Informed by conversation with Jennifer Thomas: Director of Marketing, Schizophrenia, and Jack Sheehan: Senior Director, Value and Evidence

                                                                                          Sponsored By Janssen Neuroscience

About 2.8 million adults in the United States are living with schizophrenia, a mental health condition that affects everything from how someone thinks to how they feel and behave.^1,2 A comprehensive treatment plan can be very important to an individual’s recovery journey, resiliency, and well-being and may include therapy, medication, and support services. Research has found a link between low adherence to schizophrenia treatment and schizophrenia symptom relapse, which can interrupt every aspect of an adult patient’s life, often resulting in cycles of crisis that can impact personal relationships, health, financial well-being, and more. On average, adult patients with schizophrenia have an average of 9 relapse episodes in about 5.5 years.³

Studies have shown that adults living with schizophrenia who have more relapse episodes have more hospitalizations, which can lead to significantly higher medical costs for patients, hospital systems, and payers.^4,5,6 Treatment options, like long-acting injectable (LAI) antipsychotics, that are professionally administered and can therefore help to identify medication nonadherence and delay time to relapse can contribute to lower healthcare resource utilization and cost as patients are less often hospitalized when their schizophrenia symptoms are effectively managed.^4,5,6

“Providing longer term treatment options for adults living with schizophrenia has the potential to help identify medication nonadherence since it is a professionally administered medication and may delay time to relapse,” Jennifer Thomas, Director of Marketing, Schizophrenia, said. “Medication is one part of the whole treatment plan to help keep schizophrenia symptoms controlled, in addition to counseling and self-care. It is important for adults living with schizophrenia to talk to their healthcare provider to find the right treatment plan for them.”

According to the 2020 American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, LAI medications provide greater assurance that a patient will receive medication continuously, because they are professionally administered and there are fewer opportunities to miss a medication dose.

Jack Sheehan, Senior Director, Value and Evidence, stated, “Although there is evidence pointing to benefits of LAIs, the use of LAIs has largely been reserved for adults with schizophrenia who have trouble with adherence to schizophrenia medication, in part due to previous guidelines. Medical associations like the National Council on Mental Wellbeing, however, have recently updated their guidelines to recommend LAIs for adult patients diagnosed with schizophrenia earlier in their treatment journey.” LAIs remain largely underutilized and, according to some studies, only 13%-22% of eligible patients with schizophrenia in the United States receive them.⁷

LAIs offer a number of potential advantages compared to oral medication for schizophrenia: relief from the burden of taking schizophrenia medication every day, improved healthcare resource utilization, and delayed time to relapse.⁸ Initiation of LAIs vs. orals antipsychotics may provide considerable benefit to patient outcome and potentially reduce the burden on healthcare resources.⁶

The Schizophrenia Ecosystem Tool (SET) and the Reshaping the Treatment of Schizophrenia in Adults website are 2 new resources developed by Janssen that will enhance a comprehensive approach to educating on schizophrenia and LAIs for population health decision makers (PHDMs) and payers. SET offers the ability to identify the unmet need in schizophrenia and is an interactive map that is used to visualize the burden of schizophrenia in adults in the United States.

“Healthcare systems are shifting toward delivering improved outcomes, enhancing the patient experience, and providing value-based care. At Janssen, we have applied insights from real-world evidence to be able to develop promising tools such as the Schizophrenia Ecosystem Tool (SET) to deliver educational resources that provide value to patients, healthcare professionals, and healthcare systems,” said Jennifer Thomas. The development of SET followed a process that involved identifying key metrics, acquiring data, and creating an interactive tool for visualizing the information. The tool is divided into 6 main categories, including antipsychotic utilization, healthcare resource utilization, quality measures, cost of care, policies, and social determinants of health. These categories are further drilled down into subcategories that help illustrate the need at state, and local levels. The end user can choose the measure of interest and visualize it at the national, state and local levels.^* They can also visualize 2 measures of interest simultaneously. Despite the tremendous burden of the disease, no tool like this has ever been developed for schizophrenia.

SET can help identify region-specific areas of need for greater resource allocation as well as patient groups who are currently underserved. “These key insights from SET can be used to inform mental health service planning and provision, and in turn help to mitigate the burden associated with schizophrenia for both the adult patients and the healthcare system,” said Jack Sheehan. “For example, a local PHDM can identify gaps in outcomes among patients with schizophrenia in their region. They can then compare treatment patterns and policies in the region compared with other regions to pinpoint the likely causes of the gap in outcome. Closing these gaps offers the potential of improved outcomes for patients with schizophrenia.” Additionally, the Reshaping the Treatment of Schizophrenia in Adults website can offer PHDMs ideas for how to close gaps in outcomes identified in SET, by providing the ability to initiate and maintain patient-tailored approaches to schizophrenia treatment.

The Reshaping the Treatment of Schizophrenia in Adults website is an informative tool for PHDMs who want to reevaluate their schizophrenia treatment strategy, which may include earlier adoption of LAIs for adult patients with schizophrenia. The website offers educational resources to support PHDMs and treatment team members who believe in the value of appropriate use of LAIs for adult patients with schizophrenia and could use support in efforts for a coordinated approach to care. The website is divided into 4 sections: Population Identification Processes, Expanding Internal Awareness, Collaborative Care Resources, and Process Evaluation. Each of these addresses activities that can be part of a system process to encourage appropriate and earlier LAI use and includes educational resources and tools that are intended for use by the institution as well as resources that can be used with patients and caregivers. PHDMs and treatment team members will be able to implement these resources in their care strategies to help improve patient outcomes and healthcare resource utilization.

Whereas SET is a tool to increase awareness and education of the burden of schizophrenia and  the impact of social determinants of health, as well as helping to raise the urgency to shift from an oral-centric paradigm to LAIs, the Reshaping the Treatment of Schizophrenia in Adults website is an external website that provides educational resources and information for PHDMs, including payers, healthcare system leaders, and treatment team members, who want to implement a change in their treatment strategy for adults living with schizophrenia, including earlier adoption of LAIs. Jennifer Thomas said, “By educating both internal and external stakeholders through key insights pulled from local and regional real-world data, stakeholders can come together to fill knowledge gaps and support better patient and societal outcomes.” 

*Local level data is only available for antipsychotic utilization, quality measures, costs of care, and healthcare resource utilization.

About The Experts

Jennifer Thomas is the Director of Marketing, Schizophrenia Portfolio at The Janssen Pharmaceutical Companies of Johnson & Johnson. Jennifer oversees the strategic development and execution of marketing activities for the Janssen long-acting injectable portfolio of schizophrenia medicines.

Jack Sheehan is the Senior Director Value and Evidence (HEOR) Neuroscience at Janssen ScientificAffairs, LLC. In his role, Jack leads real-world value and evidence research to understand the burden of illness and effective ways to address illness among adults with neurologic and psychiatric conditions.

References:

1 Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of general psychiatry, 50(2), 85–94. https://doi.org/10.1001/archpsyc.1993.01820140007001
2 U.S. Census Bureau. Quick Facts. Retrieved from: https://www.census.gov/quickfacts/fact/table/US/PST045219
3 Lafeuille MH, Gravel J, Lefebvre P, et al. Patterns of relapse and associated cost burden in schizophrenia patients receiving atypical antipsychotics. J Med Econ. 2013;16(11):1290-1299. doi:10.3111/13696998.2013.841705
4 Fu, A.Z., Pesa, J., Lakey, S., Benson, C. (2022). Healthcare resource utilization and costs before and after long-acting injectable antipsychotic initiation in commercially insured young adults with schizophrenia. BMC Psychiatry 22 (250). https://doi.org/10.1186/s12888-022-03895-2
5 National Council for Mental Wellbeing. Guide to Long-Acting Medications. National Council for Mental Wellbeing website. Accessed July 21, 2021. Available at: https://www.thenationalcouncil.org/topics/long-acting-medications/
6 Morken G, Widen JH, Grawe RW. Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia. BMC Psychiatry. 2008;8(32). doi:10.1186/1471-244X-8-32
7 Sajatovic, M., Ross, R., Legacy, S. N., Byerly, M., Kane, J. M., DiBiasi, F., Fitzgerald, H., & Correll, C. U. (2018). Initiating/maintaining long-acting injectable antipsychotics in schizophrenia/schizoaffective or bipolar disorder – expert consensus survey part 2. Neuropsychiatric Disease and Treatment, 14, 1475–1492. https://doi.org/10.2147/NDT.S167485
8 Brissos S, Veguilla MR, Taylor D, et al. The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal. Ther Adv Pyschopharmacol. 2014;4(5):198-219. doi:10.1177/2045125314540297
9 Offord S, Wong B., Mirski D., Baker R., Lin J. (2013) Healthcare resource usage of schizophrenia patients initiating long-acting injectable antipsychotics vs oral. J Med Econ 16: 231–239

HoLEP enables us to work toward our goals for safe, highly effective BPH treatment and a rapid return to normal activities. During surgery, we want to approach zero risk of blood transfusion. We want hospital stays to be as short as possible, moving closer and closer to outpatient treatment (Most stays for HoLEP are less than 24 hours and some only a few hours.) We want patients back on their feet immediately and back to work in less than a week. Now these goals are within reach for most patients.

