Few deny that the healthcare industry in the U.S. faces tremendous pressure to change. Few deny the role that technology will play in stimulating this change, either.
Uncertainty creeps in, though, when healthcare organizations try to address their healthcare needs. This is especially true of healthcare providers — the hospitals, medical offices, clinics and myriad long-term care facilities that account for roughly 70 percent of healthcare spending and that have spent much of the 21st century rushing to catch up to other vertical industries.
Most providers, says Skip Snow, a senior analyst with Forrester, are "very new to the idea that they have all this structured data in clinical systems." That's largely because, until recently, the mission of the healthcare CIO was ancillary to a provider's core mission. IT often fell under the CFO's domain, Snow says, since it focused so much on business systems.
Today, thanks to electronic health record (EHR) implementation, "The entire patient record is in [data] repositories," Snow says. "Trying to make sense of it is a huge challenge."
Healthcare Organizations Struggling With IT Must Adapt or Die
Snow and his colleagues recently published a report outlining five technology imperatives for U.S. healthcare providers.
Such measures are necessary, they write, because "In no other industry has technology been called on to so significantly alter the fundamental relationships that are occurring in the delivery of healthcare today … Technology has frequently been managed on a case-by-case, need-by-need basis without a strong road map being in place, which is the core of good enterprise architecture."
Forrester outlines the following technology imperatives for healthcare providers:
1. Clean up data. At a minimum, an organization should be able to import and export HL7-standard continuity of care document (CCD) files; on top of that, providers should create a metadata infrastructure that maps common medical taxonomies to structure information management models and build protected health information (PHI) security into core business processes.
2. Invest in customer and patient insight. This requires an investment in clinical, operational and financial data management tools, including master data management and data governance and complete with shared "vocabularies for core business entities."
Healthcare data analytics must be appropriately scaled, too; complex reporting and natural language processing (NLP) tools are great, but Forrester cautions that few healthcare providers are "sophisticated" enough to make such technology work.
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3. Embrace mobile. Use mobile health as a bridge between remote patient monitoring and EHR systems, Forrester suggests, as this eases concerns patients have about the complexity of telehealth. Help doctors determine which of the tens of thousands of health apps "in the wild" are worth their time and their patients' time. Ultimately, see mobile for what it is: A way to improve collaboration among increasingly disparate care team members.
4. Use emerging technology. To enhance care quality and boost efficiency, providers should consider wearable devices, cognitive computing and big data (since relational databases can't always handle complex healthcare data computations).
5. Build cloud-based business networks. Move healthcare IT services to the cloud if they don't offer core business or patient value — provided your CISO and compliance officer have reviewed HIPAA business associate agreements and have accounted for the fact that your organization's security perimeter now stretches to your business partner's firewall.
Organizations that don't address these needs face a foreboding future. Forrester says, they "will fail to deliver on the increasingly important information and process enhancements called for. They will be acquired by organizations that can harness these forces." Potential buyers include integrated delivery networks such as Kaiser Permanente and the Cleveland Clinic, Forrester says.
Healthcare IT Adoption 'Table Stakes for Survival,' Not Optional
It's a dire prognosis — as Snow puts it, "It's table stakes for survival; it's not competitive advantage" — but it need not be a frightening one. Consider that healthcare has moved from "no automation to speak of" to largely digitized EHR workflows in roughly a decade, he says, and the rate at which this $3 trillion industry is adopting information technology is actually "astonishing."
The challenge, of course, is threefold: The industry must spend money to improve efficiency; that means spending less on patient-centered care and, by improving efficiency, that essentially means spending money to reduce revenue.
To truly improve care, Snow says, healthcare organizations must look beyond their walls to two places. One is other industries. Kaiser CIO Philip Fasano, for example, came to the payer-provider from the banking industry, and other healthcare organizations would be wise to make similar hires, Snow says.
The second is overseas. The United States is great at innovation in healthcare itself but less so in care models. Health leaders in Denmark, for example, have recognized that the hospital bed is the most expensive part of medicine and have accordingly shifted their operational model to move care from the hospital to the clinic and the home.
This is inevitable in the U.S., Snow says — but, he asks, "What does that mean to technology and the consolidation that is or is not going to happen in the industry, and what does that mean to the contemporary dominant business models?"
What it means, Snow says, is that healthcare needs to use data as "brilliantly" as financial and brokerage services has been. Most providers have digitized so quickly that they don't know how to ask the right questions of their data — and now they face the "classic story," as it were, of welding the boat (empowering the art of medicine with the use of information) while floating in the ocean (providing care for the sick).
Healthcare reform and the HITECH Act have demanded that the U.S. healthcare system change radically and fundamentally, Snow says — and the operational model, technology and the tools are all responding. It won't be long before systems offer such "profoundly capable" automation that physicians serve as QA for machine generated responses (for example, "This person with the flu needs antibiotics") and can focus more attention on less trivial matters.
"It's another way that cost can be taken out of the system," Snow says.
Brian Eastwood is a senior editor for CIO.com. He primarily covers healthcare IT. You can reach him on Twitter @Brian_Eastwood or via email. Follow everything from CIO.com on Twitter @CIOonline, Facebook, Google + and LinkedIn.