Sunday, July 01, 2007

The changing face of Healthcare in Canada.

It’s all about the patient
Information technology has made a significant impact on the healthcare industry. Over the past decade, many hospitals have adopted technology to increase the efficiency and accuracy of their healthcare systems. However, with the growth of managed care and capitation, information systems are quickly evolving to meet new and more complex requirements. One does not have to look very far to see the fundamental changes that are occurring in the health care industry. Economic, social and many other drivers are forcing changes to the focus of health care. First and foremost, health care is becoming a more patient-driven industry. Over years to come, the healthcare system in most Canadian jurisdictions will not be able to sustain the increase in demand for service that it will face. The sustainability of the healthcare system depends, to an extent, on its ability to find ways to gain efficiencies and effectiveness in every aspect of its daily activity.

Challenges, market drivers and restraints
There is a demonstrated understanding of the need to shift the focus of health care efforts from the management of illness to the maintenance or promotion of wellness. As a result, there is increased emphasis on the management of diseases for example, across the continuum of care and along the lifecycle of the disease. To support this, the industry is experiencing a significant shift in how clinical decision making occurs. Specifically, the “lone ranger” decision-making practices of the past are being replaced with truly collaborative, interdisciplinary, and evidence-based approaches. Decentralized and generalized care is becoming more centralized and specialized.

Today’s hospitals are evolving toward a model that brings together all imperatives: clinical, administrative, financial, managerial, and human resources, in a way that concentrates on patient outcomes as the primary goal of the organization and the method by which other parameters, such as financial efficiency, are judged. In short, today’s savvy healthcare providers are evolving their information delivery platforms toward a more open, vendor-neutral, patient-centric environment that extends a single/unified patient view (EHR) across different jurisdictions and domain boundaries.

The market factors driving this evolution include the need to:
o Reduce errors, cut and control costs, and improve the delivery (efficiency) of patient services. Note: Patient safety and effective healthcare can only be achieved with a robust, integrated information system.
o Replace stand alone systems (best of breed.) Although they might work well in small hospitals and restricted departments, however, are incapable of scaling up. This puts a serious limitation on these systems as they become redundant in large set ups and thus have to be either replaced or abandoned.
o Leverage latest technological advancements that allow a monolithic (enterprise-wide) platform to be completely integrated and provide customization at every level. Some of the earlier integrated hospital information systems were such that they did not offer the extent of customization that departments wanted. There were problems in scaling up and closing the gaps in integration. However, all of these issues have been overcome and the modern information delivery platform provides seamless enterprise integration.

Note: On average, employing a single vendor, integrated, enterprise-wide informatics solution (versus a disparate, fragmented, silo’d model) has been benchmarked (based on analysis) to increase efficiencies by 30% minimally.

The Vision
The promise of today’s Healthcare Informatics technology is to capitalize on the opportunity to offer on-demand access to any and all relevant data from any disparate database across the continuum of care through one intuitive, unified web-based view (EHR)---whether physician, nurse, technician, administrator, referring physician, or even patient. Furthermore this unified view (Longitudinal Record) must be standards-based such that information is transferable across different health care entities (e.g. RSHIP, LHIN, RHIO.)

As an aside, the elimination of redundant processes alone using today’s eHealth technologies, combined with the convenience of single sign-on, single patient search, secure eMessaging, and full access via wireless and mobile devices (within a PIPEDA/HIPPA-compliant privacy framework)---has proven, without exception, to dramatically improve outcomes and provide higher satisfaction to both patients and providers. Note: Never underestimate the importance of cost-efficiency as providing high-quality care at a lower cost yields savings that can be reinvested in other parts of the health care system.

Ideally, any next steps related to informatics investment should adhere to providing/extending a:
o Vendor-neutral, Patient-centric environment
o Intuitive, meaningful views (customized by user) of all clinical patient data
o Clear, measurable Value add (ROI) to the provider
o Timely and accurate access to information where and when required
o Interoperability and Integration
o Standards-based solution (HL7, DICOM, XDS, HIPPA, PIPEDA, et al.)
o Replicable solution — patterns, components to all stakeholders
o Phased controlled rollout built on a scalable architecture to support future
growth, and competition
o MPI and eMessaging
o Secure, private, and auditable platform
o Comprehensive offering that addresses both Clinical and Administrative

In this proposed “best-practice” patient-centric environment, all information follows the patient as they move through the system. Complete information is therefore available to all as needed along the continuum of care.