Recently, we had the opportunity to use Lumenis’ MOSES Technology in a new approach called MOSES laser enucleation of the prostate (MoLEP). Here, we share the advantages of HoLEP and how, based on our early experiences, we think MoLEP may strengthen those advantages.

HoLEP’s Significant Benefits Over TURP
HoLEP has many well-documented advantages over transurethral resection of the prostate (TURP) in both outcomes and efficiency. One advantage familiar to many urologists is the ability to tackle very large prostates with HoLEP . Instead of treating prostates 80 cc and over with an open or robotic suprapubic prostatectomy, we can perform a transurethral HoLEP with the lowest postoperative morbidity, least blood loss, and shortest catheter dwell time.¹

It’s a misconception, however, that HoLEP is an option reserved for large prostates. We use the procedure to treat BPH regardless of prostate volume. Early head to-head studies showed improved postoperative IPSS scores, superior voiding metrics, and lower retreatment rates immediately and five, even ten years after surgery.² Additionally, the versatility of holmium technology to treat nephrolithiasis and BPH exemplifies its range of benefits. The addition of MOSES technology to the holmium platform further highlights the benefits of HoLEP over alternative transuretheral procedures like TURP.

There is significantly less bleeding with HoLEP compared to other treatment options because the laser allows us to not only enucleate the prostate, but also to precisely cauterize the bleeding vessels. With our initial experience in more than 50 cases using the Lumenis MOSES laser system, we can appreciate a unique tissue interaction with the laser energy, which results in better coagulation. Controlled bleeding improves visualization, obviates transfusion, and makes the procedure safe for patients taking anticoagulants – a major advantage in an age group where comorbidities like heart disease are common.³ We also use saline as our fluid irrigant, which eliminates any risk of TUR syndrome associated with TURP.

Perhaps the biggest advantage of HoLEP over TURP is its exceptionally low long-term retreatment rate. About 1 to 4 percent of HoLEP patients require retreatment at 10 years,⁴ compared to a TURP retreatment rate of up to 30 percent at just 5 years.² With this degree of durability, most patients will never require additional BPH treatment.

Despite the added attention around preserving antegrade ejaculation after BPH surgery, we find that with appropriate counseling, our patients are highly satisfied after HoLEP even with the high rates of retrograde ejaculation. Other side effects of the surgery include transient urinary incontinence, which is very common in men (up to 40%) after HoLEP, but resolving with persistent incontinence estimated at 1-2% 3 months after surgery. There is a low risk of urinary tract infection (again, lower than TURP because catheters are used for fewer days), prolonged catheterization, need for transfusion, or postprocedural urinary retention.⁵ Now, with the improved efficiency and hemostasis we are seeing with MoLEP, we are performing more true outpatient surgeries where patients are discharged home immediately after HoLEP with instructions for at-home, patient-performed foley catheter removal and void trial.

MoLEP May Take Another Step Forward
After the launch of MOSES Technology, our team trialed it for approximately 3 months. In our experience, we found that MoLEP markedly improved efficiency over standard HoLEP by stabilizing the laser, reducing laser fiber break back, and cauterizing more effectively during enucleation.

One of the advantages of using a newer high-powered laser unit for HoLEP is that there are two pedals that can be present with independent energy settings. We use one for incisions and one for cautery, cutting first and then cauterizing the tissue. In MoLEP, the MOSES laser simultaneously cut and cauterize. Because we do not need to pause to cauterize a vessel, we can focus on dissection without losing the plane, controlling bleeding as we go. The MoLEP procedure is also more efficient at cutting through adenomas tissue, so we can get to the desired plane and proceed faster. Our initial objective data show the technology reduces cutting time 30 to 40 percent and cuts cautery time by 50 percent compared to other laser fibers.

Anecdotally, patients appear to have less bleeding from MoLEP, compared to standard HoLEP. Burning or discomfort appear to be about the same in our small sample. To date, we only have this 3-month experience with MoLEP, and we need higher-volume, long-term data to better understand the effects of MoLEP procedure.

We Hope Colleagues Join Us
With all the advantages of HoLEP for our patients, we are working to get more physicians to perform this procedure. It has been described as being difficult to learn, but with appropriate mentorship, most surgeons feel comfortable after about 30 to 50 cases, which possibly could be further reduced with the MOSES Technology. Fellowship learning opportunities can be inconvenient for many surgeons, however, we hope to see more surgeons who perform HoLEP become teaching contacts for observation and discussion, and more companies organizing proctors, courses and workshops.

The procedure takes some time and dedication, but it is well worth the effort and investment for patients and surgeons alike. As we continue to learn more about MoLEP and other advances in treatment of BPH, we hope more colleagues will join us.

Amy E. Krambeck, MD, is the Michael O. Koch Professor of Urology at Indiana University School of Medicine in Indianapolis.

Tim Large, MD, is joining Dr. Krambeck as Assistant Professor of Urology at Indiana University School of Medicine in Indianapolis where he completed his fellowship in endourology.

References

1. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008 Jan;53(1):160-6.
2. Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int. 2012 Feb;109(3):408-11.
3. Rivera M, Krambeck A, Lingeman J. Holmium Laser Enucleation of the Prostate in Patients Requiring Anticoagulation. Curr Urol Rep. 2017 Oct;18(10):77.
4. Elmansy HM, Kotb A, Elhilali MM. Holmium laser enucleation of the prostate: long-term durability of clinical outcomes and complication rates during 10 years of followup. J Urol. 2011 Nov;186(5):1972-6.
5. Cornu JN, Ahyai S, Bachmann A, et al. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol. 2015 Jun;67(6):1066-1096.

While cloud computing has been around for some time, its widespread adoption is a recent trend. The healthcare industry in particular is presently growing and evolving to incorporate more modern technologies.

The hands-off aspect of cloud computing is especially valuable in the field because it means a service provider — the owner of the servers and hardware — is responsible not just for maintaining the equipment and systems but securing them as well. And it’s no secret that the security of healthcare information is of utmost importance.

But there are other benefits to cloud computing beyond those mentioned. When it comes to healthcare and the medical industry, cloud computing has a lot to offer. Here are the top six advantages.

1. Unlimited Capacity

The healthcare industry relies on huge stores of data, and the storage capacity needed to retain it all is substantial. To make matters more complicated, the list of requirements continues to grow as the amount of data amassed increases exponentially over time.

The beauty of cloud computing solutions, however, is that the service provider must accommodate the growing requirements and not the business collecting the data. In healthcare, this means a near-unlimited capacity is available to store all the necessary content and information.

2. Reliable Scalability

In addition to allowing for nearly unlimited storage capacities, cloud computing affords unprecedented levels of scalability. As with most industries, there are busy seasons and there are slow seasons in healthcare. The former requires greater and more powerful computing systems, while the latter relaxes said requirements.

The subscription-based nature of cloud computing services means that healthcare providers can increase system usage and decrease it as necessary, with little to no stress on their operations. There is no waiting period to scale up or scale down. It happens instantly. Simply put, cloud computing makes it possible to easily scale operations according to the necessities of market conditions, demand and seasonal requirements.

3. Seamless Collaboration

When it comes to pulling data and digital content from the cloud, it’s accessible from anywhere and by multiple contacts simultaneously. That makes for excellent collaboration and sharing experiences, which is crucial in the healthcare industry. Doctors and healthcare professionals must be able to share patient information and records between one another while still preserving their security.

Analog methods rely on paper-based records which are not secure at all. They’re also not conducive to collaboration, at least not in the same way that digital records are. Cloud computing means that the data is easy to share with anyone that needs to see it, including patients and insurance providers.

4. Enhanced System Security

It’s a common misconception that cloud computing is less secure than alternate methods. There is always some risk involved, of course, but security is almost always stronger under the control of cloud providers. This is because the service providers specialize in data management, meaning they not only have the understanding and experience but also the resources to fully lock down that content.

Cloud providers also have more resources to invest in local information security teams and tools, which translates to stronger levels of protection.

5. AI and Machine Learning Access

It’s difficult for human analysts and laborers to pour over such massive troves of digital content and information. Fortunately, they don’t need to, as they have machine learning and artificial intelligence solutions.

