Digital health and healthcare organisation strategy: four views, one vision.

Article posted on: August 15th, 2016 in the HIMSS Europe blog. Revised August 30th, 2016. Reposted with permission of HIMSS Europe.

The role of healthcare CIOs has been changing in recent years.

Initially they were a sole system’s Kerberos that was refractory to any kind of innovation, with a mindset limited to solve administrative, financial tasks.

Now, they have a more global mindset, watching over the whole organisation, and have taken on the role of the CEO’s right hand man. They are switching the focus of IT systems and services from being cost centers to being profit centers. They are conscious that their work impacts the way care is delivered and how patients / customers perceive quality of service.

But the challenges are increasing: the next step is ensuring that IT-related activities fit healthcare organisation strategy. It is key that these activities are fully aligned with the strategy defined by top management.

How can this be done?

Aligning IT with the organisation’s strategy

Let me introduce the concept of the balanced scorecard. The balanced scorecard is a way to align the entire organisation to the strategy and also to measure their performance. First described by Robert S. Kaplan and David P. Norton in the article, “The balanced scorecard – Measures that drive performance”, in the Harvard Business Review January-February 1992 issue. It was seen as revolutionary back then, because they were the first to say “what you measure is what you get”.

The balanced scorecard is defined as a set of measurements that give top management a fast, but comprehensive view of the business. And Kaplan and Norton point out that the operational measures drive financial performance.

Let me adapt it for a classical healthcare CIO role.

Courtesy of Costaisa Group ®

For them, a balanced scorecard offers a view on performance from four different perspectives: Production & Innovation, People, Customers & Patients and Financial. The healthcare CIO needs to focus on getting the best performance in each one of these areas.

Let me step into the shoes of a healthcare CIO for a moment.

Production & Innovation 

In this area we could identify for example EPRs, telemedicine and fully integrated tele-monitoring systems. We should work to avoid isolated information silos and we should be focused not only on recording data correctly but also on how to extract knowledge from this data, too. 

Initiatives such as programs to improve delivery of service to e-patients, practice communities to empower GPs, and data mining systems that could deep dive into our data repositories (big data), or perhaps programs to explore local patient behaviour in social networks that can be filtered for our community. 

This could also include, all the activities related to innovation and the different approaches to it, and could even consider searching “put-to-market” scenarios. 

People 

Our healthcare professionals. Our most valuable asset. We should empower them by promoting a culture of collaboration, across departments, with the aim to share knowledge. We should unlock the incredible power of corporate social networks. 

We could improve the visibility of our healthcare professionals helping them to build strong digital identities, through professional networks like LinkedIn, social networks like Facebook and Twitter, even supporting them in the creation of a strong professional blog ecosystem. 

It’s the best way to involve our healthcare professionals; without them, its impossible to avoid failure. 

Customers & patients 

We should improve the communication channels between patients and the healthcare organisation. And that means all channels. Social networks is a crucial part of this. 

A strategy of starting conversations via social networks is a necessary first step. Every citizen should be able to ask us using the communication channel they prefer and need to be answered in a very short time. The use of apps, mobile devices, and even the possibility to ask our professional’s anonymous questions should be considered. 

Financial 

Who pays the party? Because It’s necessary to know how to finance it. Donations? Corporate responsibility? Government funds? Advertising? 

The only limit is our imagination. 

Footnote 

CIOs should be prepared to play a determinant role in their healthcare organizations. They have got a well-trained mind. They are able to deploy paperless scenarios (and not only at a clinical level, trust me). They have got entire healthcare processes in their heads. The consequence should be better delivering of care, along with a better and more collaborative way to deliver it. 

Having a CIO’s unique view of the whole healthcare organization is the key for success. 

This is one of topics to be discussed at the new HIMSS Europe World of Health IT (WoHIT) Conference & Exhibition which will be taking place on 21–22 November 2016 in Barcelona, Spain (www.worldofhealthit.org).

