As a midwife in the Netherlands for more than twenty years, I have personally experienced how technology in obstetrics has transformed how we deliver care to expectant mothers. With more than 2,000 midwives in the Netherlands, many healthy women – those not typically at risk of complications – choose to receive care directly from a midwife in their own communities. By having access to technologies that have traditionally been found only in the hospital, we are able to provide the best care possible and can monitor for any signs of risk to refer patients to an obstetrician if needed.
I was very pleased to see that U.S. Senator Lamar Alexander is recommending the delay for Stage 3 of Meaningful Use, since it would drive the entire system to its knees. We all agree that the industry needed to change. This has been a bi-partisan initiative that started with President Bush and his appointment of David Brailer as the National Health Information Technology Coordinator back in 2004. For the past decade, this effort has been continued by the Meaningful Use program under the ONC.
I am not criticizing the initial goals of Meaningful Use (Stage 1 – Data Aggregation & Data Access; Stage 2 – Healthcare Information Exchange and Care Coordination; and Stage 3 – Outcomes Improvement). Rather, my extreme disappointment is directed to the fact that we did not pay attention to the first pillar – Data Aggregation and Data Access – to achieve outcomes improvement, which cannot be accomplished without clear and aggressive guidelines on interoperability requirements. Instead, the effort was directed to the implementation of EHRs for data entry, which created silos around few vendors. Of course, the consolidation and collaboration of healthcare providers that resulted from the Affordable Care Act (ACA) exposed the failures of Stages 1 and 2 around interoperability.
The Goldman Sachs report I mentioned in the first part of this series mentions that remote patient monitoring (RPM) enables healthcare providers to better manage high risk patients, potentially decreasing healthcare spending through better chronic disease management. Further, the report notes that most chronic disease spending can be attributed to heart disease, asthma, and diabetes-disease states that represent the most fertile ground for digital health.
Last week, I talked about how the digital healthcare revolution has arrived and its potential applications, including telehealth. Another way this digital transformation is changing healthcare is how it affects behavioral modification and adaptation.
Digital healthcare holds the promise of saving a staggering $305 billion, according to a recently published report from Goldman Sachs. The report predicts the technology revolution will come from increasing access to diagnostic, treatment, and preventative care, coupled with dramatic cost reductions. In particular, they see significant opportunities for digitally-enabled telehealth, behavioral modification and remote patient monitoring, while much of the savings will be generated by the elimination of redundant and wasteful spending in the area of chronic disease management.
While health systems are facing the need to provide better outcomes at a lower cost, there is only so much that can be achieved through consolidation, incentives, and standardization. Most recognize that in order to continue moving the needle on cost, hospitals and health systems will require fundamental redesign in the way care is provided. Business, clinical, and technology thought leadership has an opportunity to create a virtuous cycle where innovation can both inform the direction for and respond to the requirements of care pathway transformation. Mobility, interoperability, and analytics are all required to deliver intelligent data at the moment of care to the care team and consumers.
At this year’s annual HIMSS conference, a common topic of discussion was around how to continue to bring the technological and medical aspects of healthcare together to evolve, grow and support one another.
Each semester, I share with my Health IT students the many reasons that it is such an exciting time to be in healthcare. As we transition from a volume-based to a value-based incentive model, healthcare is going to look significantly different by 2020. This transformation is no longer a wish, it is no longer an option; it is our collective future. People who were previously one-foot-in and one-foot-out will be fully planted in the value-based healthcare model.