Digital transformation in healthcare

Simon Kos explains why we need to be more protective of our health data – or risk falling victim to true identity theft. 

If stolen financial data results in empty bank accounts, what could stolen health data lead to?  Simon Kos, Health Industry Executive at Microsoft, examines the state of digital transformation in healthcare and urges us to take better care of our sensitive health data.

What are the challenges and limitations around medical records? Whether electronic or paper-based, what are the root causes for the issues around sharing information?

There are two different points to that. Paper is much-maligned because of doctor’s handwriting and that it can only be in one place at one time. It’s also difficult to absorb the narrative – even if you can understand the writing. But one of the great things about paper is its efficiency. As a clinician doing my ward rounds, I could go from patient to patient. I could read a bit, document a bit, and I was highly productive. So paper was elegant in its simplicity, even if it had some limitations.

When we transitioned to a digital record, we fixed some of those limitations. Doctors’ handwriting was now legible, and you could see the same chart at many places at once. It was never locked in the boot of someone’s car or stuck in a clinic somewhere. But the digital record also introduced some workflow challenges.

Now, if you want to go around the ward from room to room, you need the right point-of-care device like a tablet or a mobile PC, and the right system that allows you to log on quickly and interact with that information intuitively. Without that technology, clinicians have to go back to the nurse’s station and look up results, and it’s no longer in real-time. If you don’t have enough terminals, that can introduce some workflow inefficiencies, which creates a lot of frustration for clinicians who ultimately just want to treat patients and save lives.

Is that one of the barriers to technology being widely adopted – the fact that it can actually have a negative effect if it’s not implemented correctly?

It’s not a barrier for it to be adopted and implemented, but once it’s in, it is absolutely one of the greatest causes of frustration for clinicians. They’re all on board with the idea of using technology effectively – because at the end of the day, health is a team game, and it’s a data industry. But if you present that information in a way that makes it difficult to get their jobs done, that’s where you’ll hear about it. The clinician who can’t get access to the record to read what they need to read, or document what they want to do, they will get frustrated and often they will find workarounds.

That’s what we’re in the midst of right now. We’ve got these systems of record, which are great; all of the patients’ information is in there. But those systems of record need to be complemented by systems of engagement. How do people use that information on the fly? How do they share information? Unless there’s the right system that’s complementing that system of record, they’ll do it using their personal devices or shadow IT.

In today’s modern cybersecurity environment, that’s risky as well as fragmenting your information.

How do you make sure you introduce technology, which is a supporting tool, that enables clinicians to deliver care?

 Once upon a time, we looked to a single provider to do it all. We said, “Righto, you’re going to be my electronic medical record provider, laboratory provider, or pharmacy system provider. You need to do it all.”

But it’s difficult for one organisation to be everything to everyone. Those systems do something really well, and that creates a longitudinal patient record, which you need. But increasingly, especially as we go down this digital-maturity journey in our society as end users, we expect those systems to be fast, intuitive, familiar, and to grow and adapt with all the other technology that we experience in our lives. I’m starting to see a decoupling of those core systems of record with systems of engagement. How do you put a flexible skin over some of those systems so that you can access them in new ways?

The second point is clinical workflow, so clinicians will use technology – and use it in the way it’s intended – so long as it’s intuitive for them and they can access it quickly. But if you roll out a great system and hide it behind a very complicated login or authentication process, then that’s challenging for them. Unlike many other organisations where you come into work, log into your system, break for lunch and that’s it, clinicians – especially in a shared environment like the emergency department or wards – are often walking up to kiosk-style devices. So the login process needs to be really rapid. If they get kicked off for whatever reason, or if they need to run to a patient, or if some other colleague comes by with an urgent need to access it, then they need to be able to regain access to that session quickly.

If we can pair the right systems with a convenient workflow tool that allows them to efficiently and effectively log on – while also assuring the security and confidentiality of those records – then you won’t get pushback from clinicians. I’ll be happy to use those systems and use them in the way they’re intended.

Who are the stakeholders in a successful digital transformation journey?

Clinicians are the ones who have the information-management requirements for accessing that information, digesting it and contributing to it over time. So they’re a key-stakeholder group. They will be able to tell you what they need and where the process is breaking down. Unfortunately in the past, those requirements were handed off to IT as a technical function to make improvements. IT are an important stakeholder, but putting in these systems isn’t a technical process, it’s actually a clinical transformation journey.

So there needs to be some sort of liaison. Classically, you’ll find them with titles like Chief Medical Information Officer. Otherwise, it might be an empowered clinician like the Director of Clinical Training or Director of Medical Services. That role is essential. There needs to be top-level support and vision. Having the right healthcare executive who believes in the power of digital – that’s important because these are complex projects, they’re expensive projects and they take place over time.

A stakeholder who has been forgotten in the past but is increasingly emerging as someone important is the patient themselves. So often these systems have been put in place for the clinicians to get the information they need at the point of care, or for the organisation to manage all the admissions, the discharges, the transfers, the appointments. But increasingly, patients have an expectation of how they access services. They’re digital consumers in other industries, and they come with an expectation of, “Hey, I should be able to see parts of my record. I should be able to manage my own appointment and do that digitally. I should be able to get the app on my phone.”

That’s an area that we can do better with going forward, and you’ll hear it with names like Patient Engagement System or Digital Front Door or Booking System. But all of that is the shift to more consumer empowerment and patient enablement.

Is the future of healthcare a collaboration between clinician and patient that’s underpinned by a suite of technology?

 We’ll never get rid of trauma and all that sort of stuff. But increasingly, the most expensive driver of our health system is an ageing population and the burden of chronic disease. So those are the capabilities that we need to improve.  Because if we do it well, we will help people stay healthy and enjoy a quality of life for as long as possible.

Secondly, that’s a big driver of cost. If we spend our health dollars wisely, we’re able to treat more people and get better patient outcomes for the dollars that we do spend. So that’s urgently where we need to pay a bit more attention.

Want more insight into the world of security, identity access management, biometrics and more? Get your fix with the IDentity Today podcast, hosted by Daltrey MD Blair Crawford. You can start on Episode 1 here or listen via Apple Podcasts, Spotify or your favourite podcast app.