EPR linked to patient safety: a proposal.

Article originally posted July 28th, 2016, in HIMSS Europe's blog, and revised August 28th, 2016. Reposted with permission of HIMSS Europe.

“All men make mistakes, but a good man yields when he knows course is wrong, and repairs the evil. The only crime is pride.”— Sophocles, Antigone

Avoiding patient harm is the next challenge for the healthcare industry. Everywhere. When we stop and think about it, the words which spring to mind include “surgical checklists”, “safety procedures”, “hand washing” and so on.

But what about EPR? What can we do about patient safety from an EPR / EHR / EMR point of view?

The problem

Let's consider the following scenario: patient harm due to medical errors.

Most of these errors are avoidable. In 2013, the “Journal of Patient Safety” stated that there are between 210.000 to more than 400.000 premature deaths per year in the U.S. which are associated with preventable harm to patients.

In Spain we’ve got statistics from “Asociación de Defensa del Paciente”, which calculate the number of litigations due to medical errors. In 2015, there were 14.430 medical errors cased (the majority of them related to waiting list issues), of which 806 resulted death.

It’s a shame.

Its worth noting that these numbers are of course influenced by the number of lawyers who are encouraging patients to sue when any complaint relating to sub standard care is made. That means increasing costs of medical practice costs for all healthcare professionals due to the growing costs of civil responsibility insurances. This can clearly be seen in the US but also we are beginning to see it in Spain, too.

How to fix it

What can be done to solve this problem?

Surely there are a lot of things we could do.

We could, for example, improve the decision-making processes. In particular, we could examine how a doctor evaluates vital signs, symptoms, laboratory test results and diagnostic images to determine a given diagnostic.

These kind of processes are supported by clinical guidelines, approved by the CMO, or provided by healthcare regional and national administrations. These guidelines include a decision-driven flowchart (or something similar) which specifies each step the doctor should follow. It’s the safest way to conduct diagnostic treatment processes, because they are evidence based, peer-reviewed procedures. Following a clinical guideline is safe for the patient, but also for the healthcare professional. And it’s cheaper for all the stakeholders, too.

And what about EPR? Well, the implementation of clinical guidelines in a commercial EPR tends to be a limited document attachment with no business rules embedded into it, except perhaps for the possibility to provide an alert when a given condition has been identified (for example, a threshold value for a vital sign or a specific diagnostic).

The proposed solution

What needs to be done? The decision flowchart needs to be imbedded as a set of business rules into the EPR. What this means is that the EPR would follow a diagnostic decision-making process driven by clinical guidelines, assessing the healthcare professional in each step, proposing suitable diagnosis and treatment options at every step, avoiding mistakes and protecting patients with the safest, most convenient procedures.

This means that the EPR would be transformed from an input tool with limited intelligence to a veritable medical record and assessment tool. A system designed to improve patient safety. The EPR in this context should be a system that is preventing harm. That is our goal.

Consider, for example, a female patient, with suspected breast cancer. All the symptoms and tests reveal that it’s breast cancer. But the healthcare professional didn’t have access to the biopsy results. And without them, they can’t make a final diagnosis of breast cancer. A typical commercial EPR, would allow this perosn to record a final diagnosis of breast cancer. 

In our proposed smart EPR it would alert us to the fact that biopsy results are missing, and offer the option to order them if we hadn’t already done so, showing a CPOE window with the relevant options pre-selected.

This is only one example of how we could improve patient safety using an EPR.

Footnote

There is a lot of work to do.

One of the most famous quotes from Star Trek is: "To boldly go where no man has gone before..."

It’s time to come together, explore the EPR technology boundaries, with a view to ultimately improving patient safety.

This is one of topics to be discussed at the new HIMSS Europe World of Health IT (WoHIT) Conference & Exhibition which will be taking place on 21–22 November 2016 in Barcelona, Spain (www.worldofhealthit.org).