Executive digest

Executive digest

Around the world there is an acceptance that health services are at least a decade behind other industries in the use of information technology to increase productivity and quality.

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Richard Bakalar

Around the world there is an acceptance that health services are at least a decade behind other industries in the use of information technology to increase productivity and quality. Unfortunately, where healthcare often has stood out is in problematic, overspent and underwhelming IT implementations — from the UK’s National programme for IT (NPfIT), to the USA’s Healthcare.gov, to developers like Google, who saw their innovations fail to take off. Paradoxically, even “successful”  implementations have sometimes made efficient care delivery more difficult, rather than less, with recent surveys of US physicians showing electronic health records (EHRs) among the principal causes of professional frustration.

The approach of most healthcare providers to extracting productivity improvements through technology so far has focused on back office efficiency and improving simple transactions, while leaving the vast majority of patient-facing activity unchanged. While the hotel, transport, retail, communications and banking industries are almost unrecognizable from 15 years ago, the promise of ‘digitally transformed’ healthcare has remained over the horizon for most systems.

Looking to those that have transformed the way care is delivered — and realized genuine efficiency and quality gains as a result — it is clear that success isn’t achieved by replacing analogue processes with digital ones. It’s about rethinking the purpose of services, reengineering how they are delivered and capitalizing on opportunities afforded by data to adapt and learn. Where technological interventions have failed, technology has simply been layered on top of existing structures and work patterns, creating additional workload for healthcare professionals.

I think we’re about to come to the next era of medicine …as much as 30 percent of what we do today we will do differently …how we evaluate patients, how we follow up on patients, how we bring the expertise in between clinicians, how we manage patients in a hospital, how we think about even the role of the hospital.

— Robert Pearl, Kaiser Permanente, US

This report aims to cut through both the narrow ambitions of ‘doing the same things, but digitally’ and the often fanciful predictions of many reports about technology’s potential to transform healthcare. We have examined the real-life stories of success and failure around the world to find out what really works in realizing productivity gains in health, how organizations can get this right (or wrong), and how the delivery of healthcare is realistically going to change in the years to come. We have identified seven evidence-based big opportunities, and seven practical lessons to capitalize on them.

Seven lessons on realizing these opportunities

We have found that substantial gains in terms of productivity and health outcomes are possible — and have been demonstrated — from specific areas of health IT. As the history of frequent disappointment and failure shows, however, digital technologies will not deliver these improvements on their own. Through interviews, analysis, and KPMG’s own experience achieving digital transformation with healthcare providers around the world, we have identified seven key lessons from those that have successfully realized the benefits and overcome the setbacks.

  1. Transformation first: Transformation comes from new ways of working not the technology itself. You need a transformation program supported by technology not the other way round. This is the fundamental lesson that underpins everything else.
  2. People problems not technology problems: The majority of the issues faced along the transformation journey are people problems, not technology problems. These require sophisticated leadership and change management capabilities.
  3. System design: There has been insufficient attention to the design of systems. Technologies need to solve problems recognized by people who are going to use them, be they patients or professionals. This requires a deep understanding of the work as well as the needs of the worker.
  4. Invest in analytics: Far too often providers make significant investments in digital systems but overlook the capabilities to use the data collected — hence the payback is never seen.
  5. Multiple iterations and continuous learning: Even with careful design there may need to be a number of iterations in the design of systems. This is a continuous process and there may be several cycles — some quite painful — before systems reach a tipping point where all of this investment starts to pay off.
  6. Support interoperability: The inability to share and combine data between different systems is a major rate-limiting step to realizing the full benefit of technology in healthcare.  A coordinated approach to minimum interoperability standards would help accelerate healthcare providers’ digital journey.
  7. Sound information governance and data security procedures: Data sharing requires strong information governance and security, particularly in the face of a growing threat from cyber-attacks. Action is required at a national and local level to help organizations hold and share data safely.

It’s imperative to remember that technology is an enabler — the focus needs to be less on implementing the system and more on implementing the changes in the business enabled by that system.

— Liam Walsh, KPMG in the US

The future of healthcare: Digital heaven or hell?

Some will look at the years ahead and see a glorious nirvana in which the messy and inefficient services of today are transformed into predictive, coordinated and personalized care. Others will see a dystopia of doctors becoming slaves to algorithms and patients drowning in a sea of data and additional expectations. Both are possible, but a look at what leading providers have already achieved — described in this report — should be cause for optimism. We conclude with our own vision of how healthcare is likely to change in the next 10 years, including that:

  • Computing will be much more ubiquitous, but much less visible
  • A lot less time will be spent by staff on administrative tasks and routine communication, as automation, voice recognition and natural language processing become more commonplace
  • New roles and competencies will be added to the managerial cadre as the shift to digital healthcare continues — most importantly advanced analytic capabilities
  • Organizational and professional boundaries will be far less visible, as integrated information technology systems dissolve many of the current divides between primary, secondary and tertiary care.

Questions explored in this study:

  • Why has it been so difficult to successfully deploy information technology in healthcare?
  • What is the current digital healthcare landscape, and how will it evolve?
  • What are the biggest opportunities for technology to improve productivity and the practical lessons for achieving success?

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