We started this work with a question — what are the opportunities to use technology to improve the productivity of the health system and the workforce in particular. We found all the complexities that might be expected and a huge scope for investment in this area to destroy value as well as create it.
A second question is why is it that he health sector has failed to gain the productivity improvements found in other industries. There are undoubtedly opportunities to streamline the work of clinicians and to use technology to lift the burden of administrative and low value tasks. However, doing this in a way that liberates productive time is difficult. The really big benefits come from more fundamental redesign of the way the system delivers care, how clinicians think and how far patients can participate. There are grounds for optimism but many reports in this area fail to confront the difficulties or the scale of change that will be required.
There are several sources of productivity improvement that will form part of plans for the next 5–10 years and digital tools can help with all of these in different ways. There are three main areas for change with progressively higher levels of risk, cultural change and potential disruption of current operating and business models.
Operational improvement. Although there is a lot of interest in new models of care, the most significant improvements in productivity over the next few years are likely to come from the combined impact of large numbers of small changes. The areas where digital tools are most likely to help are:
Redesign of the whole pathway. Doing the current work more efficiently, with fewer errors and in ways that are easier and more convenient for staff would get many organizations a long way. Additional opportunities come from the redesign of complete pathways within organizations and beyond their traditional boundaries.Reduced variation, the ability to ensure the most appropriate level of care is provided and appropriate staffing mix to demand offer the potential for very substantial savings and improvements in the effectiveness of the workforce. There are also opportunities for patient involvement with some tasks being transferred to patients and benefits from improved self-care.
Population health management. The third shift is a move from pathways to populations and a change of focus from the effective management of the patient through the pathway to maintaining the health of populations over time. This requires a mind-set shift in providers and a focus on early intervention and targeting, enabling patient self management, shared decision making and measuring outcomes and value rather than counting activities. To do this systems will need to become more adept at using digital tools to:
So what might technology mean for the way we deliver services in 10–20 years time? You could interpret what we have written as describing a future in which healthcare will transform from the messy, inefficient world it is today, with much that is clinically uncertain and variable, to a glorious nirvana of streamlined efficiency, clinical certainty and consistency and patients who are so effective at managing their own health and care they barely need to trouble the doctor. The sceptics may see a much bleaker world where clinicians are tied to computers trying to interpret a sea of data while patients are overburdened with self-management tasks and anxiety about health generated by obsessional monitoring and difficult to interpret probabilistic predictions about their genetic risk factors.
As with all disruptive forces, the outcome of health IT on healthcare is inherently uncertain. Given that health warning, our best assessment of what the future may hold, is as follows.
Seeing evidence of triumph and disaster, many will ask of health IT investment ‘are the gains worth the risk?’. The answer is unmistakable: staying with the status quo is more risky and hazardous still. Technology is already transforming healthcare delivery models, and this will only accelerate over the next 10 years. So the choice is simple: embrace it, or be left behind.
— Wah Yeow Tan, KPMG in Singapore
Firstly, information and communications technology will be omnipresent but much less visible. No more carts with PCs on the ward. Medical technology will become more and more intelligent. Data will be held remotely in the cloud allowing professionals to use hand-held devices that give them access to everything they need. Some have described the smartphone as the new stethoscope, the difference being that the patient has one too.
Technology is driving a fundamentally different relationship between patient and professional. This requires new skills for both. Professionals will develop new coaching skills in order to “activate” and engage people in their care, adaptable to the wide range of patient capabilities that will persist.
Technology is also driving a very different relationship between professionals. It supports medicine as a team rather than individual pursuit. This too will require new ways of working. As the traditional barriers between primary, secondary, community, social and mental health care are broken down so will some of the traditional roles and services. For example, the current hospital outpatient model looks increasingly anachronistic in a world where consultants can offer advice to professionals and patients remotely. Multiskilled staff with a range of core therapeutic skills are likely to become an increasingly core part of the workforce.
The management of the potential sea of data presents the healthcare and its workforce with its greatest opportunity and challenge. All staff will need to develop and extend their skills with patient, performance and population health data, while new professional roles in the area of clinical and medical informatics are likely to emerge. Many have talked about how this new access to clinical decision tools will enable all staff to work to the top of their license. This may well be true, but it may also present opportunities to work beyond the scope set by current professional boundaries.
Managerial staff will also require new analytical skills in order to maximize the benefits from the newfound intelligence about their organization and how it is operating. They will also require sophisticated organization development competencies in order to take staff on the transformation journey that technology can facilitate.
More prosaic and often neglected in this sort of analysis is the ability of these systems to just make people’s lives easier by automating administrative tasks, improving communication and helping them do their work more effectively and efficiently. In addition to disrupting, transforming and getting the benefits of big data, wearables and all the other exciting new developments we should still aim for less duplication, searching for missing information and fewer of the multiple causes of waste that get in the way of patients, clinicians and other staff and try to make their working lives better than when we started.
Technology alone rarely makes recognizable change. Replacing an old system with an identical digital process only creates more work for users.
— Jin Yong Jeon, KPMG in Korea