The healthcare industry can benefit from access to these technologies, which are capable of mining collected data for new insights and details. For example, a Seattle company called Kensci leverages machine learning to predict illness and treatment patterns. Another company called PathAI leverages technology to aid pathologists in making quicker and more accurate diagnoses.

6. Remote Care Opportunities

Because the data and computing power is all remote, the same systems are available to just about any platform with internet access, including mobile. This extends support to a wide range of platforms, creating a greater number of remote care opportunities. Doctors, nurses and health practitioners can monitor events and even provide care from around the world.

This not only presents new opportunities but also enables more accurate and far-reaching care. Imagine an on-site Doctor being able to monitor all their patient’s vital signs, remotely, while tending to others. Or a specialist that’s able to carry out a procedure from halfway across the world using remote conferencing technologies.

This form of remote-care-meets-modern-technology is referred to as telehealth, and it’s becoming more and more prominent in the field.

Reap the Benefits at a Fraction of the Cost

Cloud computing solutions allow organizations to reap the benefits of big data at just a fraction of the cost. That’s because a service provider handles the hardware and software maintenance necessary to keep the systems operational.

Healthcare providers can access cloud computing solutions with a seamless experience, gaining all the benefits above and more. That means unlimited storage capacity, unprecedented scalability and collaboration opportunities, improved security, remote care possibilities and machine learning and AI capabilities. But increased uptime, streamlined IT services and support, and optimized accessibility during major disasters and events are all part of the deal too.

In short, cloud computing is revolutionizing the healthcare industry, and there’s no room for argument on that point.

Over the past 40 years, the healthcare community has been repeatedly excited by the hope of providing better care through the effective adoption of the technology. In the hope that digital health is going to be the game changer, an aura of hype has been created amongst the stakeholders of healthcare industry. However, digital health is yet to witness a large-scale adoption that could match the hope created about its utility. There does not exist an example where digital health has successfully transformed the health system of a geography and has demonstrated a net positive return on the initial investment. Owing to the lack of a positive business case, the initiatives pertaining to digital health are losing steam.

Corporates are shutting down digital health labs, staunching investments in digital health, digital health conferences are consolidating, and governments are re-evaluating the funding regimes for such initiatives. For the technology to be able to create desired impact in this sector, the principle stakeholders namely governments, hospitals, insurers, tech developers, medical professionals, and patients need to participate equitably. The resources need to be focused on high impact areas like epidemiology surveys, legal and regulatory frameworks, geriatric care, and human resources training. For a new technology to thrive, the industry competitors and governments must work in unison to develop solutions that are pragmatic, solves the problems, reduce the cost of care delivery, and are sustainable in the long-term. Digital Health Champions also need to answer the key question; Who pays?What would the Digital Health financing model be? Digital health is not dead, but it is in a stage where its revival is an up-hill yet doable task, and above all is necessary.

Full Article

Tech revolution: First, the world was changed by the invention of wheel. The second invention that matched the magnitude of impact of wheel is the electricity. The concept of electricity has existed for over 2,000 years, but its commercial supply for civilian use began in late nineteenth century. The adoption of electricity has been very steady since then and before the World War II, whole North America and Europe had access to electricity. The third invention in the league of wheel is the internet connectivity. Post World-War II, the world realized the need of effective flow of information.

Internet has revolutionised the human civilization beyond the expectations of subject matter experts. The most significant contribution of internet is making the world flat. Internet has uncovered the change that is possible through the power of human interaction. Many industries have reaped the benefits of connected global markets through blockbuster products and borderless territories. The wheel, electricity, and internet form the backbone of the present-day infrastructure. The technology means productive man-hours, higher revenues, and targeted customer acquisition and convergence across sectors.

Henry Ford used a combination of wheels and electricity to develop the assembly line concept. These assembly lines made cars so affordable, that it changed the way we commute today. Banks use cash counting machines, which are again a precise combination of wheels and electricity. These machines have saved millions of hours of human effort by making our cashiers more productive. Interestingly, internet and global market places are making cash redundant, another seismic shift. Cellular phones have made inter-human connectivity a fundamental service. Human behaviour has evolved significantly by the fact that we are connected to everyone, every time, everywhere. The role of technology is so ingrained in our lives, that any deviation from it is unimaginable. Every industry and sector has been revolutionized by the technology. The dependency of organizations on technology has reached to a point where the survival and competitive advantage of organizations depends upon technology.

In 1950s, when the world was recovering from world wars, the digital technology was endeavouring to jump out of innovation labs into the real business world. Automation of simple and repetitive human jobs was the lowest hanging fruit plucked by digital technologies in 1950s and 60s. The governments, financial institutions, corporate organizations, and manufacturing industry were tempting to experiment with the idea that data generated can be used to break down the problems and substitute human efforts with mechanical or electronic interventions. As we see the history, military and financial institutions took a lead to transform the lab experiments into opportunities. NASA, for example, leveraged an IBM computer to put a man on moon¹. Banking industry created a business case for automated teller machines to reduce the dependency on human cashiers. This introduction marked the dawn of digital era in commercial world.

The examples of uptake of digital technologies include self-service gas stations, supermarket billings, online shopping, real-time email communications, automated ticket dispensers, candy machines, traffic signals, and cyber warfare. All these examples were advanced features of their time, as well as, saved a lot of money for the public. The proliferation of these innovations was organic in nature. Healthcare, however, has always been a shy cousin of these industries and fails to provide some strong examples of digitalization in that era. Healthcare has spent billions of dollars on committees and conferences to market the idea of digital health yet failing to find any mass adopters. For the purposes of this paper, digital health is defined as electronically connecting up the points of care so that health information can be shared securely².

There is no denying in the fact that digital health has failed to deliver³. Digital health is struggling to survive, and signs have begun to emerge that the era of legacy technologies will soon be gone. In 2012, the moratorium on all E-health and mobile health initiatives in Uganda was the signal that all is not well with digital health adoption and scaling up⁴. Since then, the number of healthcare conferences on digital health have drastically reduced. More healthcare IT companies have gone bankrupt in past five years, than in two decades before that⁵.

The National Health Services (NHS) in England and, to some extent, Kaiser Permanent are trying to implement digital health on mass scale through the effective telemedicine and digital health records projects.For the rest of the world, there is no example of digital health being implemented at national level^6,7. The industry is still struggling with rudimentary issues of interoperability, data privacy, legal frameworks, systemic acceptability, and project financing. On top of that, the changing the goal posts and direction towards robotics have created opaque lens to look through the past and future of digital health.

Hope: Health Digitization is a Magic Wand
Back in 1950s, there existed one example of digital health in the form of telemedicine. The wealthy folks of that time could use their landline telephones to speak to a physician, describe their condition, book an appointment, or even request a home visit. In fact, in 1959, Mudaliar Committee referred to the use of police wireless communication for primary health centre staff⁸. Disappointing it is, that by 1980s, it became almost impossible to get a physician on the phone and ridiculously expensive to request a physician home visit.

However, technologies like internet and sensors provided a hope that healthcare would be accessible anywhere and anytime. There was a hope that some digital solution would move the epicenter of healthcare from hospital to patient. Medical staff hoped that they would have patients’ data available on fingertips. Hospitals hoped for an instant payment from the insurance companies using secure technology. Insurance providers hoped to use data and analytics in reducing frauds and save operational costs. Above all, patients hoped to get a better care they deserve.

Everyone expected that digital technology was the missing link between “health-care” and “health-cure”. What came out was an entire conference industry built on digital health in hype of mass adoption of digital health.

The IT infrastructure in the hospitals did not move beyond billing and administration!!! And the companies that still hold on to the digital health portfolio are cross-subsidizing the losses with their income from BFSI (Banking, Financial Services and Insurance) verticals.

Electronic Medical Records (EMRs) were looked upon as the holy grail of digital health. Once all the patient data gets digitalized, infinite possibilities would open. Overtime, EMRs found it difficult to break into a physician’s office. For a considerable time, the myth prevailed that physicians are afraid of technology or physicians see technological advancements as their enemy. This myth loses its rationale when a physician’s office is loaded with technologies like digital stethoscopes, portable glucometers, latest Computed Tomography (CT) scan machines, Magnetic Resonance Imaging (MRI) machines etc. Medical devices industry has exploded in past three decades.CT and MRI machines were made commercially available in 1970s. Within 20 years, there were at least 1 MRI and 2 CT machines per million population in the developed world. At present, there are more than 10 MRIs and 20 CT machines per million population^9,10. These statistics are a proxy for physician’s acceptance to the new clinically proven technologies if they add to his knowledge of diagnosis/treatment, add to his income, and saves time for ‘doing more’ in his practice. Knowledge, money, and time are the underlying benefits when it comes to DoI (Decision on investment) for digital health.

