Healthcare works better as a democracy

Patients across the world look upon healthcare as a multi headed dictator that refuses to accept the reality that transparency and accountability are of paramount interest. While the profession is truly blessed to have the world's most talented individuals working to save lives it is also true that healthcare is creating an increasingly isolated world that is walled off from the problems that most patients face every day. It is a glittering cornucopia of hospitals, clinics, diagnostic laboratories and wellness centres that are apparently running like well oiled machines. It is a world that has shed its inhibitions about being known as a business and instead openly revels in the fact that it has created a treatment divide that reflects society at large. Healthcare institutions are on the fast track to enterprise stardom and that fact has not gone unnoticed by healthcare technology investments that have risen to more than $3 Billion worldwide and healthcare buyouts were more than $30 Billion last year (source: Bain capital). These numbers are just the tip of the iceberg and given that Asia-Africa has most of the world's population, there will be huge uptick in these numbers in the coming years. Worldwide, healthcare insurance companies rake in more than $1 Trillion as revenue and their shadow will loom large in our lives with the chilling statistic that more than 60% of the world’s population have at least one chronic ailment.

Patients are increasingly disillusioned about current healthcare practices which include:

Overloading: Patients are being treated at care centres that are understaffed and have over stressed personnel. This is a common problem that is accelerated by social networking marketing programs, increased attempts to corner patient footfall by using competitive outreach practices, etc

Rising costs: Costs for an average patient are expected to rise by almost 5% (source: Deloitte) year on year until 2020. These costs are rising on the back of increased capital investment by healthcare providers, costlier hospital visits, increased cost of specialty medicines and complex machine dependent procedures

Corrosive Patient Doctor Relationships: Patients are becoming increasingly hostile to the idea of having a trustful relationship with their doctors. The emergence of several negligence related cases worldwide have scarcely helped. Profit motives are suspected at every turn and every diagnosis test that is ordered is treated with a world weary cynicism. These and more have been noted in several patient surveys conducted across the world with the most notable being the AMA healthcare survey in 2014

Emergence of Care Silos: Hospitals for a long time have been leery of sharing information on patients to other requesting hospitals. Health record privacy and security have been the primary reasons for many healthcare institutions to not share patient data. Provider networks have created isolated directories of services that require patients to be highly skilled to find professionals to their liking. Third party EHR repositories are segmenting the market even further. Even within a hospital there are departmental procedures that are not part of the overall clinical treatment process

Lack of inter hospital collaboration: In what may sound positively antediluvian, it is extremely difficult for patients to move treatments from one hospital to the other very easily. It requires significant sign-offs from the patient and abdication of responsibility from the original care centre to make this happen. Patient information cannot be exchanged on demand and the eventual lock-in is quite painful both financially and logistically. The exception to this rule are the really large hospitals that maintain their own network of registered providers

What are the bottlenecks?

A significant obstacle facing healthcare is the lack of standardization including documentation, clinical procedures, terminology, test reports, etc. Standards abound but standardization itself has missed the bus. When a patient wants to share information across hospitals, it is invariably a stumbling block to convince other healthcare professionals to process the information. It is even more difficult to electronically transmit patient information from one institution to the other. Cost/Revenue sharing via bundled payments is nonexistent across hospitals with there being no incentive to work with the ecosystem in broadening the experience for the patient. Compelling business cases don’t exist for hospitals to address the needs of the patient once he/she leaves their facility. The hospital revenue model is based on profit maximization profit per in-patient since there is no referral system in place that spans other healthcare institutions. The system lacks mobility driven practices that build dynamism in the service model in terms of service tracking, patient sharing, remote monitoring and workload offloading. The idea of universal healthcare record exchanges seems to be as much of a reality as the lost city of Atlantis.

What is the solution?

