One of the core Aims of hospital Executives is to enhance the patient experience. Along with improving population health, reducing healthcare costs, and supporting healthcare professionals, the Quadruple Aims were conceived as a key improvement framework by the Institute for Healthcare Improvement (IHI), an independent, not-for-profit organization based in Boston, USA.  In a survey carried out for the California Healthcare Foundation in 2007, more than 60% of doctors reported that their patients sometimes or often experienced long waiting times for diagnostic tests – while 20% claimed tests had to be repeated due to lost results. These are only two issues, evidenced in one State, however, they are indicative of an ongoing US-wide failure to deliver a consistent, high-quality patient experience.
Unsurprisingly the responsibilities of clinicians and support staff in delivering high-quality patient care cannot be overstated. However the catalyst for all of this is technology and, sadly, it is not simply a matter of merely procuring it. Hence hospital Executives are still striving to overcome some of these technology challenges to realize the Quadruple Aims, more than a decade on.
C suite alignment. While all parties may agree on where they want to get, how they get there, and how much it should cost will always be a bone of contention. The Chief Financial Officer (CFO), will be looking to invest in other key services wherever possible, and leverage existing technologies unless there is an overwhelming case otherwise. Similarly, the knock-on effect of digital transformation may result in the need for more training, or the need for staff with different skills which may be of concern for cash-strapped Chief Human Resource Officers (CHRO). Indeed, technology is only as strong as its end users, so with all the will in the world, the intended outcomes of a new application, or piece of equipment may not be realized, if it is not operated in the right way.
Budget. It is not just the CFOs who are cognisant of budget constraints.The Chief Technology Officers themselves (CTOs) are torn between justifying short term spend, and the need for long term cost optimization. For example, while there may be no immediate need to upgrade technologies, failure to do so may result in increased security threats, the risk of systems falling over, and ultimately therefore technology that is no longer fit for purpose. Spreading costs over several budget years may be a more realistic way of achieving the end result, although this isn’t always possible.
Complexity. The complexity of the web of legacy networks and applications that have evolved over the decades cannot be overstated. It’s not possible to simply take a blank canvas and start again, so technologies need to be updated gradually, whilst remaining compatible with legacy systems. Furthermore, even teams within the same hospital may use applications in different ways, so the ability to view and prevent breakages in end-to-end workflows when things need to be modified may not always be possible.
Legacy systems. Trying to align inpatient, outpatient, and third party patient services when none of the systems talk to each other is one of the primary challenges for any CTO. Software is selected based on a number of factors by different stakeholders so interoperability was not front and center when databases and other critical applications were designed. Similarly, end user processes may also need to be reviewed before technology can be modified. But while it may no longer meet the needs of one user, it may well serve the needs of the other users, so at what point is new technology justified?
Too many problems at once. The problems may be so sizable that it can be difficult to see where to start. A transformative digital tsunami may be needed, but this pipe dream will first need to be broken down into incremental steps, with realistic timescales, and realistic targets. A phased approach is likely to be needed, with testing at each stage, before progress can be made to the next. This will require strong project management, and the expectations of the C suite to be managed accordingly.
However, for those able to overcome these challenges, there are significant opportunities to improve patient care. For example:
1. Reduced waiting times for diagnostic tests and treatment
Take medical imaging. With modern medical imaging technology, patients are able receive cutting edge patient care. This probably goes without saying. But beyond simply purchasing the equipment (and it’s not cheap!) the complexity of these modalities mean there are unique threats to enabling as many patients as possible to be seen, within the shortest time frame possible.
In order for this to be achieved, CT, MRI, PET scans, ultrasounds, and X-ray images need to be uploaded, viewed, stored and retrieved quickly – even when demand is unpredictable. In Canada for example, patients can still expect to wait 5.4 weeks for a computed tomography (CT) scan, 11.1 weeks for a magnetic resonance imaging (MRI) scan, and 3.5 weeks for an ultrasound, despite an increase in the number of diagnostic tests being undertaken each month.
2. Aligned primary/secondary/tertiary services
Take patient records and the sharing of referral, diagnostic, and treatment data. With aligned and secure data workflows clinicians are able to see and coordinate patient centered care at relevant points on the patient’s care pathway. This overcomes costly and time consuming process efficiencies and improves communication with third parties.
But this cannot be achieved without significant changes to policy and practices, and enhanced, secure data sharing. Indeed one of the biggest headaches for IT teams, and frustrations for clinicians, remains the ongoing inability to access patients records from different departments, hospitals and healthcare providers.
3. Virtual patient care delivery
Take telehealth. It has the potential to relieve the burden of hospitals the world over. There are patients that cannot travel to a hospital, or are vulnerable and therefore should not travel to a hospital – unless the severity of the situation calls for it. While appointments with primary care physicians and family doctors can now be done virtually, there is still a long way to go before this is fully embraced in hospitals where a hybrid approach is still likely to remain appropriate for many services.
And before you can even get to a point where hospital doctors and patients are able to communicate virtually, patients need to be brought into the technological fold and digitally engage with primary services. But this is no small feat, with 25% of adults ages 65 and older report never going online. Although, given the challenge of getting through to some practices on the phone, it is hardly surprising that 68% of patients that are online in the US say they’re more likely to choose medical providers that offer the ability to book, change, or cancel appointments online. Thankfully, many secure telehealth conferencing facilities exist, although that may still be a significant worry for some. However, as outlined, if there is not good organization of care across the interface between primary, secondary, and tertiary care the benefits are limited, so is the expenditure warranted?
Conclusion
Technology has enormous potential to speed up waiting times, eliminate process inefficiencies, and improve access to patient records. Having the technology itself though is not enough. Fundamental legacy infrastructure constraints need to be overcome if the threats to harnessing this technology effectively, and ultimately enhancing patient care, are to be realized. Healthcare infrastructure is an incredibly complex beast, often funded by multiple stakeholders, and with different vested interests and agendas, resulting in complex, legacy IT, and outdated processes. This complexity is also the result of an incredibly fluid operating environment, which faces daily crises, which can afford little downtime (if any). All of this leads to major challenges when it comes to trying to modernize the existing systems, which IT teams may not have full sight of. But with highly available, integrated, scalable, resilient, and modernized infrastructure, technology has the ability to play a pivotal role in the provision of quality patient care.
About Liam Canavan
Liam Canavan is a Healthcare Specialist and #ADCHero at Loadbalancer.org, guardians of uptime, and experts at load balancing medical imaging applications, using clever, not complex, load balancers that put hospital IT teams in control.