Money chasing digital health:USA is paying around $50,000 to each physician for adopting EHRs. In 2009, the US Federal Government set aside $27 billion of the American tax payers’ funds to boost the adoption of EHR.Billions of dollars were budgeted for training health information technology workers under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

“For physicians willing to adopt EHRs, the financial incentives offered by the federal government were substantial. The average physician with at least 30 percent of his or her patients covered by Medicare is eligible for up to $44,000 in total incentives. A physician with at least 30 percent of his or her patients covered by Medicaid is eligible for even more, up to $63,750. As of May 19th,2011 320 health care providers (including 283 physicians and 37 hospitals) had received a total of $75 million in Medicare incentive payments for demonstrating meaningful use of electronic health records. The relatively slow start was perhaps to be expected” as quoted in an article from the Commonwealth Fund¹¹.

Despite this huge budgetary allocation, the digital adoption in American clinics and hospitals is far from ideal. Less surprisingly, fax machines have taken a refuge in American health system^12,13. We need a deeper study as to how and why 95% of physician practices and hospitals in South Korea have transitioned to a fully digital state using EHRs without monetary support from the government. Almost all these EHRs provide some smart functionality like identifying drug interactions and patient communications, in addition to medical data storage¹⁴.

The USA policy is a classic case of dollars chasing EHRs, and not EHRs chasing dollars. If EHRs are beneficial in principle, the physician practices should be adopting it for their own profit. But the true value of EHRs has not been captured as of today. Additionally, this example sums up the success day of lobbyists in the Capitol Hill. The bottom line is, digital health, when looked holistically in terms of deployment and use, hasnot been resounding success.

The positive side is, hope never dies. The narrative has shifted from e-health/telemedicine to fitness devices, machine learning, artificial intelligence, block-chain,and automation. The hope is that these technologies would bridge the gap in access to right care. Google, Apple, and Amazon are driving their success in healthcare through patient centered approach. The hope remains that automation would reduce errors in healthcare, as it did in manufacturing industry. The hope is patient data could travel instantly like money travels in financial sector. The hope is that every patient and disease condition is accounted for like items are tracked in Walmart. Patients have expressed consent to share their health data, if their hopes are rightfully met.

Hype: Digital Revolution is Knocking the Doors
Back in 1970s, when automation, mechanization, and digitalization were sprouting up, another paradigm shift was being orchestrated by Walmart. Being a retailer, Walmart was very close to consumers. It understood their needs, communicated these needs to manufacturers, and delivered products which were consumer centric. Walmart made consumer the king.

“Patient Centric Approach” became a hype phrase in healthcare conferences in no time. Ten years ago, the digital platforms created a hype that healthcare will undergo an overhaul in ten years. Ironically, nothing changed in those ten years.

Healthcare conferences are a major source of useful information and unnecessary hype in this sector. In the digital health conferences, experts would talk about patient data privacy, data analysis, data portability, etc. Not many digital health providers discussed about patient itself. Top-down approach adopted by digital initiatives has landed on its face. Healthcare needs a bottom-up approach, where patients dictate their needs and providers improvise themselves to cater to these needs. Companies like Apple, Google, Facebook, and Amazon, who have deep access to consumers and their data, are positioned very well to make digital health a success. What happened to Nokia and Blackberry in the cellular industry, might happen to most of the digital health providers in near future.

Dotcom moment: During the hype phase of digital health, every corporation invested in building a healthcare division. Software veterans like Microsoft, Qualcomm, Siemens,Intel,Oracle, Cisco,BlackBerry,Nokia etc. invested billions of dollars in developing healthcare solutions. Manufacturing conglomerates invested in health tech to hedge their risks. Venture capitalist funding flow in healthcare increased exponentially. Healthcare organizations like Mayo Clinic and MD Anderson invested a significantly in digital health offerings. IT companies spent millions of dollars on healthcare conferences to get a tap on hype or build their client pipeline by getting leads. How long did this hype survive? Microsoft dropped down its HealthVault app¹⁵. Google declared that “Google Health” has failed(16). Mayo clinic & Noaber Foundations Joint venture spins out their digital arm Vital Health and then sold it to Philips(17). MD Anderson ended contract with IBM Watson health, after losing over $62 million in digital health experiments(18).

Even the ‘Digital Health conference’ industry is shrinking, losing momentum, and consolidating. mHealth summit was acquired by HIMSS. It is important to note that mHealth summit a leading conference on health and mobile based technologies was backed by National Institute of Health (NIH) and Fogarty International Center¹⁹.The Connected Health Symposium organized by Partners HealthCare, merged with the Personal Connected Health Alliance’s (PCHA) ‘Connected Health Conference’ to stage a single conference since 2017²⁰. Health 2.0 got acquired by HIMSS²¹.The consolidation in the event organization space is an indicator to dwindling confidence in digital health events. The WHO trimmed their team in eHealth department drastically. In 2004, there were 22+ support staff at the WHO’s eHealth health unit. By 2008, it was reduced to about 14 and in Jan 2017, 3 people with no dedicated support staff, and in Dec 2017, the eHealth unit was left with just one staff.

98% of the digital health start-ups have failed to survive²². No single healthcare start-up attains unicorn status (more than $1 billion valuation). There is not a single example, except National Health Services (NHS) and to some extent, Kaiser Permanente of a large-scale implementation of digital health solution. Smaller countries like South Korea and Estonia have made remarkable implementation of digital health solutions but the percentage of global population impacted by them is akin to a rounding error of numbers. These examples point in a direction that all the hype about digital health was based on speculation instead of facts. The result is, people lost time, corporations lost money, and health system have sustained inertia.Someone, somewhere has got something wrong in digitizing healthcare.

Halt: The Non-starter
In 1990s, when digital technologies and platforms were going viral with software and websites, the protectors of healthcare invested their energies in building a strong wall to keep status quo intact. In a time when people could do banking from home, book tickets from anywhere, and get groceries delivered at home, hospitals are enjoying a romantic relationship with paper and fax. Less surprisingly, healthcare industry missed the digital wave. What is the reason behind digital phobia of healthcare industry? Despite all the hype created around digital health, there is a reason why the experts failed to declare digital health dead? Despite examples and comparisons with other industries, healthcare has not adopted technology to the level it should have.

The need for Digital Health is far more than ever before; holding back the ubiquitous implementation of digital health is estimated to cost over a trillion dollars annually to the global population.

A technology like digital health records would help physicians to better manage their operations, increase health access to the patients, and lower the long-term healthcare cost for the payer. Yet, EMRs failed to establish a rapport with physicians because the physicians cannot find the value-add worth their time and money investment²³. The biggest reason for the failure of digital health is that more energies have been spent in developing policy manuals and organizing conferences, than developing a product, financial models and solve the interoperability issues that can demonstrate value to the user and demonstrate clinical evidence for better healthcare delivery.The hope that patients will get better healthcare with the help of technology is fading away. EMRs solved the issue of billing and data storage, not access and care. The EMRs failed because they were designed around hospitals and not for patients²⁴. The need is to design patient centered solutions.

The digital health has not paid off to the investors, users, and the patients. This technology has not earned the value it promised for the governments,healthcare providers and the patient communities. A bigger focus was laid on the development of the business case. Digital health industry should have shifted focus from tuning business model towards fixing the service model. With most of the software being sold as a service, digital health should be viewed as a service to the key stakeholders of the healthcare industry. Going forward, the hype and promises should be driven by the magnitude of impact created, and not by the speculation of company valuations. It must be a game of ‘clinical value creation’ and not just ‘financial valuations for investors’.

Moment of Truth: A Call to Action
The industry and the governments have begun to get the sense of the failing digital health initiatives. We can either declare the digital health as dead or initiate are suscitation phase. Another truth is, the rules of the game have changed. Doctor is no longer the king of healthcare, patient is. Digital health is transforming from a standalone product to becoming a service to support clinical outcomes. As the businesses are driven by the profit motives, follow the money. Money in healthcare can be backtracked to insurance companies (payers) and patients. Health insurance providers would have larger role to play in digitizing health sector to save costs and gain competitive edge.

The digital health is in a state of atrophy as suggested by the history its evolution.The nomenclature and the goal posts have kept changing over the past two decades, helping to rebrand the idea of IT in healthcare.

We are back from “Hope, Hype to Halt”to hope again and it looks tough to take off. We need to galvanize the global efforts for deciding a roadmap as to what are the building blocks. We must take start at hurdle race once again, but the path and goals must be clearly articulated with evidence of impact documented as we go along.

