The Healthcare industry whether payer, provider, pharma or medical device manufacturer finds itself at a very interesting crossroad: the patient is the center of attention and each entity now has an increased focus in achieving outcomes from delivered services.
For providers care coordination of at risk patients in particular accountable care, the threat that re-admissions pose, the need to move non critical patients from ER to more cost effective walk-in facilities; operational efficiencies in specialty access, nursing operations and a flattening of in-patient revenue and the need to build referrals for acute care are driving changes to existing business models.
Pharma is long past blockbuster drugs and the merger and acquisition spree to diversify its drug portfolio and is certainly not immune to an outcome centric approach. Pricing will be determined by outcomes and pricing erosion by generics. Pharma will look at ways and means to reach out to patients to manage adherence, making clinical trials more efficient and simultaneously collaborating with other organizations for research into newer drugs.
Medical device manufacturers are seeing new buying centers in the US as a result of the payment sunshine act and in Europe the muscle of a buying consortium. A significant portion of the portfolio is subject to commoditization from players from China and Turkey amongst others. These manufacturers are taking their case to emerging markets and are looking to services to protect their franchise in mature markets.
Finally payers are reacting to the changes brought in by the Accountable Care Act. The exchanges, (look what happened to the payers before and after the exchange became operational in Massachusetts), 50 million new enrollees will enter the system, some through the exchanges others through Medicaid expansion, limits on administrative expenses, no rescission just to name a few. Payers are experimenting with accountable care models, some consolidating managed care medicaid assets, info-medic technologies or simply acquiring hospitals to become payer providers.
This is a “services” moment for the healthcare industry, service that focuses outcomes.
Healthcare providers are responding to changes in the business needs, analyzing opportunities to drive operational efficiencies as well as delivering care through accountable care models. Accountable care requires access to patients wherever they are in the care continuum- in hospital, extended nursing, skilled nursing, hospice or home. Care needs to reach the patient in any care setting. This shifts the paradigm from patients walking in the door to receive care to care coordination and care being delivered to the patient anywhere. Technologies such as video and telehealth can bring access to the patient in any care setting, allowing borderless delivery of healthcare as a service.
As provider systems vie for patients, patient experience and outcomes will be key differentiators. Smart hospitals with technology can provide the creative edge as well as enable new ways to deliver care. In room videos that provide entertainment, education, physician rounding, EMR access for visiting physicians, patient access to families, surveillance and monitoring, connecting patients to nurses can significantly enhance care, experience and with collaborative multi specialty access from specialists anywhere impact even outcomes. Whether in-patient with acute conditions, outpatients in rehab or with chronic conditions payments will be tied to quality cost and access. As care transitions from one setting to another systems needs to integrate the delivery of healthcare and manage these transitions. Provider systems may see the need to share assets such as EMR, PACs, Quality management, analytics and deliver them as a service to the extended ecosystem.
With access and new business models such as accountable care the nature of healthcare will gradually change from prescription to participation. Care coordinators will draw in physicians and specialist to oversee patient examination. Immersive video and Telehealth will allow a group of specialists to examine and determine a treatment plan.
Collaboration across the care continuum is key and immersive collaboration with high definition video is centric to this change. Video in some form or the other has been around for over 25 years, but it existed in pockets or as some would like to call it science projects it never became mainstream. For collaboration video to become mainstream it has to address business problems and become part of the business architecture, in essence integrate into the IT architecture. Standalone video collaboration systems create islands of automation but do not integrate into hospital business assets the scheduling, EMR, ePACS, billing and quality management systems. Further they lack scalability.
As Healthcare operations integrate care pathways with collaboration and participation, home health, care coordination they need to work with various technologies video, wireless, the need to accommodate smart phone, smartPADs – location, context, security, content creation and distribution, delivery of smart Apps, contact centers and patient relationship management. Healthcare services have to be delivered using the network as a platform. This needs the business architecture to be integrated to the IT architecture and the IT architecture to the Network architecture. The network architecture can be built on a solid medical grade network that is smart, intelligent, extensible, sustainable, flexible, modular, scalable, interoperable, economical and future proof. This is complex and needs a strong architectural foundation with services and applications that use these services.
At the end of the day is there an ROI?
