At last week’s iHT2 Health Summit at the New York Academy of Medicine, I had the pleasure of introducing Dr. Ben Kanter, chief medical information officer at Palomar Health, California’s largest health district. During his presentation, Dr. Kanter discussed the new $1B, 11-story Palomar Health Medical Center in western Escondido which opened for patient care on August 19, 2012. Called the “Hospital of the Future” by healthcare pundits, the new Palomar facility integrates key technologies, such as EMR, video and collaboration solutions, into an environment that uses nature, light, and outdoor space which work together to promote healing.
During the design phase, Palomar’s leadership team, including Dr. Kanter, worked closely with Cisco on the goal of creating a higher level of mobility and collaboration among clinicians, patients and their families. Cisco technologies currently in use include unified communications (video, WebEx, Wireless IP Phones) along with Unified Computing System, all tied together via a wired and wireless Cisco medical-grade network.
Dr. Ben Kanter, chief medical information officer at Palomar Health:
“The ability Cisco provides to tie everyone in the hospital together – patients, nurses, pharmacists, physicians, infection control, administrative teams -- through a security optimized, mobile and video-enabled environment, will have significant, positive impact across the healthcare continuum. Now patients have greater freedoms within the hospital, without compromising their health, as they are observed both inside and outside of hospital walls. And the ability for our doctors to review patient information from a mobile device, and conference in a nurse and a specialist at the same time to discuss the case, will completely change patient care.”
We invite you to learn more about Palomar Health and to watch a four-minute highlights video about the new medical center.
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.
As INSEAD and UC Berkeley Professor Morten Hansen says, “The goal of collaboration is not collaboration itself, but great results.” Working with many of our customers, we’ve developed a framework for assessing the true ROI of collaboration, and it falls into three distinct categories:
Operational ROI allows you to assess how collaboration eliminates or avoid costs associated with running your business. You might cut travel, reduce infrastructure needs, lower bandwidth or energy costs, save on office space and so on. Collaboration tools can replace or reduce the need for many of these types of costs.
Productivity ROI refers to savings generated from more efficient processes, accelerated decision-making and reduced cycle times. Collaboration can lead to significant productivity gains in any number of ways, such as optimizing within lines of business or matching your organization’s expertise to opportunities early on.
Strategic ROI can be the hardest to measure, but perhaps the most transformative. This kind of ROI occurs when collaboration enables your business to take a giant leap forward in areas like enhancing customer satisfaction and loyalty, accelerating innovation, introducing new business models or entering new markets. These types of changes can also reshape an industry in fundamental ways.
These three types of ROI sometime manifest themselves differently across Read More »
At Cisco, we believe telemedicine can improve the quality of healthcare. To demonstrate some of the possibilities of telehealth, Senior Product Manager for Healthcare TelePresence Luke Leininger highlighted at InfoComm our next generation mobile telemedicine cart. The new device delivers high definition video technologies in a portable, user-friendly package.
Watch the video below to learn more about the cart’s simple user interface, which makes for easy connections between patients and their otherwise inaccessible healthcare providers. Read More »
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.