Leveraging IT for Better Healthcare

Clearly, patient value is the ultimate goal of healthcare delivery. Any IT system that serves healthcare has to deliver within that paradigm

The challenge of applying information technology to healthcare should not be underestimated. Healthcare is undoubtedly one of the most, if not the most, complex sectors of the economy.

Since the past decade every year, we keep on hearing stories, read reports, seen studies and projections about how Information Technology (IT) will revolutionise hospitals and healthcare delivery. Each year we wait with bated breath and eager anticipation for the revolution that just doesn't seem to happen! It made me think about what prevents us from achieving what other (lesser) industries have managed without much ado. And more importantly what we need to do to overcome the obstacles.

In my belief, the top three etiological factors of 'hypo-Its' or low IT use in healthcare:

• User Resistance
• Partial Usage
• High-costs

User Resistance

This recurring phrase is used by most IT gurus and vendors to explain disappointing low usage of IT in healthcare. I am a domain consultant to a leading HCIT company as well as practicing doctor and it is a phrase I find not only puzzling but also insulting and annoying. We are talking about an industry where top-of-the-line latest cutting edge technology is utilised everyday to revolutionise surgery, dramatically enhance diagnostics and deliver therapeutics. Futuristic science fiction has already arrived in today's healthcare with remote controlled patient monitoring, robotic virtualised operation theatres and cath labs, targeted drug delivery systems and endoscopic capsules that once swallowed, navigate the GI Tract like mini-submarines. Every hospital management will woefully tell you how budget-breaking imaging equipment is already considered obsolete by the radiologists by the time they finish installing it.

So are these leaders in use of advanced and complicated equipment, the very same doctors who apparently balk at using a simple PC in their OPD? It is hard to believe that doctors are the greatest 'challenge' in IT implementation. I believe that IT/ HIS that demonstrably delivers on better patient care or on saving time and costs will be accepted immediately just as airlines and pilots adopted ILS, autopilots and web ticketing. However, if the HIS/PACS/IT only adds to the complexity of keeping patient record while yielding incrementally small gains in viewing or access, I would naturally expect 'user resistance.' A serious rethink what our IT solutions really delivers, and to who, will yield the answers we need to best serve the mainstay of healthcare-the doctor.

Partial Usage

The second obstacle cited is that of 'partial usage' or incomplete data inputs. We pride our IT solutions on being tightly integrated Enterprise Resource Planning Softwares (ERPS) that deliver best results when used seamlessly by all the stakeholders. While successfully eliminating departmental 'silos' we created new ones around the hospitals we serve. Patient information (and his life) does not go in abeyance when he leaves the hospital. More so in a country like India, where the fragmented healthcare delivery and out-of-pocket payers lead to frequent hops across providers creating continuity gaps in patient records. The biggest change required in healthcare IT is openness in the system. The ability to record and display important patient clinical data from sources other than within the hospital. This could be self recorded ECG's transmitted via the telephone lines or blood sugar levels via the internet or an X-ray taken in remote locations or medication /clinical monitoring details entered by a home nurse. Similarly, relevant patient clinical data will be required to be accessible to the same home nurse caring for the patient, the radiologist reading the X-ray at the remote site or the traffic cop who is the first responder at the accident site. Every HIS, EMR, PACS will need to interact in real-time with each other and with patient monitoring gadgets at the hospitals, consulting rooms, homes, workplace etc. The intelligence of design of this interaction will be a key factor in the success of IT in healthcare. Since healthcare delivery does not stop with hospitals and payers are not always the insurance companies, any system we build now will need to keep in mind that patient care occurs at multiple independent sites through multiple independent providers paid for by disparate payers. This enabling healthcare network can be exponentially enhanced by a responsive open IT structure.

Cost Concerns

The third obstacle to effective implementation has an easy to fix, but unfortunately means marketing suicide for the vendor brave enough to say it aloud. IT can do everything you want it to do, but this will come at a cost in terms of complexity of the ERPS, networking and server capabilities and the number of input-output devices required in user areas.

Like in other areas, there are no free lunches in healthcare IT. If you would like a completely paperless hospital you must be prepared to spend enough in all these three areas and add ongoing staff training costs. You can see in this case it would be worth your while to do a careful cost-benefit analysis prior to investing. Or else it may be better to stay with the paper trail which is difficult to beat in portability, ease of use and low costs! But we all know the numerous drawbacks of maintaining paper records. In significant US-based studies of IT in healthcare, the single most important finding is that healthcare providers that invest in and utilise IT only in the billing or clerical areas do not optimise the investment in hardware and software. However, hospitals that fully utilise HIS for both clinical and operational functioning, with complementary networks and devices, reap the benefits of improved care and costs. It does little good to pit vendors against one another and beat them down to a level where they will agree to provide what is an operationally sub-optimal system. After all you would not walk into a car showroom, tell them your budget is fixed at Rs 50,000 and buy a car without three doors and a wheel!

It is not enough to introduce IT into current practice since that will yield limited benefits. The real opportunity is to utilise information to transform process of care, while IT is crucial, it is not the panacea (Porter 2006).

Clearly 'patient value is the ultimate goal of healthcare delivery.' Any IT system that serves healthcare has to deliver within that paradigm. Therefore the top three (yes, three again!) key result areas for IT in technology are:

• Clinical—Improved clinical outcomes
• Financial—Lower costs and improved cycle times
• Administrative- Improved service measures

Every IT solution must be evaluated on its delivery in these areas with a cost/ benefit analysis conducted on the same parameters before investment.

I am sure my readers have many ideas on the other shortcomings that prevent IT from realising its potential in healthcare and I would like to hear from you all. IT techies, although well meaning, can sometimes unknowingly create a barrier between the users and the system. It would be a good idea if we, the users, could reclaim the ownership of how IT is designed for healthcare. What better place to begin than here at Express Healthcare forum and what better time than now?

The writer is Managing Director ARYA Hospital Management Solutions and Domain Consultant Wipro Health Care Information Technology seemag@vsnl.net