The role of the Government must evolve. Governments need to go beyond its current role of acting as a catalyst to derive consensus amongst stakeholders.Providing funding and operational support at national or global level is the need. For example, the Government of India is funding telemedicine as an integral service at Health & Wellness Centers and collaborating with private players to operate these centers²⁵. Three major developments in 2018-2019 could well give the much-needed boost as one last chance to lift the adoption of Digital Health.

First major development is the mHealth resolution at the World Health Assembly proposed by the Indian Government and this resolution received global support ²⁶. This resolution signals an increased focus on mHealth, but the rest is a grounds-up movement.The second major development was the launch of the Global Digital Health Index, which may play a role of a barometer for adoption and maturity of digital health²⁷.

The index was launched alongside the World Health Assembly in May, 2018²⁸. Third major development is the guidelines on digital interventions for health system strengthening launched on 17th April, 2019²⁹. These guidelines would help the governments of the WHO member states to take decisions on deploying digital health solutions across the continuum of care. Governments must not miss this opportunity to take a stewardship role for digital health and all stakeholders must get together to ensure that it happens.

The healthcare systems across the world are becoming unsustainable. Technology can help the health systems, but we must start with human interoperability before technical interoperability, human-ware before software or hardware. Challenges in healthcare are opportunities for digital health. Digital initiatives in other industries have worked the best when the implementation was orchestrated by the whole industry as a uniform effort.

Aftermath 9/11, the initiative of developing a process to deposit cheques electronically was develop by big banks in a unison. Perhaps, this offers a cue to what is needed.

It’s time that the industry takes the lead on patient centric and clinical outcome driven solutions.In this hurdle race between technology and medicine, the patient is the goal post, and healthcare will win by adoption of technology across the continuum of care.

The government(s) takes the lead in catalysing integration of digital tools in delivery of care and the UN, WHO & ITU work in unison to provide an umbrella cover for guidelines, standards and legal frame-works, best practises and shared common goal to ensure success leveraging the latest developments.

Time to re-start is now and convert Digital Health’s Hope, Hype and Halt to Hope , Heal and Health !

References

1. IBM. The Apollo Missions. IBM 100 Icons of Progress. [Online] IBM, 2018. [Cited: 04 30, 2018.] http://www-03.ibm.com/ibm/history/ibm100/us/en/icons/apollo/.
2. Australian Digital Health Agency. What is digital health? https://www.digitalhealth.gov.au/. [Online] 2015-19. https://www.digitalhealth.gov.au/get-started-with-digital-health/what-is-digital-health.
3. Joseph C. Kvedar, Alexander L. Fogel. Why Real-World Results Are So Challenging for Digital Health. NEJM Catalyst. July 10, 2017.
4. GSMA. mHealth Country Feasibility Report: Uganda. [Online] 2015. https://www.gsma.com/mobilefordevelopment/wp-content/uploads/2017/05/mHealth_Uganda_R.pdf.
5. Becker’s Hospital Review. 98% of digital health startups fail — here’s why. Becker’s Hospital Review E-weekly. May 18, 2016.
6. Cruickshank, John.Healthcare without walls: A framework for delivering. s.l. : 2020health.org, 2010.
7. Galewitz, Phil. Kaiser: Your doctor will see you now – in this telemedicine kiosk. [Online] June 20, 2016. [Cited: April 30, 2018.] https://www.usatoday.com/story/news/2016/06/18/kaiser-how-far-telemedicine-has-come/86084092/.
8. Gupta, Rajendra P. Healthcare reforms in India: Making up for the Lost Decades. Healthcare reforms in India: Making up for the Lost Decades. New Delhi : Elsevier India, 2016, p. 190.
9. OECD Data. Computed tomography (CT) scanners. [Online] Organisation for Economic Co-operation and Development, 2017. [Cited: April 30, 2018.] https://data.oecd.org/healtheqt/computed-tomography-ct-scanners.htm#indicator-chart.
10. Data, OECD. Magnetic resonance imaging (MRI) units. [Online] Organisation for Economic Co-operation and Development, 2017. [Cited: April 30, 2018.] https://data.oecd.org/healtheqt/magnetic-resonance-imaging-mri-units.htm#indicator-chart.
11. Schilling, Brian. The Federal Government Has Put Billions into Promoting Electronic Health Record Use: How Is It Going? The Commonwealth Fund Newsletter. [Online] https://www.commonwealthfund.org/publications/newsletter-article/federal-government-has-put-billions-promoting-electronic-health.
12. Reece, Richard. Why Doctors Don’t Like Electronic Health Records. MIT Technology Review. September 27, 2011.
13. Yaraghi, Niam. Going Digital: Here’s why more physicians are going to be adopting electronic health records. US News and World Report. September 24, 2015.
14. Current Status of Electronic Medical Record Systems in Hospitals and Clinics in Korea. Young-Taek Park, Dongwoon Han. 3, 2017, Healthc Informatics Research, Vol. 23, pp. 189–198.
15. Foley, Mary Jo. Microsoft to drop its HealthVault Insights apps. ZDNet. January 2018.
16. Rao, Leena. Google Shuts Down Medical Records ad Health Data Platform. TechCrunch. June 24, 2011.
17. Cohen, Jessica Kim. Philips acquires Mayo Clinic spinout VitalHealth. Becker’s Hospital Review E-weekly. December 8, 2017.
18. Herper, Matthew. MD Anderson Benches IBM Watson In Setback For Artificial Intelligence In Medicine. Forbes. February 19, 2017.
19. Barr, Paul. HIMSS buys mHealth Summit. Modern Healthcare. Februry 17, 2012.
20. Cusano, Donna. Connected Health Symposium to merge with PCHAlliance conference. [Online] Telehealth and Telecare Aware, October 21, 2016. [Cited: April 30, 2018.] http://telecareaware.com/connected-health-symposium-to-merge-with-pchalliance-conference/.
21. Sullivan, Tom. HIMSS acquires Health 2.0 conferences. Health IT News. April 19, 2017.
22. Chase, Dave. Why 98% of Digital Health Startups Are Zombies And What They Can Do About It. Forbes. May 18, 2016.
23. Minor, Lloyd. Doctors are burning out because electronic medical records are broken. QUARTZ. Auguat 25, 2017.
24. Gur-Arie, Margalit. EMRs Were Designed for Billing and Not Optimized for Patient Care. [Online] HIT Consultant Media, March 6, 2013. [Cited: April 30, 2018.] https://hitconsultant.net/2013/06/03/emrs-were-designed-for-billing-and-not-optimized-for-patient-care/.
25. Press Trust of India. Government launches telemedicine initiative ‘Sehat’ . The Economic Times. August 25, 2015.
26. Digital Health. Organization, World Health. Geneva : s.n., 2018. SEVENTY-FIRST WORLD HEALTH ASSEMBLY. A71/A/CONF./1.
27. Cella, Gina. Health Leaders Announce Global Digital Health Index to Track and Improve How Countries Around the World Use Digital Technology for Health. [Online] Personal Connected Health Alliance , September 21, 2017. [Cited: May 8, 2018.] http://www.pchalliance.org/news/health-leaders-announce-global-digital-health-index-track-and-improve-how-countries-around.
28. GDHI. GLOBAL DIGITAL HEALTH INDEX. [Online] 2018. https://www.digitalhealthindex.org.
29. World Health Organization. WHO releases first guideline on digital health interventions. WHO Newsletter. [Online] World Health Organization, April 17, 2019. [Cited: April 21, 2019.] https://www.who.int/news-room/detail/17-04-2019-who-releases-first-guideline-on-digital-health-interventions.
30. Health Survey & Planning Committee – Mudaliar Committee .Health Survey & Planning Committee. Ministry of Health , Government of India. Delhi : Govt. of India, 1959.

Here are five proven ways hospitals can boost the efficiency of their workforces.

1. Attach RFID Tags to Equipment
If hospital workers don’t know the location of equipment they need to use, patient care can be compromised. The facilities may also need to compensate for the lost equipment with costly rentals or replacement purchases.

However, radio frequency identification (RFID) tags can eliminate the common problem of misplaced equipment. Michigan Medicine is a 1,000-bed facility with five buildings on its campus. The hospital also handles 12,000 pieces of equipment and decided to improve the tracking of those items with RFID tags. Hospital administrators made that decision after the patient equipment manager received 200,000 item requests in one year.

RFID systems let people use dedicated interfaces to see the precise, real-time location of the things they need. Then, they spend less time searching for the items and can devote more minutes to patient care.

2. Deploy Continuous Electronic Monitoring Equipment
Hospital employees know that patient monitoring is one of the essential components of high-quality treatment. Keeping tabs on a patient’s vital signs and other characteristics informs medical staff if medications or other interventions have the intended effects. However, checking on all the patients in an area of a hospital is time-consuming. That’s why there’s a growing interest in hospitals using continuous electronic monitoring (CEM) technology for 24/7 checks.

