Back A big step forward
D. Murali
| Digital hospitals can stay ahead of competition by leveraging technologies to integrate information sent from labs, patient beds, pharmacies, physician offices, and patients themselves, says a study. |
THREE initiatives straddling technology and medicine were launched in Chennai on July 16. These were NeuroDbase, a unique customised electronic medical record system for Indian neurologists, Neuropsychiatry Online, a joint effort by the Neurosciences India Group and IIT Madras to provide Internet-based counselling to people living in rural areas and Pubmedinfo.com, a unique public portal for health-related information, as the media reported.
Many may not be aware that since 2001, space-based telemedicine network has been on, with the ISRO providing telemedicine technology and connectivity between rural/remote hospitals and super speciality hospitals, especially in the areas of ophthalmology and community health.
Undoubtedly, these are noble moves that take health service far and wide. But let us shift our focus to a study, though of the US, of how IT is put to use in "36 digitally advanced hospitals, chosen on the basis of their reputation in the industry for implementing advanced clinical systems", and compiled by PricewaterhouseCoopers in its report titled Reactive to Adaptive: Transforming Hospitals with Digital Technology available on www.pwc.com.
"Hospitals are widely criticised for not adopting information technologies more quickly. Many have taken a reactive posture, sceptically deferring the expensive purchases of technologies that can improve patient care and efficiency," notes PwC, pointing out that a reactive approach doesn't help. What is needed, instead, is an adaptive attitude, suggests the report.
For, digital hospitals can surpass their competition by leveraging technologies that integrate information sent from laboratories, patient beds, pharmacies, physician offices, and even patients themselves, assures the study.
"These digital hospitals are compressing processes, adapting to market forces, generating the quality data that payers increasingly demand, updating the clinical data that physicians and patients expect, and preparing for reimbursement changes that inevitably will occur."
But what is a digital hospital? "It is an effort, a spectrum, and a concept; it is a process of managing more by computer and less by manual processes. In a digital hospital, all information about patients and about health choices is digital and is available everywhere it's needed, so information can be retrieved, processed, sorted, and prioritised using information technologies. A digital hospital is the use of electronic information beyond administrative and billing purposes - really integrating electronic information into the clinical aspects of the delivery of care." Thus read a few of the definitions by experts cited in the report.
It may be elusive to look for a precise definition of a digital hospital, so PwC identifies the essential applications because such a hospital comprises "a completely automated and deeply integrated set of health information services capabilities that fulfil clinical, financial, and administrative requirements." A key finding is that `the fully digital hospital remains rare, and is typically a specialty cardiac hospital'. Most hospitals today are characterised by systems in financial and back office operations, apart from a few clinical applications such as in the lab and pharmacy, that too non-integrated, rues the report. The best practice, therefore, would be to broaden and deepen integration of information systems with medical devices and other technologies.
But that's not enough, PwC urges, because the `desired future practice' on the `digital health system continuum' will be the `digital health community' where interconnected networks of healthcare delivery organisations securely pass standards-based information freely as required. If the idea seems hazy, please note that the digital hospital is "more a conceptual construct than a well-defined set of technologies" and that it represents "an architectural concept."
A dismal finding in the report is that "the healthcare industry has made significantly less investment in information technology than many other industries that rely, perhaps even less than healthcare, on information management". On an average, hospitals spend 2.5 per cent of their operating budgets on technology, while hospitals in the process of digitisation spend 3 to 5 per cent, states the report.
But remember that you can't buy a digital hospital off-the-shelf! Nor is it a one-time event. Integration of all the subsystems is a tough burden that has to be borne by the software vendors and the hospital executives, says PwC.
"Integration engines, Extensible Markup Language (XML), and the various information exchange standards such as HL7 Version 3.0 that are gradually stabilising can all help, but they do not magically make the challenge disappear."
Since the required solutions may not all be available from a single vendor, the hospital has to integrate the products of multiple vendors.
The report cites the view of some commentators that computerised physician order entry (CPOE), clinical data repositories (CDRs), nursing documentation, controlled medical vocabulary solutions, clinical decision support systems (CDSS), and pharmacy solutions must be an integrated solution from one vendor, in the interest of smooth functioning.
Among the many recommendations from the accounting firm, let me mention two that I found catchy. First, that substantial benefits may not appear until a sufficient level of automation has been reached. That's the `tipping point', a function of both investment and sufficient process change having occurred, notes PwC.
And second, the suggestion to engage patients and payers, when planning the project. "Patients are becoming more knowledgeable of technology that supports clinical care, and they want their providers to use the latest equipment.
At the same time, payers are becoming more open to offering hospitals financial incentives for improvements to safety and effectiveness through technology investments," is a piece of insight that I guess escapes the notice of many hospitals.
Patients, if you cared to listen to them, "have the best perspective on what constitutes a good patient experience".
A report worth a patient reading by doctors and hospital administrators!
Picture by Bijoy Ghosh
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