Technology and the Business of Health Care

Craig Wright, M.D., Chief Medical Officer, The Portland Clinic
Craig Wright, M.D., Chief Medical Officer, The Portland Clinic

Craig Wright, M.D., Chief Medical Officer, The Portland Clinic

In 2009, the government passed the Health Information Technology and Economic and Clinical Health (HITECH) Act that resulted in $35 billion of incentive payments for providers to install Electronic Health Records with the goals of increased efficiency, reduced costs and improved quality for the American health care system.

This year marks the 10-year anniversary for the Meaningful Use digital age of health care. Today, providers continue to spend billions of dollars on technology platforms, meaningful reporting and data security. The costs associated with maintaining and developing IT infrastructure is a key driver for industrial swings including the consolidation of health systems, rural hospitals scramble for viability, and the employment of physicians by large health systems. Technology is a revolutionary force and will continue to transform the business of health care.

As in most revolutions, the end users bear the biggest burden of change. In health care, the end users are often doctors and nurses who are at the front end of providing patient care. Despite often feeling overwhelmed, end users are unanimous about not going back to the world of paper charts. The gains in safety, communication, legibility and quality are immense.

However, we must find a way to decrease the friction for providers who labor with charting, which often includes cumbersome data entry, as they discharge their clinical responsibilities. A significant challenge for physician efficiencies is the huge variation in how work is done. The workflows for routine services such as office visits, ordering tests, patient follow up, and triage, often varies widely depending on specialty, staffing and training. Despite the uniqueness of each practice, technology developments that improve throughput with less friction hold tremendous opportunity for health care organizations. Voice recognition, seamless navigation of data, streamlined revenue cycles, and cleaner documentation systems have transformed many industries, including banking and transportation in the past few years. Despite health care’s inherent complexities, similar technology enhancements can improve productivity while decreasing workforce frustrations. Health care is ripe for technological efficiencies that provide a direct economic payback and help organizations attract and retain talent.

From the patient’s perspective, traditional health is far from being convenient, easy or coordinated. Patients are concerned with the cost of care, long wait times, and inconvenient hours and locations. High-deductible insurance benefits and increasing service expectations are driving consumerism in today’s health care environment. This can be especially disruptive in the low-acuity services historically provided by primary care, which is leading to a proliferation of retail and immediate care options. Technology-based innovations that focus on disrupting traditional health delivery is popular with venture capitalists and other sources of investors. Large purchases of health care like Amazon- Berkshire Hathaway-JPMorgan Chase, are investing millions of dollars to innovate and make health care easier to use and less expensive. In response, many health care systems are developing their own patient portals to increase brand loyalty. Common functions of these consumer-facing apps include:

• online appointments

• results for lab and radiology studies

• medication refills

• online bill pay

• wait time estimates at urgent care centers

• way finding to facilities (or around facilities)

• and much more

Many health care organizations are also actively managing their brand through digital and social media strategies. It is true that word of mouth remains the strongest way to build, or destroy, a provider’s reputation. However, in today’s environments people communicate through digital modalities rather than direct conversations. In addition, social media is a potent aggregator and amplifier of a message. A provider is at a distinct disadvantage if they do not have effective internet, search engine and social media initiatives. A growing industry is vendors that can provide effective and easy to execute digital health care solutions.

Another growth area is helping providers manage chronic diseases, especially as health care reimbursements shift from volume (fee-for-service) to value-based (performance) incentives. Performance incentives are often tied to cost, quality and patient experience for a defined population. A typical arrangement could be that a health system will have a bonus payment for the Medicare members of a particular insurance company based on diabetes management, patient satisfaction and total cost of care. Chronic diseases like diabetes, lung disease and coronary artery disease all have effective interventions that change the course of illness if applied at the right time during the disease process. From a cost perspective, these chronic diseases, and their sequalae, now account for the majority of health care spending in the United States, as opposed to acute events like infections, surgeries, and trauma. Technology innovations have a critical role for effectively managing chronic diseases, especially outside of the walls of hospitals and clinics. Collecting, coordinating, and reporting on metrics like blood pressure, blood sugars and lipids as well as quantitative measures like exercise, diet and motivation are essential in the management of chronic conditions.

Finally, the highly anticipated role of artificial intelligence and data mining certainly holds promise for health care. The digital age of health care has created more data than ever before, allowing for the discovery of anomalies and patterns within large data sets across organizations. This combined with the explosion of digital devices in our everyday life will create disruptions, efficiencies and innovations that will surely change how health care is delivered in the future.

Health care spending is predicted to be 19.9 percent of the GDP by the year 2025 making it one of the largest industries in our economy. In addition, the social and political ramifications of health care are hard to overemphasize in today’s environment. Technological advancements are deeply intertwined with the future of health care and innovations will impact how providers do their work, improve access, and build patient loyalty.

Reimbursement for many providers is also shifting from volume to value-based outcomes, and technology solutions are needed to effectively manage both individuals and defined populations.

These truly are interesting times for the business of health care.

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