It’s now easier to do that than before since many patient wearables can track changes. In the past, CEM technology was mostly in critical-care units or places with specialized beds and associated equipment.

There are also alarm and notification (A&N) platforms that sync with CEM tools and immediately let medical workers know about shifts in a patient’s condition that require urgent action. In one example of what’s possible, an algorithm takes data from CEM platforms and electronic health records and uses it to determine a patient’s risk of sepsis. It reduces sepsis fatalities by nearly 23% and detects it 18 hours sooner than clinicians can.

CEM technology allows hospital employees to make the most of their work hours by getting real-time data they can use to support care decisions. It also reduces the time spent performing manual vital sign assessments.

3. Rely on Health Care Answering Services
Many hospitals have outpatient facilities where people go for everything ranging from chronic illness management to minor surgeries. In small or understaffed units of a hospital, people who primarily deal with patient care may also need to multitask by answering incoming calls or scheduling appointments. When that happens, overall productivity levels often go down.

Fortunately, medical answering services can provide call overflow assistance. They enable patients to reach human operators instead of voicemail messages when they need to get in touch during business hours. Then, outside of that timeframe, answering service companies engage with patients through after-hours help.

If patients experience complications after procedures or other potentially urgent situations, an answering service can either dial the appropriate provider on a patient’s behalf or let the caller know how to connect with them. Answering services allow providers to focus more on patient care instead of administrative tasks that could get them sidetracked.

4. Install Wayfinding Equipment
Statistics say no-shows cost health care facilities $150 billion annually. When people don’t appear for their appointments, the associated staff members have to juggle their responsibilities and look for productive ways to fill empty time slots. Many things can cause people to miss their appointments, including getting lost and not finding their way fast enough to be there on time.

An unspecified cancer research center in the U.S recently invested in wayfinding equipment from Phunware that gives patients and visitors navigational information through an app. Additionally, hospital staff members can push updates to the app, such as to tell people about a section of the hospital that’s closed for renovations.

Then, the customer service experience should improve, and workers should find it easier to concentrate on their duties instead of being interrupted by people who need directions.

5. Create and Launch Chatbots
E-commerce companies commonly use chatbots, mainly to provide quick answers to frequent customer questions. Useful applications exist in the health care sector, too. In the United Kingdom, Moorfields Eye Hospital built a chatbot that lets patients ask about their conditions. It also has accessibility features for visually impaired users.

Triage chatbots also exist that encourage people to describe their symptoms and get trustworthy advice about the kind of care they need. Some people criticize this technology, but it could allow individuals to get personalized information that may be life-saving. Some triage chatbots make assessments in a couple of minutes or less.

When people use them, they could get help in making decisions about promptly attending local health facilities for further assistance or taking part in home-care measures until they can visit their primary care doctors.

Additionally, chatbots could give people answers about the recommended ways to take prescribed medications, the locations of the pharmacies closest to them or the process to go through when making an appointment. Then, the health care workers who would ordinarily answer those calls have reduced burdens and can spend more time doing other tasks.

Worthwhile Technologies Can Make Hospitals More Efficient
This list gives a sampling of the broad range of technologies available to hospital administrators that want to help workforces cut down on inefficient processes and get more done. Before a facility invests in one or more of them, it’s ideal for representatives to take the time required to research the pros and cons linked to each solution.

With time-poor or disengaged staff, mistakes caused by a communication breakdown or administrative errors – new procedures being ignored or vacations not being covered – can have serious knock-on effects for patient care, let alone brand reputation.

The healthcare technology headlines today are dominated by robotic operations, virtual doctors, blockchain and mixed reality, but many organizations are urgently seeking out internal software that simply serves and enables staff to do their jobs quickly and efficiently, and communicate and collaborate as a high-functioning team, rather than being mired in paperwork and administration once patients have left, or roaming the building looking for one another.

One 2016 study of 57 physicians, looking at the allocation of time in ambulatory practice, found that for every hour of clinical face time provided to patients, nearly two more hours are spent on EHR and desk work during the working day. Physicians spent another one to two hours per day of their personal time doing additional computer and other clerical work.

Clerical and administrative work can usually be reduced through simple online process automation, which also reduces the margin for human error, while the digital workplace can serve as a content-rich knowledge base for keeping staff updated on new procedures, compliance and training – and, importantly, track who hasn’t seen it, removing the need for managers to chase people up.

But all the technology in the world won’t help if staff aren’t properly prepared or trained for new communication and collaboration tools, workflows or HR self-service. For some, change can be daunting and requires a delicate hand.

A 2018 YouGov survey around UK workers’ expectations and views on technology change in the workplace found workers were overwhelmingly confident about such change: 73% felt they would be able to adapt and update their skills if new technologies were to affect their current jobs. But 19% lacked confidence, which rose to 24% for respondents over the age of 45.

What that tells us is internal technologies deployed to boost efficiency and make life easier for staff cannot be a ‘fire and forget’ solution. Thoughtful implementation, and special consideration for those less confident with tech or happily entrenched in their comfort zones, should be a priority.

The following steps will minimize the risk of sloppy implementation of new technologies, help you manage the fear of digital change artfully, and ensure staff are prepared, trained and even excited by what’s coming…

1.    Involve staff
End users of the internal technology you choose can be involved early on. Picking representatives from different departments and teams to select the new software can be key to getting buy in later on.

As the new software is rolled out, gradually add users from different departments in smaller ‘pilot’ groups. This helps iron out specific issues unique to departments but it also generates excitement through word of mouth, as those pioneers feedback to their peers what the tech can do.

McKinsey’s 2018 survey on organizational change found those planning for the long-term sustainability of changes from day one were 70% more likely to report successful digital transformations than average.

These ‘top digital implementers’ were also 71% more likely to agree with the statement that they’ve shown clear, organization-wide ownership and commitment to their change across all levels of their organization and 62% more likely to agree that they showed clear accountability for specific actions during implementation.

2. Think ‘experiential’
The big draw for digital workplaces is the strong social media element. Internal social feeds that staff can populate with ideas, comments, stories, and photos – and earn some peer recognition – is a really engaging prospect to many. Populate the feed with some rich media before staff go in, and encourage staff to post their own.

To coax people into the system for the first time, it’s a good idea to make sure that everyday processes like vacation requests or expense submissions are only accessible through the new system. Think of it as an icebreaker.

3. Solve problems
It can be easy to fall into a pattern where common problems are seen as the norm. Do staff have to arrange their own cover if they are ill? Are nurses wasting valuable time hovering outside doctors’ offices to pass on information verbally?

New tech is often viewed as disruptive, but if it solves irksome problems like these that have somehow become the status quo, and staff see an immediate uplift in efficiency, you’ll have instant fans.

4. Offer training
Training from product specialists or suppliers needs to range from a simple tutorial of the key functions for technophiles to multi-session workshops for the technophobes. Product specialists that come into train will also be more than happy to enthuse about the tools and help the skeptics adjust and embrace.

An e-learning portal that sits within your software could include user training videos that can be watched at any time, and accessed on a smartphone, as well as training for procedures and compliance and personal development.

OVERVIEW
Northside is one of the largest integrated health systems in Georgia. Through inorganic and organic means, Northside has experienced dramatic growth over the last few years, especially in outpatient operations which now number well over 200 locations throughout the state. During this period of dramatic growth, Northside’s Supply Chain department’s focus was primarily on optimizing the cost structure for direct spend categories such as medical/surgical supplies, implants and capital. With this in mind, Northside identified several indirect categories to leverage outside expertise and avoid the prohibitive cost of building and maintaining those skills internally. The Northside Leadership Team turned to Accenture to assess these indirect spend categories and identify potential savings. Accenture employs flexible business models with deep category experience to implement savings and improve sourcing and procurement processes.

The project was part of an overall procurement sourcing effort for indirect spend with the first few initiatives being energy and telecom. The program has yielded impressive savings to date while simultaneously improving contract compliance. Accenture audits bills to identify adherence to existing contracts, looking for over payments and potential refunds. They also consult a proprietary benchmarking database to compare costs and vendor performance.

The Northside Profile
The Northside system consists of an extensive network of state-of-the-art facilities that include three not-for-profit hospitals in the Atlanta metro area; Northside Atlanta, Northside Forsyth, and Northside Cherokee. With more than 800 licensed beds, Northside operates more than 200 hospital affiliated outpatient centers and medical office buildings throughout the state of Georgia.

There are more than 2,500 physicians on staff and over 14,500 employees at Northside. In addition, the hospital logs over 2 million patient encounters annually and is recognized for its expertise in maternity services, women’s health, cancer care, surgery and radiology.

