Health systems: Improving and sustaining quality through digital
transformation
Health systems in developed countries face a twofold challenge:
ensuring financial sustainability and improving quality. Digitization can help
health systems achieve both these objectives and unlock substantial value
through lower spending and superior healthcare delivery.
Rising
costs, uneven quality
Healthcare is claiming an ever-increasing
share of national wealth. In recent years, healthcare expenditure in
Organization for European Cooperation and Development (OECD) countries has been
rising at a rate one to two percentage points faster than GDP. If this trend
were to continue, healthcare would represent more than 25 percent of France’s
GDP—and more than 35 percent of the US’s—by 2050. Clearly, action is needed to
bring costs under control.
Moreover, medical errors and other safety
lapses persist even in the strongest health systems and are often caused by
inconsistencies in care and lack of adherence to good practices. Outcomes vary
enormously across healthcare systems and among the care providers within them.
For instance, maternal mortality is four per 100,000 births in Italy, but more
than three times higher in the US, at 14. Postoperative pulmonary embolisms and
thrombosis affect 865 of every 100,000 patients leaving a hospital in France,
but just 107 in Belgium, a difference of 706 percent. Regular albumin screening to prevent complications is
provided annually for 88 percent of diabetics in the Netherlands, but for fewer
than 30 percent of those in France.
A recent study revealed that medical
errors are the third-most-common cause of death in the US after cancer and
heart disease, accounting for more than 250,000 deaths every year. Addressing
these issues and the variations in care practices and quality that cause them
is another priority for all countries.
Addressing
the challenges through digital innovation
Digitization offers benefits in both costs
and quality. One large OECD country estimated that by implementing existing
digital technologies, it could reduce its healthcare expenditure between 7 and
11.5 percent. At the same time, it could improve quality through measures such
as monitoring chronic conditions more effectively to avoid acute events,
increasing adherence to best practices, improving clinical decisions, and
promoting healthier behaviors.
Digital innovation can transform
healthcare in three main ways:
By improving care-delivery models through
seamless data and information exchange. The
rise of chronic conditions is making it more important to integrate patient
care pathways across care settings. Digital solutions can greatly facilitate
the seamless exchange of patient and other information and data between
providers. Telehealth and mobile health solutions can improve the effectiveness
and efficiency of maintaining patients at home, thereby avoiding unnecessary
hospital stays, improving clinical outcomes, and reducing the costs of care.
Finally, the use of digital tools to enhance clinical decision making and the
monitoring of treatment protocols—as Kaiser Permanente does through the use of
its eHR (electronic medical record) system—can significantly reduce variability
and increase adherence to good clinical practice.
By harnessing the power of data through
advanced analytics and transparency. More
and more applications that rely on healthcare data analytics are available to
support patients in understanding and managing their medical condition and
influencing their medical care. New data-enriched tools and algorithms are
constantly emerging, including decision-support tools, online services, and
smartphone apps. Examples are Indigo’s Archimedes, which helps care providers
influence patients’ lifestyle and behavior choices, and www.drugs.com, a
website helping patients identify potential contraindications and
drug-interaction risks.
Providers making crucial clinical
decisions about diagnosis and treatment will increasingly be supported by tools
such as algorithms that compare a patient’s clinical and other data with large
datasets and draw on the full body of scientific literature. As the number of
diagnostic tools (such as imaging and “omics” sciences) continues to expand,
and as the sum of biomedical scientific literature doubles every five to seven
years, more initiatives supporting medical decisions and patient care, such as
IBM’s Watson, Syapse, and Flatiron Health, will emerge and mature.
Analytics also promises to support drug
and device developers in many ways, such as by helping them identify the
patients likely to respond best to a particular drug. In addition, the use of
medico-administrative databases can in some cases provide a more effective way
to address requirements for real-life drug evaluation and monitoring.
Finally, the collection and publishing of
data on outcomes and quality of care can also allow healthcare systems to
modulate tariffs and orchestrate competition among providers based on their
quality of care, and should be a major lever for raising the overall standard
of care across healthcare systems.
