Monthly Archives: March 2014

Change Focus from Cost to Value via Patient Outcomes!

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I’m a TED fan, if you are not aware of TED.com you need to be! To whet your appetite invest under 13 minutes to watch this lecture, here.  Stefan Larsson, (not to be confused with Stieg although, some parallels may exist with the Millennium Series!), describes the reasoning behind the ICHOM initiative, (ichom.org), who according to it’s site:
“The International Consortium for Health Outcomes Measurement (ICHOM) is a non-profit organization founded by three esteemed institutions with the purpose to transform health care systems worldwide by measuring and reporting patient outcomes in a standardized way.”

Here is the simple concept:
slarssen_value

The problem is that we have been measuring the cost and using that as the metric how do you gain a measurement of the ‘outcomes’? That is the role of ICHOM, to measure the outcomes and create the benchmarks as well as find best practices. (If you didn’t watch the lecture he gives examples in hip replacement and prostate surgery.)

The key message is that wherever there has been a focus on improving patient outcomes the costs have dramatically dropped, not too much of a surprise there! I’m guessing that your immediate reaction is, ‘That is all good but who is going to do all this data collection work?’ Interesting is their answer is to use the data that should already exist in patient records as well as involve the patient themselves, reuse and distribution of workloads.

I only have one question, if we have been benchmarking in enterprises for decades, how come this is a new concept in healthcare?  There are numerous benchmarking organisations in various sectors who study a multitude of issues and collect data and publish the benchmarks for these aspect.

I think the answer is simple, in healthcare it’s not that easy!  In commercial organisations there are a relatively small set of quantitative ‘variables’, and in the most they revolve around PROFIT! This may include derivative measurements of cost/efficiency/productivity. However in healthcare the inputs are both numerous and not always quantitative, but today that is no longer a barrier.

Love it or hate it, the ‘Big Data’ revolution taking place has produced technologies and methodologies to compute with ‘subjective’ data! Now measuring patient outcomes and the factors that affect it can be mechanised and thus reasoned over to improve the ‘value’ within our healthcare system.

Now while Australia is participating in ICHOM’s work and I wonder how much impact their results will have on our system as a whole?

Can Technology Transform Healthcare?

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How many times in your life do you have an opportunity to make a real difference? I think I have one of those!  EMC has asked me to look at how we can help transform healthcare with the technologies we create and way our customers innovate with them.

Why do I think it’s such a massive opportunity? Because all the elements are there, an urgent requirement, existing proven solutions and a direction that is compelling.

The Urgent Need
There are many forces driving a structural change, from individual’s demands, to the availability of skills, etc. But let me just paint the dire financial picture. Over the last decade in Australia, the growth in healthcare spending has been about double GDP growth.  If GDP is an indication of the tax base, then more and more of government spending is required for healthcare. Now add in the fact that the majority of health costs occur in the latter stages of life, these costs are going to grow faster in the future as the baby-boomers push the population age up! There is a problem today and the diagnosis is bad, this is an unsustainable situation, something has to change!

Existing proven Solutions
I believe that the answer is in transforming the system using technology, (no surprise to anyone who reads my blog.) Let me outline what I see as the major trends and how technology is vital to these:

–          From Hospital to Home.
My father was a radiologist and he used to say ‘Don’t go to hospital –more people die there than anywhere else!’ Although if you study the statistics, hospitals are becoming more dangerous places as more people contact new diseases and complications due to their stays. The point I want to make is that this method of care is like a mainframe, a time shared resource that you have to go to, but is this the optimal model? In computing terms we are moving to the second generation after this model due to better utilisation, more efficient and lower costs of computing. Surely healthcare infrastructure must transform away from this mainframe model as well?

–          From Consultation for Collaboration
When I grew up we had a family doctor, and he was almost part of the family. He knew my grandfather, (also a doctor), and knew me from the moment I was born until I left the country, I don’t think I saw another doctor! He knew everything about me, not just my medical history, but my lifestyle – (rugby injuries), my neighbourhood, (lived a couple of blocks away). Today, especially as you age, the number of clinicians a person consults with is growing, while there is little to no collaboration between these specialists.

More fascinating, (as I grew up in a radiological darkroom), is that although all x-rays are taken digitally, the patient invariably walks out with a film in their hand! Surely healthcare information must be accessible, shareable, and persistent?

The Future of Healthcare or “From Prognosis to Prevention”

Today healthcare diagnoses and treats, tomorrow we will analyse and avoid! The most promising outcome of technological advancement, as well as the most fascinating, is to truly understand how our bodies truly function and from this knowledge be able to avoid getting sick and to keep us strong all through our lifetime.  I was confused, I thought the practice of medicine was a science, however today for the most part it’s an art. But as we gain an understanding from a genetic and molecular level how the body works, the practice becomes a science, a science of ‘wellness’!

The only issue with this is the magnitude of the data we are dealing with, we are simply drowning in data. The massive amount of research data that is published on a daily basis is way beyond the practitioners capability to ingest and so diagnoses are made that are not based on full knowledge. For the individual, we are creating ever increasing amounts of data from wearable technologies to the tsunami of sensor data. Surely gaining meaningful use from all this data is the key to transforming the quality of the healthcare system?

I invite you to join me on this journey, to share your thoughts and let’s make a difference together!