The Impact of Technology on Care Delivery Processes to Improve Efficiency and Outcomes

In early 2019 the International Hospital Federation formed the first ever Young Executive Leaders group which had the purpose of engaging young healthcare leaders from around the world in identifying future needs in the provision of healthcare. This article summarizes one of the sub-groups’ report on The Care Delivery Process, in which they discuss how innovation and technology can affect the process by which care is provided, including telemedicine, the importance of measurement and organizational adaptability at all stages of technological maturity. Click here to read the full report. 

Authors: Dr. Mina Cheng (Hong Kong), Ms. Olivia Deschamps (France), Dr. Yi-Hsun Huang (Taiwan), Ms. Silvia Moreira Da Silva (Portugal), Mr. Scott Mortensen (USA), & Mr. David Ross (Canada)

INTRODUCTION

The majority of our group’s work on the topic of telemedicine occurred prior to the COVID-19 pandemic. Our world has changed significantly and COVID-19 has encouraged the rapid and focused implementation of virtual care strategies in many countries. Our reflections on the state of telemedicine around the world including the related legislative environments are based on pre-COVID-19 policies; however, the perspectives, strategies and case studies presented remain relevant in post-COVID-19 world. We are hopeful that to the extent progress has been made to further encourage the adoption and appropriate funding of telemedicine around the world, that these advancements are maintained going forward.

Our discussions and research converged on three themes of how innovative technology in healthcare can change and improve processes and structures, generate efficiencies and ultimately improve patient outcomes, including:

  • Telemedicine: The use of telemedicine to drive creative care delivery processes and where to start.
  • Measurement: The importance of measurement in technology implementations, understanding cost and funding methodologies.
  • Adaptability: Adapting and innovating today by leveraging your electronic health record and other technologies, regardless of their maturity level, to improve process.

Our report encompasses the reflections of our group members, cases studies (annexes) from our organizations and countries and citations from related articles and studies.

1 – TELEMEDICINE

Hypothesis

Telemedicine presents an incredible opportunity for healthcare, contributing to improved access to care, improved patient outcomes, improved hospital efficiency and lower costs across a patient’s cycle of care for both provider organizations and patients. This opportunity has been underscored by the COVID-19 pandemic.

Reflections

As our group began discussing telemedicine it quickly became apparent that the level of telemedicine maturity varied considerably across our group. In some countries, employers, health care insurance providers and health care organizations began to collaborate and experiment with telemedicine several years ago. Employers saw an opportunity to generate efficiencies while improving outcomes. Although many reimbursement/coverage environments did not incentivize telemedicine, there was still a drive to invest in and expand telemedicine. The opportunities for efficiency, including lower episodic costs and lower cycle of care costs were significant; revenue growth was not the only driver. These countries are now much further along in their telemedicine journey.

Countries with health systems more heavily supported by public funds are just beginning to explore and invest in telemedicine (e.g. Canada, France, Portugal, Taiwan, Hong Kong) as these systems, already facing resource constraints, provide less opportunity for risk-taking (investment) to achieve gains. Many of us have seen or experienced barriers to implementing telemedicine strategies because of funding methodologies that incentivize in-person care and do not effectively support or recognize virtual care strategies.

We quickly realized that telemedicine would be an area rich for discussion and learning across our group.

Regarding Utilization of Telemedicine

Are the funding models supporting your organization creating barriers to leveraging technology to support the most effective patient care pathways? Our discussions and research suggest that the implementation of telemedicine strategies, in some countries, is being hampered by the funding models in place.

Advocacy with your funder(s), collaboration between your health system partners, and taking risk to demonstrate the benefits of telemedicine to funders and health care organizations can help to eliminate the incentive barriers amongst organizations.

The ability to invest in technology to support a telemedicine strategy could be severely hampered by a funding environment that does not equitably recognize telemedicine. In the next section, we discuss some of our reflections on strategies to implement a successful telemedicine strategy, and how best to leverage technology when you face implementation barriers.

Regarding Implementing Telemedicine Strategies

Technology is moving at a fast pace. Patients are beginning to expect the integration of technology in many other areas of their lives. Our health care models and funders need to move to align with this expectation. As young leaders, the onus is on all of us to continue pushing for this change for our patients, ensuring we are delivering the right care, in the right way, at the right time.

The potential benefits of telemedicine are significant for health systems, funders, individual providers and patients.

  • Implementing telemedicine pilots to build a case for support is critical in areas with unsupportive funding environments.
  • Keeping it simple early on can help avoid the upfront investment being the barrier to implementing a successful telemedicine strategy
  • Identifying the clinical roles you can insert around a patient and physicians can help improve patient navigation and overall efficiency in the system.

Our industry will be pushed in this direction by the expectations of patients. The strategies above can help ensure your strategy is successful despite the many barriers telemedicine currently faces globally. In countries where the COVID-19 pandemic has led to the rapid adoption of telemedicine strategies, we are hopeful this momentum will be maintained.

2 – MEASUREMENT

Hypothesis

As a group, we all agreed that measurement in health care is important. This assertion is intuitively obvious; however, we all shared experiences where a project wasn’t as effective as it could have been. Measurement, whether it was project milestones, key performance indicators or baseline and future state assessments, should have been prioritized.  Measurement in healthcare can be improved.