Through process automation. Many healthcare processes can be digitized,
including appointments, logistics, patient records, admissions, human resources
and rotation management, and billing. In addition to providing efficiency
gains, automation can also improve patient care: for instance, remote
monitoring of intensive-care units via patient sensors and a central control
room led in one case to a 22-percent reduction in mortality rates and a
23-percent reduction in the average length of hospital stays. Digitization can
also bring significant benefits in the area of clinical trials, such as
improving the efficiency and reliability of clinical data collection and trial
monitoring and optimizing trial design through the use of modeling tools.
Three
ways to accelerate digitization
Although there are clear benefits from
extending the digitization of healthcare, obstacles remain. Healthcare systems
often struggle with a range of issues including limitations and constraints on
data collection, access, and sharing; resistant mind-sets; an excessive focus
on risks to the detriment of potential benefits; and misaligned incentives.
To help overcome these obstacles and
accelerate digitization, healthcare systems should seek to:
1. Enhance
data and modernize data infrastructure, management, and access. To
capture the full benefits of data analytics, healthcare systems will require
ready access to a hugely expanded array of data. They should consider investing
both to enhance the data collected (for instance, through the development of
patient cohorts and registries and the collection of data on patient-reported
outcomes) and to develop their data-analytics capabilities, as value will
reside as much in algorithms as in the data itself.
Legacy
systems are unlikely to be able to cope with these demands, so a new, modern
data infrastructure will be needed. One possible model could be an open
cloud-based platform aggregating data from different sources, with an operator
who manages the infrastructure and data access, promotes data collection and
quality, and provides a means for patients to manage their informed consent.
The operator would have to collaborate closely with regulators, understand
healthcare delivery, appreciate the need to protect sensitive patient data, and
be trusted by patients. If a national health system or a national payor in each
country were to take on this role, a step-change in mind-set and capabilities
would be needed, as it involves acting as an ecosystem manager and attracting,
certifying, and managing a community of innovators as well as operating a
technical platform loaded with sensitive data.
2. Create
incentives to support new practices and mind-sets.Digitization
involves a shift toward a more data-driven culture with continuous and
transparent evaluation of professional practices, that in turn requires changes
in the mind-sets of healthcare professionals. To achieve such a shift,
providers need to develop and communicate a clear change story that outlines
the benefits as well as the risks of a digital transformation.
They
also need to adopt funding mechanisms that provide incentives to adopt new
behaviors, such as episode-based payments, outcomes-driven performance
payments, or even capitation-based models as adopted in Alzira, Spain, in which
a private provider takes responsibility for providing care for a given population
in return for a fixed per-capita payment. Current approaches such as
fee-for-service models reward the volume rather than the value or quality of
care provided, and seldom provide incentives for robust clinical data
collection and collaboration across care settings.
In
addition, digitization will require changes in professional training and
medical education as well as training, funding, and other forms of support for
healthcare professionals and institutions as they implement new digital tools
and methods.
3. Adjust
legal and regulatory frameworks to improve data exchange. The
sensitive nature of healthcare data requires its usage to be regulated to
protect patients’ privacy, but scope remains to enhance data exchange. Today’s
fragmented country regulations often leave health data in silos, impeding
projects that rely on diverse sources of information. For example, one EU
country may permit the use of historical clinical data while another prohibits
it, and yet another allows it under a specific license—a complex situation that
reduces the range of information on which researchers can draw for their
studies.
Establishing
a common European framework to harmonize the collection, processing, and use of
patient and healthcare data would be an important improvement. Another option
would be to move toward a more open approach that relies on a risk/benefit
assessment of individual cases and a robust tracking and monitoring of each
permitted usage of the data, as at Kaiser Permanente, which provides access internally
to clinical and claims data for specific uses, with tight monitoring to flag
and address any potential misuses.
Harnessing the full potential of digital innovations in
healthcare could have a profound impact on the quality and financial
sustainability of health systems. It would also involve profound changes for
care providers and healthcare professionals. To shift mind-sets, healthcare
authorities will require a clear and compelling vision and ambitious action.
But the benefits for both quality and economics will be well worth it.
By Thomas London and Penelope Dash
http://www.mckinsey.com/business-functions/digital-mckinsey/our-insights/health-systems-improving-and-sustaining-quality-through-digital-transformation?cid=digistrat-eml-alt-mip-mck-oth-1608
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