DIGITAL TRANSFORMATION OF HEALTHCARE

BENEFITING MEDICAL PROFESSION

SB Bhattacharyya, Member, National EHR Standardisation Committee, MoH&FW, GoI, India || Member, Health Informatics Sectional Committee, MHD 17, BIS.

With digital enablement of the various processes and care delivery-related tools, no medical practitioner may choose to remain immune from it. This article discusses the digital transformation of healthcare accrues various benefits to the medical profession and the professionals.

Digital transformation of healthcare has been happening for quite some time now. With the advent of Computerised Tomography (CT scan), and Ultrasound Scanning closely followed by Magnetic Resonance Imaging (MRI) scan and Positron Emission Tomography (PET) scan, the practise of radio-diagnostics was transformed from collecting X-ray images to visualising internal organs in three dimension and identifying lesions with pin-point accuracy. Computer-guided radio-therapy to deliver radiation therapy as accurately as possible minimising healthy tissuedamage and use of robotic surgery have all contributed in helping deliver levels of care which was no more than a pipedream even a couple of decades ago.

Digital Transformation of Healthcare

Digital transformation is the integration of digital technology into all areas of a domain, fundamentally changing how the various players operate and help deliver value to consumers. It is also a cultural change that requires organisations to continually challenge the status quo, experiment and get comfortable with failure.

With computerisation of medical records, availability of test results almost instantaneously, and big data, the medical professional of tomorrow will have to contend not only with a massive body of knowledge but also align them with an equally impressive volume of data to deliver the best of possible care on a continuous basis.

Impact of Digital

While all of these have largely benefited the patient, the focus of all healthcare activity, the effect on the medical profession at large and the professional who must handle all the technology has not been given much attention. This is unfortunate since it is the man behind the machine who is the most important factor for the success or failure of the machine. A medical professional today is a much-stressed person having to not only deal with a large body of knowledge that is ever-growing almost daily but also continuously upskill to be able to handle all the various ‘“gadgets”’ that are now demanded by the consumers of their services.

The impact has been significant, particularly since all this transformation never really considered what it all means to them. When the onslaught of expectations of the patient, carers, payers, administrators and the law are factored in, the impact is nothing short of catastrophic. This should not be so. Like everyone else, the medical professional completely justified in seeking the answer to ‘“what’s in it for me?”’ Once that question is effectively addressed, healthcare will really be what it should be.

Digital’s Benefits

It is true that digital transformation has benefited the patient, and this is rightfully so, the medical professional is unable to comprehend how exactly it has made his life any easier. All the available evidence, if anything, appears to indicate that it has made it more stressful; at least on surface.

This is not exactly the case. The benefits, although tangible, are largely hidden due to their ‘“soft”’ nature. These are largely indirect that need to be derived.

Let us Study Each of the Points above in Some Detail.

Process Automation

Through automation of manual processes using machines enabled by digital technology such as image scanners, auto-analysers, robots, and systems for such tasks as test results reporting, patient administration, billing, inventory management, communication, generation of results, tracking of patients and their payments, ensuring materials required and informing all stakeholders are accurate, on-time and performed on a mass-scale.

The utilisation of such instruments and systems has been delivering visible improvements of care delivery by reducing delays that almost always results in negative impact overall.

There is enough evidence to prove beyond any reasonable doubt that this has helped medical professionals to care for the ever-growing population with continuously increasing diseaseburden better and faster.

Alert Systems

Such system form part of the broader clinical decision support systems that are capable of instantaneously identifying conflicts in terms of clinical assessments and order items that are due to allergies, contra-indicated conditions, wrong doses, interactions, missed allergic conditions.

Iatrogenic errors are a well-known contributory factor in increasing both morbidity and mortality that can be avoided by reducing errors and omissions by incorporating these systems into one’s care delivery processes.

Better Care

Through the introduction and regular use of diagnostic analysers, imaging scanners, radio-therapy units, robotics, telemedicine, and digital systems the ability of medical professionals to provide better care is greatly enhanced.

