From the UK’s scaled-back ‘NPfIT’, to Obama Care’s bug-stricken exchanges, to Australia’s under whelming up take of national personal health records, the recent history of health IT has not always been smooth.
From the UK’s scaled-back ‘NPfIT’, to Obama Care’s bug-stricken exchanges, to Australia’s underwhelming uptake of national personal health records, the recent history of health IT has not always been smooth. Examples of spiraling costs, slow take-up and elusive productivity gains are found in virtually every health system around the world. Why has healthcare delivery been so resistant to digital transformation, and when big investments have been made why have strategies so often failed to pay off?
The history of technology, as it enters industries, is that people say, ‘This is going to transform everything in 2 years.’ And then you put it in and… nothing happens. And people say, ‘Why didn’t it work the way we expected it to?... . And then, lo and behold, after a period of 10 years, it begins working.
— Robert Wachter, UCSF School of Medicine.
Examining the stories behind setbacks at local and national levels, perhaps the most important lesson of all is that becoming a digitally enabled healthcare provider isn’t about replacing analogue or paper processes with digital ones. Where implementations have failed, technology has often simply been layered on top of existing structures and work patterns, creating additional workload for healthcare professionals. The technologies that have released the greatest immediate benefits have been carefully designed to make people’s jobs or the patient’s interaction easier, with considerable investment in both the design of the tool and the redesign of ways of working.
A pattern that appeared time and again in the stories examined was great expectations of new technology clashing against an initial period of frustration and reduced productivity. Benefits would eventually materialize — often after 2 or more years — but weathering this ‘digital dip’ was an important hurdle that has led to many transformation strategies being scaled back or even abandoned.
A case in point is electronic health records (EHRs). These are an essential foundation to any digital strategy, but rarely do they produce any immediate benefits to the frontline. In reality, most organizations see an initial phase of added inefficiencies before the tools that work off the EHR (patient flow management, e-prescribing, automated alerts and data transfer) are developed, implemented and get to work. The unexpected pain of the initial EHR implementation has caused many providers to get stuck in the dip — unable to roll back to previous systems,but unwilling to invest further to get the benefits.
Robert Wachter, in his recent book The Digital Doctor, notes that poorly designed systems have led to significant increases in time spent on data entry and multiple unhelpful alerts — with some research showing nearly half of emergency physicians’ time spent on data entry. A 2013 RAND survey of physicians across the US found widespread dissatisfaction with EMR systems, concluding that although most approved of the EMRs "in concept”, in reality they were among the principal causes of professional frustration and dissatisfaction.
Happy users is the golden criteria for the success of HIT implementation. Users should be effectively engaged throughout the project cycle. Talk to them, work with them to get what they want, realize and have them check whether it’s what they want. Then repeat.
— Dr Kim Liu, KPMG in China
Examining the widespread failures to derive the full value from digital technologies in healthcare, and what separates the stories of success, we have distilled seven important lessons about how to achieve real benefits from a digital strategy:
Thought flow impacts the decision-making process, that is, it either enhances or makes it worse through the way we display digital information on a computer monitor or on a mobile device, so the concept of presenting the right information, to the right person, at the right time is very important.
— Richard Bakalar, KPMG in the US
1Boonstra A, Versluis A, Vos J (2014) Implementing electronic health records in hospitals: a systematic literature review. BMC Health ServicesResearch 2014, 14:370
2Broderick A, Lindeman D (2013) Scaling telehealth programs: lessons from early adopters.New York: The Commonwealth Fund, 2013
3Cresswell K et al. (2013) Ten key considerations for the successful implementation and adoption of large-scale health information technology.J Am Med Inform Assoc 2013; 20(e1): e9–e13
4Bell, G. and Ebert, M. (2015) ‘Health Care and Cyber Security: Increasing Threats Require Increased Capabilities’ KPMG.
5Triggle, N (2014) Care.data: How did it go so wrong? BBC News
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