Healthcare needs to think of itself as a gigantic enterprise and leverage transparent models that benefit all stakeholders within the system. Patient convenience is a key driver as is service experience. It must dispense with protectionism and instead focus on developing a profit sharing ecosystem that will provide maximum care to patients at affordable costs. The healthcare business model must increasingly turn towards service optimization with focus on patient volume. The industry must enhance its ability to provide quick turn arounds, segment services, personalize patient handling and leverage institutional interoperability.

Patient care must be distributed across the ecosystem with the focus being convenience for the patient, affordability and efficiency of care. A patient with post operative care requirements could conveniently get it done at a local care centre with the coordination of the specialized hospital responsible for the operation. A patient could be admitted into a geographically remote specialized hospital from a care centre close to him based on the local physician's diagnosis backed up by electronic transmission of health documents. Preventive health programs can be conducted by smaller care centres following standardized operating protocols served up by coordinating hospitals at a fraction of the cost. Geriatric patients can be treated at home as much as it is practical by coordinating treatment procedures across specialized hospitals, physician run clinics and specific home care providers.

The binding force between different healthcare institutions will always be transparent automated workflows that are optimized for the mobile platform. It unifies workflow silos that exist at all levels and creates a closed loop ecosystem that can continuously optimize service quality. It allows hospitals to circulate information with complete accountability and transparency. Universal workflows are those that start by automating interoperability procedures across the healthcare spectrum. These openly accessible workflows will involve doctors, diagnostic facilities, hospitals, patients, clinical/administrative staff, regulatory bodies and insurance companies. Coordination is achieved by building open accessible workflows that can be leveraged by all care centres irrespective of their location/specialization. These workflows will deal with admission, patient transfers, post operative care, discharge, cashless payments, preventive health programs, insurance reimbursements, telehealth, home care, health profile analysis ... and the list goes on! Eventually universal healthcare workflows will penetrate care centres and unify all tasks (clinical, administrative, emergency, regulatory, payment and advocacy). This will allow EHR providers to ship access to documents as part of these workflows thus achieving a colossal milestone for the healthcare industry.

Healthcare can learn from other process oriented industries and not build complex monolithic applications to service their needs. The era of mobile workflow has dawned and Business Process Management (BPM) frameworks are the right solution for such a system. BPMs will allow the individual healthcare provider a high degree of customization. Secure text messaging services can be integrated to ensure secure inter hospital communication and enable document sharing. Cloud storage is the perfect repository for EHR documents and can be easily plugged in to the overall solution. Internal clinical procedures need to be implemented as BPM workflows so that end to end integration into the universal workflow set becomes possible. Integration with electronic wallet systems is a snap and the entire payment process can be completely automated. Workflow analysis will make for better decisions in revenue management, point of care, risk coverage and setting insurance premiums. The ultimate beneficiary is the patient as any healthcare service can be tracked, optimized, approved, overhauled, validated and personalized.

How will it impact the existing ecosystem?

Times are changing and healthcare is becoming a seething vortex of disruptive solutions that are profoundly altering the landscape. Application vendors will have to open up API to integrate with external workflow systems. The healthcare services online marketplace is evolving at a rapid rate and will be a fundamental driver for universal workflows. Telehealth by integrating portions of the ecosystem into a hub-spoke model is further creating the need for electronic coordination amongst institutions. Regulatory bodies will demand transparency in audits as well as inspections. Patients will ask and receive procedural data records thereby bringing enormous transparency and infusing optimism. Standard operating protocols will be opened up to enable patient sharing causing instant democratization of the entire industry.

Universal healthcare workflows form a truly disruptive model that welds the ecosystem together instead of sundering it. It has been gathering momentum ever since healthcare providers decided to cocoon themselves. Universal workflows are coming and there is nothing the industry can do to stop it. The healthcare start-up landscape is vibrant and companies are attempting to redefine the industry by focussing on EHR exchanges, clinical analysis, simplifying billing, patient wellness, clinical productivity, etc. Each new healthcare start-up is a catalyst that is building the momentum to create a revenue sharing unified ecosystem with open standards and endless opportunities. Healthcare is in the crosshairs of a war between the Goliath and David. The ultimate victor is you!