Northside performs more than 20,000 system-wide infant deliveries annually, diagnoses and treats the most cancer cases in Georgia and the most breast cancer cases in the southeast.In addition, Northside ranks in the top 1 percent in all robotic surgery programs in the country. In a typical year, Northside will perform more than 50,000 surgeries.

Opportunity
Amid top-line regulatory pressures—along with rising consumer expectations for improved service and outcomes—healthcare organizations are challenged to rein in costs. However, many organizations are unsure how to transform sourcing and procurement operations to drive down costs while maintaining quality.

Rapid organizational growth coupled with a more complex infrastructure provided an opportunity to review several indirect spend categories. Due to prior successes with supply-chain improvement projects, Northside turned to Accenture for assistance in managing indirect spend categories that had the potential for significant sustainable savings. Accenture uses flexible business models and applies digital technologies to improve sourcing and procurement results

Solution
The project team’s focus began with sourcing and procurement in two key areas: energy and telecommunications. To touch on the complexity involved in this project, for every entity with an electric meter, a monthly bill is generated. Northside had approximately 300 energy accounts to manage across scores of facilities. The energy category covers not only electricity but natural gas; both have options for suppliers in addition to distributors. In the telecommunications category, expenses cover thousands of wired lines, as well as high-speed data, fax and mobile-phone services.

“Accenture reads each line item of 200 accounts, reconciles the accuracy of each line against the appropriate Northside contract charge, and then dispositions it for charge back purposes to nearly two thousand Northside department codes.”

• Online billing portals were set up to improve visibility into detailed account information.
• A proprietary benchmark database is also utilized to compare costs and vendor performance.
• Processes have been migrated from paper to digital means, enabling faster analysis of aggregated expenditures.

During the course of the initiative, members of the project team stay in constant contact with Northside personnel to identify, evaluate and monitor cost-saving opportunities in light of service reliability and quality. Consistent power, for example, is vital for operating and emergency rooms, and dependable communication channels are essential for prompt coordination of care and back-office efficiency.

“Selecting Accenture to manage several indirect spend categories allowed our supply chain organization to focus on our core competencies during a period of rapid growth. Effective leveraging of internal and third party resources and expertise has provided the proper balance for yielding optimal savings across the system. Accenture had the category expertise, data analytics and the advanced methods essential for enabling Northside to save millions of dollars on utilities and telecom. CARL WALLER—Vice President, Supply Chain “

Results
Accenture’s managed services approach dramatically simplified bill review and payment activities, and rationalized the portfolio of Northside service providers in energy and telecommunications. In one example, Accenture was able to simplify the Accounts Payable process by identifying 300 energy accounts, consolidating multiple billings into a single invoice per vendor and enabling payment through electronic transactions. Based on leading practices, the project team was able to negotiate refunds and more favorable contractual terms for Northside. Key financial results, achieved in non-labor areas, include:

The managed services approach is helping Northside stay within contractual terms to achieve its desired savings. Accenture continues to monitor trends in the energy and telecommunications categories so that once acquisitions are integrated into the growing organization, they will also be able to benefit.

Due to the success of the ongoing projects, Northside management has expanded the scope to other service categories including information technology.

Ongoing savings help to shore up the bottom line, which increases funds available for mission-critical objectives, charity and improving patient care. The savings are also vital for providing a competitive edge in Atlanta’s growing market for healthcare.

ACCENTURE INSIGHT-DRIVEN HEALTH
Insight Driven Health is the foundation of Accenture’s innovation-led approach to more effective, efficient and affordable healthcare. Our committed professionals operate at the intersection of business and technology to combine real-world experience, business and clinical insights and innovative technologies to deliver the power of insight driven health. That’s why the world’s leading healthcare payers, providers and public health entities choose Accenture for a wide range of services and technologies that help them use knowledge in new ways—from the back office to the doctor’s office. Visit www.accenture.com/health

With new advances in wire-free localization technologies for surgical guidance and excision of small, non-palpable, imaging-detected malignant or high-risk breast lesions, Mills Peninsula Medical Center saw an opportunity to improve upon the quality of care and patient experience for those requiring these procedures, while improving efficiency and capacity for these services and procedures.
Harriett Borofsky, MD, Medical Director of Women Imaging, explains how Mills-Peninsula Medical Center implemented wire-free localization.

What was the main objective in implementing wire-free localization?
In embarking upon wireless localization procedures, our objectives were to assess overall patient tolerance and satisfaction while undergoing these procedures, to determine ease and accuracy of reflector placements and complications for the full gamut of mammographic, tomographic and ultrasound detected lesions, including those lesions requiring bracketing, and to assure successful intra-operative removal of all reflectors and index lesions. Secondary outcomes would be improved overall efficiency and capacity of radiology and operating room services and positive impact on margin status, compared to traditional wire localization procedures.

Who were the champions of this effort?
The wire-free localization effort was led by myself and Andrea Metkus, M.D., Medical Director of the Breast Cancer Program and breast surgeon at Mills-Peninsula Medical Center.

After a review of available wire-free localization technologies, the Radar Localization System was selected for a 15-patient feasibility study. The lead radiologist was trained in reflector placement and deployment and the lead surgeon was trained in intra-operative reflector retrieval procedures. All patients diagnosed, via minimally invasive tomographic, stereotactic, ultrasound or MRI-guided core needle biopsies, with high-risk lesions requiring surgical excision or malignant lesions amenable to breast conservation surgery with lumpectomy, were referred for surgical consultation.The surgeon then referred appropriate patients for reflector placement prior to their scheduled surgery. The first 15 cases were performed and reviewed for successful reflector placement and retrieval, complications and patient tolerance and satisfaction.

Our feasibility study and results were officially presented to the New Procedure and Technology Evaluation Committee, Mills-Peninsula Medical Center, comprised of the hospital’s CEO, CFO, Chief-of-Staff, Vice Chief-of-Staff, Nursing Supervisor, managers of the radiology and surgical departments and foundation president.

Following official approval, the wireless technology was funded by the Mills-Peninsula Medical Center Foundation. The new technology was then promoted and communicated to the hospital staff and physicians through department meetings and a written article in the Professional Medical Staff Newsletter.

What outcomes were observed upon completion of the project?
Our project and feasibility study on wire-free localization procedures confirmed a positive impact on patient experience for those requiring these procedures, an improved overall efficiency and capacity for the radiology and OR departments by decoupling the surgery and radiology schedules, successful localization and surgical excision of reflectors and index lesions in all cases and elimination of surgical mishaps related to wires and wire localization procedures.

For many patients, the most dreaded aspect of breast surgery is the needle localization prior to the procedure. This requires patients, who are NPO, to have uncomfortable wires placed two hours prior to scheduled surgery. Wire-free localization procedures proved to be easily and conveniently scheduled, well tolerated by all patients and without complications.

All index lesions, including those requiring bracketing, were able to be accurately localized. Our experience confirmed this procedure to be easily learned, quickly performed and incorporated into the breast imaging center’s workflow for all localizations, including bracketing of complex lesions, with high accuracy.

For the operating room schedule, wire-free localization increased capacity to start procedures early in the morning, while eliminating unexpected delays due to vasovagal events, complications and transportation issues related to wire localizations on the day of surgery. For the radiology/breast imaging department, the technology eliminated the need to place wires on the day of surgery and avoided procedure and capacity conflicts.

How did your team innovate to reach the stated goals of the project?
This was the first collaborative project conducted between the breast center and the outpatient OR teams, supported by the administration and funded by the foundation. We had several meetings of lead physicians, staff and administration to discuss the project, address concerns and training and assure seamless workflow and patient safety. It was an exciting collaborative effort, benefitting our mutual patients and our department’s workflow, which was embraced by all.

To achieve a successful wire-free program, it was essential to create new protocols and work flows for wire-free localization scheduling, procedure performance, image access on the day procedure and specimen radiography and documentation on the day of procedure. This too was a collaborative effort between surgery and radiology scheduling and OR staff, requiring changing decades-old habits.

While we are still refining our processes for wire-free localizations, we are so encouraged by the positive impact it has had on overall patient experience and quality of care, easing patient anxiety and procedure time on the day of surgery, while improving workflow and overall capacity, especially in the operating room.

As a key target for hackers and state sponsored cyber-thieves it is thought that the value of a healthcare record is seven to ten times greater than a credit card record. This is because protected health information (PHI) has a longer “shelf life” than traditional financial data, and it can provide a unique view to a population for foreign governments.

When hackers succeeded in stealing, or even deleting thousands of medical records, the resultscan be catastrophic. Not only does it damage the organizations reputation and potentially result in numerous lawsuits, there are clearly negative implications for the rights of patients and customers.