Over the past year we have worked on various models to define a potential ROI for the new healthcare needs. We took a business centric approach looking at the business problem and then identifying value drivers that either brings operational efficiencies or drive new revenue. We focused healthcare segment provider, pharma as well as medical device manufacturers. We built several models some for our customers and validated them:
Accountable care - to what extent can collaboration, video and Telehealth solutions increase cost savings and improve quality metrics to increase the shared savings
Corporate Campus Clinics – how can Telehealth extend the reach to satellite branches, increase uptake through specialties at the main campus and the spoke branches driving benefit both to the Company in increased savings as well as increased penetration and revenue to the medical service provider
What is the business justification for Telehealth and video to assist in reducing readmissions
What is the ROI in moving patients from ER to Urgent care and how could that change be managed
The business justification for using collaboration technologies to increase referrals as well as build specialty networks for operational efficiencies
Is there an ROI in Training and education?
Some of these models looked at problems that were not driven by reimbursement but had enough value drivers to deliver hard savings and justify the investment. Our models show there is a positive ROI in each of these settings.
As any model goes any change is multidimensional. Any new delivery model should become part of business strategy. A structure should be created to implement this new strategy; appropriate architecture approach and platform solutions should drive the strategy, processes need to change to implement the strategy, finally people should be trained with appropriate change management to make this work.
Is there an ROI, yes but the health of that ROI will depend on how well the organization manages this multidimensional change.
Like most families, we are looking forward to the long Labor Day weekend. It will be filled with family, ribs, beer, some yard work, and yes, some Cisco work. And this year we will have a new guest. The latest member of the Barney family, Hayden, arrived just in time to celebrate Labor Day weekend. Although I am sure her mother is not looking back fondly on her recent labors, the rest of the family is. And we are all grateful for the healthy little girl.
But I will have to tear myself away from Hayden, ribs, beer, and yard work for, yes, Cisco work. But that won’t be as painful as it sounds. Thanks to the advanced technologies at Cisco I can work from home. The way I ‘labor’ has definitely changed. I can collaborate over videoconference on my Cisco Telepresence EX-90 with a few of my colleagues to finish up a project while never leaving my house. I live in Ohio, and while my team is located in San Jose, for a few hours on Saturday it will be as if they are all at my house – except they have to get their own beer.
Cisco has changed the way we labor in many important ways, but no more so than when it comes to clinical care. Cisco has created a platform with unified communications and video-based collaboration that is transforming the patient experience and clinical processes by bringing together physicians, specialists, therapists, patients and families together. This collaboration can take place quickly without anyone getting into a car, train, plane or boat. And it becomes stunning when you think about how this can impact the care of a child.
Imagine your child needs cardiac surgery. And he needs a specialist. But that specialist is several hours away from your home. At the Great Ormond Street Hospital in London, Co-Medical Director Professor Martin Elliott, a pediatric cardio-thoracic surgeon uses information and collaboration technologies to improve the quality of care and the experience for the child and its family in a very meaningful way. Listen to Professor Elliott discuss the experience for the medical team, the child, and the family as they prepare the child for surgery.
Collaboration technologies can improve not just the pre-surgical experience, but the follow-up care as well.
For the past 14 years, Dr. Patrick Byrne from Greater Baltimore Medical Center Johns Hopkins University has been making annual trips to countries in the developing world, volunteering his services to correct cleft and lip palate deformities in children. However, in many countries, including Nicaragua, the required post-surgical speech therapy care is simply not available. Using WebEx technology, Dr. Byrne and team can now provide that specialized treatment remotely for the first time ever. Within just three months of speech therapy conducted via WebEx, the doctors saw significant improvement in patients’ speech. The online meeting technology also proved the perfect tool to train local providers on best practices for follow-up procedures. Listen in…
From peeking at Brittany Spears medical records to the theft of almost five million medical records from a tape back-up, no healthcare issue garners more adverse publicity, or passion, than violations of patient privacy. While you might expect that since the institution of HIPAA and quarter million dollar fines that this is relatively uncommon now, you would be wrong. A stunning incidence of nearly 18 million breaches of privacy has occurred over the past two years according to a recent report from ANSI, the American National Standards Institute. That is equivalent to the population of the states of Florida or New York.
As the world moves towards adoption of Electronic Health Records and Health Information Exchanges, concern for the vulnerability of private health information is escalating as the scale of these data breaches reach epic proportions. A West Coast health care system experienced the theft of electronic health information for 4 million of its patients. And another major academic medical center inadvertently disclosed the electronic health records of 20,000 of its patients. The risks are real and global. And they leave an organization -- any organization -- subject to severe legal and financial damage, not to mention the damage to their reputation. None of these organizations were cavalier about their security compliance. But let’s face it, the workforce is larger and more mobile. The data is more prolific and ubiquitous and takes on many different forms. And the thieves are getting more sophisticated.
