Digital transformation in healthcare has finally arrived. What have we learned and where should we go next?

staff - Thursday, May 16th, 2019

"About 85 percent of hospital executives say digital innovation is part of their long-term strategy," stated Niren Gandra, MD, citing data from a recent American Hospital Association survey.

Exploring challenges and opportunities related to digital innovation was the focus of a roundtable discussion hosted by Cedar at Becker's Hospital Review's 10th Annual Meeting in Chicago.

Dr. Gandra is Head of Partnerships at Cedar, a patient payment and engagement platform designed to improve providers' financial metrics while enhancing the patient experience. He posed several questions about digital transformation to roundtable participants and Joel Allison, former CEO of Dallas-based Baylor Scott & White Health and a member of Cedar's advisory board. During Mr. Allison’s 17-year tenure he led Baylor Health Care through its merger with Temple Scott & White in 2013 to become the largest nonprofit health system in Texas.

The sprint to digitize

Industries such as telecom, airlines and financial services have far outpaced healthcare in adopting digital technologies. "Healthcare lags way behind," said Dr. Gandra.

Mr. Allison shared a few likely reasons for healthcare's slow adoption, including cost, complexity, regulation and security concerns. However, he sees attitudes changing and the pace of adoption picking up. 

"Everything's going to go digital," said Mr. Allison. He sees digital innovation and technology creating higher quality for the patient and improving how care is delivered. In Mr. Allison's view, healthcare executives no longer need to be convinced of the need for digital transformation. They are now asking questions like, "How do we get there and how fast can we go?"

Clinical vs. financial technologies

Dr. Gandra observed that hospitals and health systems tend to make investments for clinical advancements, but it is less common for non-clinical technologies to receive the same priority. Clinicians often instigate change and serve as champions for new technologies, noted Mr. Allison, but nonclinical technologies often lack the same champions or organizational support.

The most significant operational IT innovation in healthcare has been the EHR. While a substantial investment, the EHR created a digital platform that is changing how care is delivered. Mr. Allison's health system saw the EHR and other digital technologies as "a way to improve care, change the models of delivery and create convenience and satisfaction."

As the CEO of a faith-based organization with thin margins, Mr. Allison was also interested in using nonclinical technology to enhance revenue cycle management and address frequent complaints from patients and employers who had trouble understanding their hospital bills.   

Cedar, founded to transform the patient financial experience, takes technology that works in other industries and applies it to parts of the revenue cycle that are often neglected, such as how patients pay their bills. Dr. Gandra said, "Our clients have seen increases in collections, better operations and very high patient satisfaction."

Build or buy

When asked if health systems prefer to build their technology internally or buy it from vendors, Mr. Allison said, "[At Baylor,] we found it was a combination of both." They brought in an IT visionary to paint a picture of the future, which focused on mobility. This inspired the health system's leaders to build a strong IT function, including implementing new positions such as chief digital officer, chief technology officer and chief medical information officer. The organization adopted a philosophy that if a technology could be developed internally and leveraged across the organization, then that was the path to take. Otherwise, the system would partner with a vendor.

For their vendor search, Mr. Allison's organization hosted its own version of the business-related reality TV series "Shark Tank." The concept worked well in bringing together internal IT leaders and external vendors to identify opportunities for digital transformation. Approximately 100 vendors presented ways in which their technology could improve patient care, improve quality and lower costs. After initial presentations, the Baylor team chose to partner with about four vendors.

Challenges and opportunities when going digital

While digital technologies are a necessity in healthcare, two major challenges must be addressed.

·         Usability issues. Although EHRs have existed for two decades, "The EHR is still not that [user] friendly," said one roundtable participant. Dr. Gandra agreed. When switching from paper to electronic records, the electronic version was more difficult to navigate and made delivering care less efficient. Mr. Allison attributed difficult-to-use EHRs as a reason for physician frustration and burnout. He also believes excessive focus on technology can dehumanize the physician-patient interaction.

·         Lack of interoperability. The fact that EHR vendors build technologies that don't easily "talk to each other" makes it difficult to move information. This is a major point of frustration for physicians, patients and health systems, many of which have grown through mergers and acquisitions and operate on multiple EHR platforms. Mr. Allison cited an adage, "If all trains in the country can run on the same gauge rail line, why can't IT run the same so it's easy to move information?"

Roundtable participants called on the major EHR vendors to improve their usability and make their systems interoperable. If the vendors fail to act, which has been the case to date, the government may need to intervene.

Despite these challenges, the opportunities for digital technologies are immense. Here are a couple examples:

·         Integrated Delivery Network (IDN) integration. "I think consolidation [of health services and health plans] is going to continue," predicted Mr. Allison. As this occurs, he views technology playing a key role – particularly at large IDNs – in bringing all components of a delivery network together.

·         Telemedicine. Mr. Allison sees two primary telemedicine applications. First is for management of patients with chronic diseases, who are the most expensive to treat. Telemedicine can lower costs by keeping these patients out of the hospital. The second application is to engage millennials around wellness and prevention.

The continued application of technology to integrate care delivery across disparate cites and reach patients outside the walls of a hospital will help to reduce costs and generate a better care experience for patients. By incorporating lessons in consumer engagement from other industries and placing an emphasis on collaboration, hospitals and health systems can use technology to tailor the care experience to better meet patients' needs and expectations. 

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