This is consequent to factors such as reduced inpatient stay and outpatient visits, that lead to more patients with pressing problems to be cared for thus ensuring better utilisation of the time and effort of medical professionals instead of precious resources such as hospital beds or appointment slots being occupied by people who are convalescing and do not require immediate attention or constant supervision. It has definitively been found that much of morbidity and mortality is caused by hospital visits or stay due to nosocomial infections. These are reduced to the point of elimination when patients are discharged to home and followed up using remote consultation or telemedicine.

This causes people being cared for to be happier as they are able to spend more time in the comforts of their home surrounded by their near and dear ones with lesser physical exertions. Both of these are not possible in hospitals and during visits to doctors just to be told everything is good and either to continue the same treatment or stop as they have now achieved the expected outcomes.

Medical professionals benefit from the increased reputation due to satisfied patients and payers who benefit from lesser pay-outs. The provider facility also has reasons to be satisfied as more patients get served and with the most income being generated within 72 hours of admission, their higher turnover within that time-frame leads to the bed being freed up instead of remaining unoccupied by those who pay less while consuming the same amount of services. The incentives to medical professional is simply too large to ignore.

Continuous Improvement

This is basically an extension of better care mentioned above, additionally using analytics that help ensure optimal outcomes at optimal costs.

Unfortunately, this is mostly an aspirational technology that is largely confined to the “nice-to-have” space as robust data collection systems that are effectively able to demonstrate their usefulness in delivering continuously improving levels of care are mostly unavailable. Ones that do exist, are still largely in experimental stages running in very large institutions and by early adopters. Up until they are in mainstream use, their ability to benefit the medical professional will continue to remain largely unproven.

Transparency

Rigorous use of information systems, particularly those that help capture medical records, transparency in the clinical decision-making that results in case management can be established in a most effective and demonstrable manner. Using secured access control and robust audit trail, the various legal requirements related to data privacy, confidentiality and provenance of decisions can be met.

Unfortunately, and most regrettably, proper and effective medical record systems that medical professionals can meaningfully use in clinical settings, particularly critical ones, are largely conspicuous by their absence even in this day and age.

Busy medical professionals find it very difficult to re-skill themselves in non-clinical activities like recordkeeping that requires them to learn the use of keyboards or even to interact with machines throughout the day while examining patients, making critical decisions that could be the difference between survival and fatality, and generally being in high levels of stress is an ask that is way too much.

However, making the use of such systems a part of their repertoire makes patients, payers, administrators and the law, feel confident about all that goes on in the near-opaque world of clinical decision-making, to the point of gaining enough knowledge to feel confident about all that was done and the reasons thereof.

All of this leads to increased revenues, albeit indirectly, due to fewer denials and elimination of penalties levied due to instances of errors that are suspected to be those of negligence but found to be not.

Interestingly, this particular digital transformation has the potential to have maximal and almost instantaneous impact on the medical professional from the benefits pointof-view by lessening their liabilities while concomitantly increasing their reputation as an ethical practitioner thereby restoring the long-lost God-like devotion that the people under their care used to have in the past. A factor not be trifled with, nay aspired to with the greatest of determination, yet sadly given the short-shrift due to lack of suitable systems that can facilitate it.

Conclusion

Digital transformation has permeated through the entire fabric of our daily existence. Healthcare has not been immune to it, although the process itself has largely been insidious. With the advent of easy accessibility of information to every individual and the love-for-self, it is only natural that a person in sufferance will demand the best of care to help alleviate their condition. The medical professional must ensure that he is able to deliver. The process cannot be one-sided with the professional’s requirements not being met. After all, it is he who is behind the machine and makes the difference between success and failure of the machine. Had he not been suitably impressed, no digital scanner so vital for delivery of healthcare today would have ever seen the light of day. Therefore, the industry needs to ensure that all digital solutions that are available for healthcare are robust enough to suitably empower the healthcare professional and provide sufficient incentive for him to make it an integral part of his daily practice.


--Issue 42--

Author Bio

SB Bhattacharyya

SB Bhattacharyya, MBBS, MBA, FCGP is a practising family physician and health informatics professional working as business solution architect for IT in the healthcare and life-sciences domains. He is Honorary State Secretary (2015), IMA Haryana State, Member, National EMR Standards Committee, MoH&FW, Member, Health Informatics Sectional Committee, BIS and Ex-President, IAMI. His main interests include EHR, predictive analysis in medicine and application of machine learning techniques for treatment protocol planning.

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