We spend a great deal of time and effort trying to make healthcare more affordable and to ensure better outcomes. Too often, the upshot is to reduce all problems and challenges to a singularity in search of a silver bullet. It never works, but it seems like human nature to take that approach.
Salesforce has taken a tactic that is bearing fruit, in part because it isn’t really trying to fix healthcare. Instead, it has set a more modest goal of making the information flow a little better. It turns out that this can have big positive effects.
Like many industries, healthcare began its information automation odyssey many decades ago by building systems of record — places that stored diagnostic data for rapid retrieval. Initially that was plenty, because a single doctor usually took care of the patient. When multiple specialists began treating the same patient, data got big and demands for it increased significantly.
Today an army of people participate in patient care — from nurses and technicians to doctors, both generalists and specialists — and they all need access to the patient’s data. Hospital IT was set up to serve the information needs of doctors in the hospital, but data consumers increasingly call for data in and out of the hospital and at all hours.
The End of Hospitals?
This is all brought home in “Are Hospitals Becoming Obsolete?” published earlier this week in The New York Times. In the article, author Ezekiel J. Emanuel, MD, presents some startling information for the layperson. For example, the peak year for hospitalizations in the United States was 1981, and they have been declining ever sense.
In 1981, there were 6,933 hospitals in the U.S., while there are now 5,534. It’s not healthier lifestyles that account for the decline, though. Healthcare, like Elvis, has left the building in favor of clinics, ambulatory surgical centers, birthing centers and other noncritical care centers.
Patient data has not kept up with the trends. Much of it still exists at the hospital or other places where it first was gathered. For instance, lab or radiology studies may remain on the servers of a hospital or radiology practice, and primary care doctors must be able to log into those systems to get results.
It’s also not unheard of for a doctor to need multiple datasets on a screen at the same time to make intelligent treatment decisions.
What’s needed today are integrative systems — what we in the business world might call “systems of engagement” or even “systems of intelligence.” Such systems might capture data from the relevant third-party applications in a practice’s geography to provide practitioners with all the necessary patient information on a screen or at least on a device.
When necessary, those systems should be able to crunch raw data to produce the information that practitioners need to make decisions.
Salesforce’s approach has been to capture care data from various sources, extract information through artificial intelligence and other methods, and then deliver it to the healthcare provider at the point of service, which puts the patient in the center of the care network. It also opens a lot of new opportunities that hospital systems don’t have the bandwidth to address.
For instance, a patient on a long-term treatment plan — such as for diabetes or asthma, for instance — would benefit not simply from a diagnosis and a prescription, but also from a friendly phone call. Simple periodic check-ins can do much to help patients stay on plan and avoid costly readmissions. The technology needed for this approach to healthcare is all in the CRM bucket.
This approach fundamentally changes healthcare. It goes from a 20th century model of fixing something that’s broken to a 21st century model of preventing an outage. It’s the same basic idea as the Internet of Things, only with people. In the IoT, it’s preventing a machine outage; when applied to people it’s supporting wellness.
Many cloud computing enthusiasts have despaired of ever seeing much progress on that front for healthcare. It’s too this or too that, or just too hard to expect healthcare providers to cross the chasm to cloud computing.
Perhaps we’ve been looking in the wrong places for results. Hospital and practice-based systems do a good job as systems of record, and rebuilding them in the cloud might have benefits — but at unacceptable costs. Even if the costs were low, we’d be fixing the wrong problem.
When cloud computing arrived at the front office, it changed the work of the front office. We’re seeing the same thing now in the back office. Business processes that barely could be imagined are coming on stream.
The same appears to be happening in healthcare. Although there’s still a long distance to travel, the flexibility of the cloud and the creativity of its users have been opening new vistas, even in the stodgy world of healthcare IT.