This is where unified communications can provide efficiencies of operation by presenting information to the doctor that pertains to the current care scenario rather than the "whole patient history and record". Recently we have the case of the patient who had been "let-off" home, when in fact the patient should have been quarantined. Difference in the way users interact to the system allows for simple handover tasks to be missed out. A unified communication solution sitting over an EHR has the ability to present "relevant" information with Efficiency in Workflow and Speed in communication
- eClaims & Payments: We all have now got very accustomed to making our payments online, be it banking, eCommerce, air travel, etc. Healthcare woefully lags behind in this regard. It will be great to see innovations happening in this area that allows for faster turnaround times for receivables for instance, from an insurance company. With advent of payment options from using hashtag payments on twitter to the payment gateways, healthcare needs to embrace technology across the various departments for a faster receivables management.
- Procurement and Supply Chain Management: The innovations seen in the eCommerce of late provides for a great case study, and for incorporation of "lessons learnt" and best practises into the healthcare procurement process. Instead of utilising technology to allow for increasing the efficiency of the procurement process within the purchase department, healthcare organisations majorly still rely on the traditional approach. The incorporation of a closed loop procurement process that connects the vendors and the hospitals is limited to emails, faxes and phone calls. Negotiated prices on the contracts are stored still in excel sheets and undergo revisions for each order placed. We believe this space surely requires some change to bring the benefit to both the hospital and the vendor. After all each call, email and fax adds up to the cost of the procurement. eProcurement can also benefit large organisations in putting together group purchase organisations which have the ability to get better pricing for the enterprise in a multi-location scenario. Vendor contracts managed through such a system have proven to provide a measurable ROI for such systems. Manage by exception in this scenario does provide a faster turnaround times.
- Laboratory Reagent Procurement and Management System: As is the case for the procurement of drug and non-drug items, laboratory reagents too require a solution that provides the equipment vendor the visibility on the number of reagents that need to be supplied based on the number of tests performed by the lab. This process automation will also allow for better inventory management of the reagents and procurement process can be streamlined.
- Move from "Relational-First" to "Analytics-First" HIMS: We have seen the progress of Healthcare IT in the hospitals and have often been faced with the requests from the users (clinical, administrative, financial, etc) for "reports" based on the data being collected. In each of these scenarios, you will find the vendor generating the report from the database and "delivering" the same to the customer. Apart from the transactional ability of a HIM solution, customers look at the ability and ease of generating the "insightful" reports from the system. Now, with the advent of analytics, traditional relational structures in HIMS should be reviewed to bring in a more "Analytics-First" approach. With our understanding of the healthcare processes and the types of reports that are generated from the HIMS, vendors should look at enabling data structures that are geared for a dimensional analysis of the data that is being captured within the HIMS system. IT should not be approached to generate this report or that report, rather the physician should be able to easily get a response for the effectiveness of a drug regime on a patient, or the billing department should be able to get information regarding the outstanding bills or the inventory department has a "Dashboard", enabled by default, showing the items that need to be replenished.
- Telemedicine Solutions: With the advent of 3G and 4G services, Telemedicine is on the cusp of going mainstream. We have been for years having Tele-Consultations with our physicians and doctors via phone and email. These consultations generally stay out of the view of a health record and could be prone to errors and is perhaps a safety issue. But with the advent of the underlying services that can support a more comprehensive approach to telemedicine, we can now allow for patients to have Tele-consultations for specific scenarios, for instance, followups to review lab results. Which can lead to follow up visits by the patients to the hospital if so required by the doctor. We also feel that telemedicine will, in the future, also bring into the ambit the traditional "black box" area of a patient care, i.e. the patients' home. Technology will enable many more data points to be captured and relayed live or periodically to the patients' physician. Anomalies in the data will be analysed using the "Analytics-First" systems and provide specific tasks to be performed via the unified communications solutions available with the doctor.
- Workflow Management Systems: I have kept this aspect at the end, purposely. This is one area which needs to be incorporated within the healthcare systems at the earliest. I feel that the 80 percent of the processes within a healthcare organisation are handled easily by the traditional way of coding, But there are 20 percent of the workflows and rules that need to be implemented as a "customization" by most vendors. This brings 'up' the cost for implementing a healthcare solution. There is a need now to bring in BPM, rules engines, notifications (push-pull) and alerts into the base framework of the HIMS so that coding for exceptions can be reduced and incorporated with much ease and simplicity using these tools. Each hospital is unique in their requirements and there will always be a use case scenario that would not have been handled earlier, incorporating workflow technologies into the solution will only enhance the delivery process for the customer, thereby keeping the cost of implementation under control.
These are some of the "Fringe" systems which I consider, are also required to provide a better quality of care and service delivery. After all, it's about "Speed in Communication and Efficiency in Workflow" that enables a more evolved care delivery process.
Lastly, would also like to point out that implementing these systems in conjunction with an HIMS requires interoperability of patient, administrative and care information, I strongly recommend the use of HL7 based standards for exchange of healthcare information. The standard allows for the information to be accurate and has the ability to be used across multiple "fringe" systems and enables you to evolve your solutions as the standards evolve. Proprietary approaches to integration and interoperability are fraught with issues of evolution and maintainability.
Looking to join the Healthcare innovation drive?
Start at the Fringes.
Additional Articles by the Author
- Health ID as Patient IDs unifier in India by Manish Sharma
- 5 Steps towards an Integrated Digital Health Experience in Indian Healthcare in 2016
- Top Healthcare & Digital Health Predictions for 2016
- Zen Clinicals: An Activity & Workflow based solution (1 of 3)
- RFID in Healthcare: Usecases from Hospitals