IT professionals are fighting to secure information, appropriate access and confidentiality — all within an environment where immediate access to data is literally life and death.

Start with the basics – training and procedures

But where should healthcare organizations direct their focus not only help to safeguard sensitive patient data, but also to satisfy an array of overlapping compliance requirements from the Health Insurance Portability and Accountability Act, or HIPAA to the United Kingdom’s Data Protection Act.

First, address the human aspects of security by providing effective ongoing training and ensuring you have robust security procedures in place. Make sure you create and share a security policy with everyone in your company and include any penalties for poor security that will be enforced.

Our research however showed that across healthcare, 39% of employees did not receive IT training upon joining the company and 37% of companies did not even have a documented IT security policy to speak of. These naïve and irresponsible approaches to securing sensitive data speak volumes about how easy it is for hackers to access a healthcare network.

It’s thought that 70% of the data losses are caused by human error so these negligent users are your unwitting participants in phishing and social engineering scams. They take the bait and help to infect endpoints with malware that may be the attack (as in the case of ransomware) or simply provide a foothold for further actions by criminal online organizations.

Users are human. Training will never be enough

But creating a culture of safe IT practices amongst everyone in your company is not enough. Users are human, they are flawed, and they are careless and often exploited. They will always act outside the boundaries of policy and sometimes common sense. Whilst most individuals given the appropriate information, will pursue a course of action that supports the organization’s security initiatives, most is not all. This trust needs to be verified. An organization cannot continue to blame the user and demand even more training.

What’s more, it isn’t always an incompetent or ill-prepared member of staff who opens up a company’s data to hackers.

The Malicious Insider or External Attack
Malicious users are your insiders that have shifted their loyalty from the organizationwhere they work to themselves, and are engaged in some kind of inappropriate activity (such as hacking, data theft, etc.) that benefits themselves over the organization.

The external attack is likely more a member of an organization than a loner. These individuals leverage hacking, social, malware, and many other toolsets to create a way into your network. Once inside, they work to take on one or more sets of elevated credentials to provide them with greater access and an ability to move about the network in an attempt to identify valuable data.

Spotting any of these is difficult.

When you boil it down, the only way to really tell if someone has been exploited, is a malicious insider or an intent external threat actor is by allowing them to perform actions (such as launching applications, authenticating to systems, accessing data, etc.) and determine whether the actions are inappropriate.

But given the majority of your user population doesn’t act the same way each day – let alone the next week or month – it makes more sense to spot the threat actor by looking at leading indicators of threat activity, rather than waiting for the threat activity itself.

One of the most accurate leading indicators is one no malicious insider or external threat actor can get around – the logon.

Stopping threats at the logon

The simplest and most common activity to every threat action is the logon. Nearly all threat actions require a logon using internal credentials. Endpoint access, lateral movement between endpoints, external access via VPN, remote desktop access, and more all share the common requirement of a logon.

The concept of logon management centers around four primary functions – all working in concert to maintain a secure environment:

• Policy & Restrictions – Establishes who can logon when, from where, for how long, how often, and how frequent (simultaneous sessions). It can also limit specific logon types (such as console- and RDP-based logons).
• Real Time Monitoring & Reporting – Every logon is monitored and tested against existing policies to determine if a logon should be allowed. Reporting helps ensure detailed insights for any investigations.
• IT and End-User Alerting – Notifies IT and the user themselves of inappropriate logon activity and failed attempts.
• Immediate Response – Allows IT to interact with a suspect session, to lock the console, log off the user, or even block them from further logons.

In essence, logon management makes the logon itself a scrutinized and protected event.The ability to successfully logon (and remain logged on) becomes more than just whether the right credentials are used.

A logon management solution will detect an abnormal access attempt based on the customized and granular logon policies that are set for that particular account (employee). It will act accordingly – either denying or approving the logon – and alert IT (or the appropriate user themselves) if stipulated.

No logon, no threat

Logon Management is a simple, efficient and effective means of thwarting potential threats. It provides a protective layer at the logon, which logically exists before action occurs, to stop the threat entirely. No logon, no threat.

Some of the potential insider threat scenarios that are now thwarted include:

• Genuine but compromised logins from exploited users are now useless to malicious insiders or would-be attackers.
• Careless user behavior such as password sharing, shared workstations left unlocked or logging into multiple computers simultaneously is now eradicated.
• Access to any data/resource is now always identifiable and attributed to one individual user. This accountability discourages an insider from acting maliciously and makes all users more careful with their actions.
• Suspicious activity is alerted on offering IT the chance to instantly react.
• Users are notified with tailor-made message and alerts – including alerts on their own trusted access. Informed employees are another line of defense.

For Windows-based networks, IS Decisions logon management solution, UserLock, provides a comprehensive layer of security at logon. Using a mixture of enforceable logon policies, alerting, and response actions, UserLock uniquely empowers IT organizations to leverage the active directory logon as a critical security checkpoint – before threat actions take place.

No technology can completely eliminate the chance of an attack, but there is a way to drastically reduce the potential risks. Tools such as UserLock offer greater control for admins and completely restrict various careless user behaviors, as well as encouraging good behavior through alerts and notifications. Just what the doctor ordered.

Consider the vast amount of data at their disposal. As clinical engineers go about their work, they collect vast amounts of valuable information, including when medical devices aren’t where they are supposed to be, how frequently a device needs repair, and the cost of labor, parts and travel time.

However, that data is largely isolated, and frequently not being utilized to its utmost potential. That’s because for an astonishing number of hospitals, this data is still entered on spreadsheets. And there it sits: useless to the organization at large because the information is not readily available and accessible except to the person who knows it is there.

The solution lies in implementing a modern system – one that is mobile-enabled and data-driven – that can process and share information in real-time so that decisions can be made quickly and an organization can operate at peak efficiency, with minimum downtime for those critical devices that hospital staff rely on. Not only will creating this type of agile system empower your clinical engineers, it will deliver tangible benefits across compliance, cost and contract negotiation.

Improved Compliance
Take compliance: when the National Health Service (NHS)comes to the door and says, “Prove that you are maintaining your devices,” it usually results in a mad scramble – one that can raise blood pressure for days. Where are the records? What about all those devices that couldn’t be located? Was maintenance performed in a timely manner?

However, an integrated system that allows clinical engineers to log data online every time they work on a piece of equipment from their mobile device eliminates any cause for apprehension. Instead of scrambling around trying to locate multiple, disparate records, a report can be easily printed within five minutes, containing all the requisite details. Importantly the data is complete, accurate, and up-to-date.

Being able to log data in real-time from any device can also ultimately help reduce the preparation costs that associate with compliance by as much as 90 percent. For a 600-bed hospital system, this could translate into $100,000 per year or more in savings.

Performance Monitoring
Then there is the matter of purchasing. Imagine that you have expanded your hospital. Market share is high. It’s the perfect time to purchase a new MRI. Which one will you buy? The one for $2 million, or the one for $900,000? You have an MRI from each manufacturer currently in your network. Now is the time to ask, “How do these two machines stack up?”

The power of data analytics can lead to improved purchasing processes and significant cost savings. For example, data collected from clinical engineers on the performance of each machine could help you identify important factors such as how often the machine requires repairs, what those repairs entail from a labor and cost standpoint, and what is the cost of the downtime that could result in the event of a breakdown.

By leveraging this data, hospitals have the potential to drive down medical equipment spend by as much as five percent. That may not seem like a lot in itself, but consider: if the annual spend for medical devices for a hospital is $50 million per year, a five percent decrease in spending would translate to cost savings of $2.5 million.

Contract Negotiation

Finally, consider contract negotiation. Maintenance contracts for equipment are a major budgetary line item. However, a platform that can take the data provided by clinical engineers and use it to automatically compare what it would cost in terms of travel, parts, and labor to perform maintenance on a piece of equipment in-house vs. the cost to renew a manufacturer’s contract for the same device would speed up the decision making process and save money. For example, suppose the service contract on an MRI is $107,000 per year. In a matter of minutes, advanced analytics would be able to tell you whether it would cost more or less than that to maintain the MRI internally or seek outside support.

By making data-driven decisions and negotiations with regard to contract management, it is frequently possible to save 10 percentor more on contract spend. If contract spend was, for example, $15 million per year, a 10 percent savings would be $1.5 million – a very significant ROI.

Unlocking Success
The value of a mobile, connected, real-time system for medical device management goes far beyond making the clinical engineer’s job easier, which it certainly does. The true value of such a system is that it recognizes clinical engineers hold the key to success for multiple departments within the organization – and leverages the data and insight they access to unlock the keys to success in a way that will benefit both the entire hospital and the patients being treated.