Reflections

We discussed measurement in three contexts:

  • Measurement of baseline and future states prior to a technology implementation, such as an EHR.
  • The measurement of clinical processes to truly understand cost, utilizing techniques such as time-based activity-based costing to evaluate costs in detail, while also considering the need to evaluate cost across a patient’s cycle of care and not isolated to one clinical service or organization.
  • Achieving sufficient measurement of clinical, financial and other data to inform effective funding methodologies that can incentivize optimal technology and care pathway decisions across the cycle of care.

Measurement of a Technology Implementation

Measurement can and should be improved in healthcare. It does not always need to be an arduous exercise; it simply needs to be prioritized.

In the busy and complex environment that is healthcare, we can all, at times, become distracted from measurement and simply push forward towards what we perceive to be a desired future state, leaving us unable to measure our results even when we feel that we have achieved what we set out to do.

This is a simple message. It is intuitively obvious. But the fact that we all continue to experience initiatives that lack appropriate measurement in healthcare means that it is a message worth sharing.

Measurement to understand cost

Many of us have had experience engaging in strategies to improve the accuracy of clinical expenses reported within a case costing initiative. The more accurate the analysis and the lower the reliance on allocations, the easier it becomes to engage clinical teams in a conversation about performance improvement, both clinically and financially. Technology plays an integral role in improving the accuracy and timeliness of information for decision-making.

Dedicated resources are needed to achieve these outcomes and investing in interface capabilities to bring systems and their unique data sets together (like supply chain and the electronic health record) can significantly enhance clinical decision-making, sometimes in real-time. The hospitals our group represents span HIMSS levels from 1 through 7 and yet all of our hospitals were pursuing some form of advancement in this area. Every hospital can and should be looking to make investments to enhance their measurement capabilities, regardless of where they are in their EHR journey.

Measurement to Support Effective Funding Methods

If you’re looking to break down silos between organizations and drive efficiencies across that full cycle of care, in our experience, gaining access to the largest set of clinical, financial and other data will unleash your ability to implement novel funding models.

Following the money will often lead you to the richest sources of this information.

3 – ADAPTABILITY – ANYONE CAN INNOVATE

Throughout this report we have highlighted several case studies or organizations that are innovating with technology in healthcare. What is so interesting (but also maybe obvious) is that the examples we have shared in this report are occurring in hospitals or health systems at vastly different levels of technological advancement. Some hospitals have a fully interconnected EMR, in some cases with full interoperability across several hospitals. Others are just beginning their journey towards an electronic medical record and the data collection, measurement and decision support opportunities that come with it in support of patient care.

In an industry as complex as healthcare, working in organizations as complex as a hospital, it can be easy to feel helpless to move things forward when the perceived barrier is a gap in technology like a fully interconnected EHR. Our reflections as a group have provided us with many examples reinforcing that you can and should leverage technology in small and big ways, no matter what perceived challenges you may face and no matter how early your organization is in its EHR journey.

It is also important as an organization undertakes a technology project that it is viewed first as a clinical transformation opportunity to improve patient outcomes and generate efficiencies across the patient’s full cycle of care. The underlying benefits to the patient and clinical operations (like reduced errors, alerts leading to improved and timeline treatment, reduced patient length of stay etc.) will be the key drivers of financial benefit for all stakeholders.

Beginning a technology project with a main goal of cost reduction can distort the thinking and decision-making of a project team. A primary goal of cost reduction can actually reduce the financial benefits that can be realized across the patient’s full cycle of care, particularly if the cost reduction goal is contained to one program or one organization within a more care pathway involving multiple care providers and organizations.

Ensuring that it is clinical leaders that are acting as the executive sponsors of these foundational projects (versus your finance, IT or health information management leadership teams) can help ensure this mindset is maintained. If your funding models allow you to capture, share or realize benefits across a patient’s full cycle of care, the ability to maintain this mindset, putting the patient first, is further enhanced.

What can you do today to further your organization leveraging technology? You don’t need to wait for a fully interconnected EMR. Leverage what you have today. Big or small, you have the power to improve process, positively impact both patient care and efficiency, while moving your organization further along its technology journey.

Artificial Intelligence (AI) and Virtual Reality (VR) will play a significant role in the delivery of health care in the future. At the outset of our journey as part of the Young Executive Leaders Initiative, we intended to discuss AI and VR in more detail, but ultimately, we elected not to. All of our experiences with AI and VR were too new or completely lacking.

A key conclusion for our group is that the education and exposure to AI and VR technologies will be critical for young leaders as we assume more senior health care leadership roles. We will be afforded with the opportunity to guide future implementations of AI and VR technologies in our organizations. To do so, we will need the tools, experience and training to make the right AI and VR decisions to harness the power and benefits of these technologies for our organizations and our patients.

Younger generations are less likely to be satisfied with the status quo (both as a patient and those working in health care) and the pace of change expected by our younger generations is accelerating every day. Those expectations are already beginning to be felt in health care. As young health care leaders, we share this expectation. We should be able to influence positive change in our organizations. We should be looking for the opportunities to innovate with the technology we currently have at our disposal, but we should also be looking for what we don’t have today, but need to improve patient care.

Despite the many challenges we face in health care, our work together has reinforced to us that the future is bright. The passion that everyone working in health care carries with them every day will continue to move us forward and our ability to leverage technology will only accelerate our progress towards improving the lives of the patients that we serve.

To read the full report and all case studies, please here.

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