But so are the solutions. In the past, it was necessary to balance mobility with security-the more mobile, the less secure. Not anymore. Cisco’s AnyConnect combines industry-leading Cisco cloud and premises-based web security and next generation remote access technology to deliver the most robust and secure enterprise mobility solution on the market today.
In my previous blog, I talked about how virtualization is picking up momentum in the healthcare industry and how this is resulting in simplified clinical workflows and providing nurses and physicians with fast access to the applications and information they need to support positive patient outcomes. In this blog, I would like to touch on one of the key areas where virtualization has made a significant impact – desktop virtualization.
Hospitals frequently use shared dictation terminals to host their clinical dictation applications. As doctors complete multiple patient rounds, they make their way to one of these dedicated workstations, plug their personal microphone into the workstation, and dictate their notes from their previous rounds. The delay between completing rounds and dictating patient data is inefficient, but more importantly, it creates the potential for errors. Access through shared and dedicated workstations also tethers the clinician to specific terminals that can only be used when the doctor is in the clinic. For example, there is no easy way to access clinical reference imaging applications when the doctor is away from the clinic and wants to quickly review images for a specific patient. Instead, the doctor must either call a peer at the hospital to review the images, or incur travel time to go to the hospital.
Finally, although the shared workstations distributed across the clinics and hospitals are centrally managed, the software operating on each workstation can quickly drift away from its original configuration as users install specific applications not hosted by the data center or use the workstation in other ways that compromise the original “golden image.” As a result, every workstation and application that a caregiver uses can behave differently. A hospital’s IT group can potentially spend most of its time chasing repetitive workstation issues and errors, as well as managing different instances of almost applications. IT administrators constantly face the challenge of unwanted installations, as well as the incompatibility between images from one shared workstation to the next. Upgrading desktops and applications can be a difficult task, requiring many hours of effort on each workstation.
Virtualization continues to be a hot topic in the healthcare industry with many industry pundits calling this technology a potential game-changer. There seems to be a lot of excitement around how this technology can help the healthcare industry in terms of cost optimization and efficiencies. Some of the key virtualization drivers include the move towards electronic medical records (EMR) deployment, support for increasing number of mobile devices, and providing secure access to patient-sensitive data to authorized individuals (HIPAA compliance).
I do believe that healthcare organizations have much to gain by embracing virtualization in their networks, data centers, and end-user workspaces, but they must have complete confidence that benefits can be achieved without compromising core requirements for clinicians, administrators, and IT. In order to build this confidence, one must clearly articulate the “incremental” return on investment for adopting virtualization technology. I have seen and heard several bold claims as to how virtualization is going to transform the healthcare industry but yet those very claims are light on how it’s truly going to help healthcare organizations be “incrementally” better. I keep emphasizing “incremental” because that is the true value-add customers are looking for in order to justify their investments. In today’s macro environment, everyone is being tasked to do more with less.
In most healthcare environments, clinical and administrative applications are client-server based. Often a nurse or a doctor who has to enter data into an application ―for instance, an EMR application― does so from a shared workstation. This task starts with the user identifying himself/herself through a secure login process that can take anywhere from 1 to 2 minutes. After entering the data, the user often immediately logs out, leaving the station available for the next user. In an average healthcare setting, clinicians will repetitively access such workstations for data entry, sometimes as often as 50 to 70 times per shift. The cumulative productivity loss can add up to about an hour (60 times, with a 1-minute login procedure each time). The nurse or the doctor could use this time more productively by meeting with patients or other clinicians and increasing the number of patients they can see. This is just one example where virtualization could provide the “incremental” value-add by significantly cutting the productivity loss, which has a direct positive impact on patient experience.
Healthcare industry is at an interesting cross-road due to the confluence of virtualization and cloud computing. Several healthcare organizations are viewing virtualization as a stepping stone in their cloud journey. Increasing number of healthcare applications are being used in a virtualized environment – either at server level or desktop/mobile level. This is resulting in simplified clinical workflows and providing nurses and physicians with fast access to the applications and information they need, wherever they are, to support positive patient outcomes. Over the subsequent blogs, I will articulate how Cisco virtualization platform is providing the “incremental” value-add that gives the healthcare organizations the complete confidence they need to embrace this capability. Until then, stay tuned.