Why is digitalisation in healthcare inevitable? What solutions does it offer? An interview with Dr Charles Alessi, Chief Clinical Officer at HIMSS.
Why is digital transformation inevitable?
- The ageing population and multimorbidity = “overheating health and care”
- Movement from volume to value – moving to population-based capitated systems
- Prevention becomes more critical – and care is being delivered from a variety of places by a variety of people – we need a single version of the truth
- Insights essential – hence the importance of EMRs and agreed taxonomy and analytics – as well as assessing progress via maturity models
What are the opportunities?
- Digital transformation is not merely a transcription of a medical record – it is an opportunity to re-imagine care for people
- Patients have become consumers, and digital transformation makes a more customised and personalised approach possible
- Digital transformation enables the use of Artificial Intelligence to automate and gain insights to improve care
- Precision medicine starts to become possible for the mainstream, not the exception
- Precision health becomes the new personalised, predictive public health
Challenges for physicians (and the reasons for burnout):
- Behaviour modification in non-communicable diseases
- Filling the treatment and administrative gaps
- Managing clinical risks rather than excluding it – which is inherent to success in emerging value-based systems
- Delivering consistent quality care in different geographic locations
- The democratisation of care and managing shared decision making
- Managing the complexity of multimorbidity & patient expectations
- Accurate and consistent contemporaneous record-keeping
Changed nature of the physician/patient relationship:
- Value-based systems drive the management of risk not only its exclusion
- From didactic approaches around giving information to a longitudinal relationship accompanying the person (no longer the patient) in NCDs
- Physician selection and training still mainly 20th century
- Seeing the value of behaviour modification training for physicians and care workers
- Consent – starting to embrace dynamic rather than blanket consent
How will we handle this transition?
- The “ask” around transitioning from the traditional to the 2020 model is enormous
- The development of the primary care home in the traditional model still rudimentary where it is operational
- Governance and process and metrics, let alone financial flows, around the Integrated Practice Units (IPU) still not able to be articulated coherently
- All ageing and multimorbidity and the urgency for other additive solutions increases
- The workforce is ageing at exactly the same rate – although if transition succeeds, potentially requirement may decrease
- Effortless adoption of clinical decision support in mainstream practise is still not widespread
- Delaying the expression of symptomatology from NCDs and in cases development of the disease is the rational next step and can only be achieved via a precision health approach
Precision health is achievable by:
- The use of personal data, appropriately safeguarded, to change the conversation we are having with individuals – business to consumer approach
- Driving personalised engagement at scale, using technology to direct people to advice and interventions that are relevant to individual requirements
- Anticipate and communicate risks in a way that invokes an action, directing people to screening, health checks, social prescribing etc.
- Add a new perspective to population datasets with granular personal information
- Employing real-time feedback and continuous improvement of what works.
What solutions does digitalisation offer?
- Better support of our workforce – from digital immersion classes to phased and sensible EMR deployments where the clinical flow is at least as necessary as “closing the gaps” and ensuring the claim mechanisms remain central
- Clinical decision support – embedded within EMRs to better assist health workers supported by AI to reduce the number of keystrokes + emergence of voice
- Training – in behavioural modification techniques and enabling empowered consultations
- Exploiting digital transformation as a “clinical extender”