Picture a scenario where, by collecting the right data and using today’s sophisticated analytics, our health system could predict when a patient with chronic conditions might get very ill and require hospitalisation, and intervene before that happens, thus saving the health system millions, and improving the outcomes for patients. A pipe dream? No, it is actually happening in the Basque country in Spain, where an e-health pilot is using today’s big-data technologies to do just that.
eHealth week runs 13-15 May, and one of the main events is the World of Health IT (WoHIT) – a gathering of 2,500 health and IT professionals on the advancement of health IT in Europe. It takes place in Dublin for the first time this year, to coincide with the High Level eHealth Conference co-organised by the European Commission and the Irish Presidency of the Council of the European Union.
Among a bevy of global e-health experts coming to town is Mark Knickrhem, global managing director of Accenture Health, which is involved with the Spanish trials. Based in Singapore, Knickrhem has a long track record of guiding large provider organisations in clinical change programmes. Prior to Accenture, he was a partner at McKinsey & Company, where he also focused on helping hospitals and physician organisations develop market-focused strategies supported with technology.
At a time when countries like Ireland and Spain are struggling to do more with less in their creaking health systems, Knickrhem painted a picture of an efficient and patient-friendly system through the use of technologies that already exist today.
Healthcare and the over-65s
The health system challenge is at its most severe when it comes to the over-65s, said Knickrhem. With our well-documented aging populations, the rising rates of chronic disease, and increasingly expensive treatments, the World Health Organization estimates that by 2015, chronic diseases will account for 64pc of all deaths, a 17pc increase over 2005.
As policy-makers worldwide struggle to deliver better outcomes at lower costs, Knickrhem, and many of his peers, believe that ‘connected-health systems’ - IT-enabled networks that capture all patient data and allow it to be shared – are the key to better, cheaper and more accessible care.
Indeed, RAND Health, the non-profit health policy research organisation, estimates that interoperable electronic medical records (EMRs) could cut between US$142bn and US$370bn from the projected 2018 US healthcare bill of US$4trn.
“The pressure is finally on the industry in all developed, and even developing countries, because of the aging population, and populations gaining weight as they age,” Knickrhem said.” If there’s anything that’s certain in medicine it’s that an older and heavier population is more expensive. And when you have so many people at once coming into the most consuming years of their lives, 60 years plus, then that is putting unbelievable budget pressure on health systems around the world.”
Yet the move to information-based systems has been slow in health compared to other sectors. “I’ve worked in many service industries over the years, telecoms, financial services and others, and there is a pretty good understanding now that service industries compete on information. That’s how they improve and deliver services.
“But there’s been just one industry that since its inception really hasn’t had electronic information at its fingertips. I think health is the last service industry stepping into the digital age.”
The digitisation of healthcare
Knickrhem points to two major trends in the last five to seven years which suggests a seachange. The first is the ‘digitisation’ of health, which is to say the electronic medical record itself (ERM), an integrated piece of software within one organisation, like a hospital system. The other, he said, is what is known as connected health or health information exchange, which involves bringing all the data together from disparate systems – hospitals, clinics, GP offices, even pharmacies – to create one view of the patient.
Both of these trends are most distinct in Asia and Australia, where significant investments are being made in e-health, Knickrhem said, prompting his own move from Los Angeles to Singapore in recent months. Closer to Europe, unsurprisingly, the Scandinavian countries are probably the most advanced. “Countries like Denmark and Finland are strong at the ERM level within organisations, and they are now stepping up to the level of connected health.”
Change of mindset
While the perception is often that concerns over security and data privacy are what has held the digitisation of health data back, Knickrhem said, while it can be an issue, the real barrier has been to change mindsets.
“When you are dealing with highly skilled physicians, this requires behavioural change, asking them to do things differently than they’ve done for years and years. Plus until a few years ago the technology simply wasn’t good enough.”
Now, he said, the technology has finally got to a point where productivity does not have to be impacted, and doctors are getting over the resistance to put technology between them and their patients. What is more, in many countries the pressure is coming from the regulatory bodies and financing agencies (Ministry for Health equivalents).
“They’re saying, ‘If we’re going to continue to pay we want to see output measures and that starts with metrics. They are being asked to report on these things, and of course that is something which is impossible off paper-based records,” Knickrhem said.
Knickrhem is familiar with the system in Ireland, as Accenture has worked on EMR projects with the likes of Tallaght Hospital in Dublin. “Ireland is at the early stages of the journey,” he said. “But the potential savings for a healthcare system like Ireland’s are huge.”
The real win from having digital health information is less about individual cases than about major policy changes based on data, he said, pointing to the major advances that could be made from looking across patient populations, and properly understanding how diseases are being treated at present, and where clinical pathways can be improved. “When you have all the data, there’s a big cost-saving opportunity.”
E-health pilot project
The most exciting development is around data analytics, he said. This brings us back to the e-health pilot being run with Accenture in the Basque country in Spain, where it is helping that region bring all of its clinical data together and beginning to add genomic data, in order to make solid predictions around the care of people who are already ill.
“We’re still years away from being able to predict this in healthy people, but what we’re getting really good at is being able to predict which already sick people are going to get really sick and need hospitalisation if there isn’t an intervention made, and then mobilising the medical system to do something about that.”
The result, he said, is significant savings in costs, and improvements in quality of life of patients who are, for example, 65 and over with multiple chronic conditions, who would need significant hospitalisation in coming years if they were not treated at home or in a doctor’s office in time.
“The data helps the patient tell you when they need intervention and allows you to organise home help teams, including doctors and nurses – specialists that visit them to keep them out of the hospital. We’re finding in some populations an 80pc reduction in the number of hospital days in that very sick group – which is a big user of hospital days. For me this is the real promise of integrated health.”
Enter big data
And this big data approach becomes even more meaningful if you start to add genomic data, said Knickrhem, potentially allowing analysts to comb through the data and identify patients that have a certain genetic background and family history, and certain clinical patterns, such as being at risk of developing type 2 diabetes.
It involves pushing a health system to behave differently. In Valencia, Spain, where similar pilots are being run, incentives are put in for the doctors to treat patients in their homes, thus keeping them out of the hospitals.
“In most health systems, even in Ireland, that would be a challenge right now, even though the system itself would benefit tremendously,” Knickrhem said. “I think this digitisation of healthcare and this big data revolution is going to both help and challenge the organisation of medicine, and the separation of financing and delivery.”
The other challenge will be the willingness and ability to invest. In the US, where such connected health systems are being put in place, the all in health IT costs rise from around 2pc of the overall health budget to the 4-5pc range, he said. So, while that compares favourably with the financial services industry, where that would stand at around 8-9pc, there is a considerable investment involved before the inevitable payback of, for example, reducing hospital days.
Pilots like that in Spain, which is already in the process of being rolled out to 200,000 people, will be key to adoption, he said. “The one thing that I’ve learned in my career in health is that when there is a good idea and you can prove it to scientists, physicians, and nurses, they adopt it very quickly.”
Adoption will ultimately come from necessity, he said, as among clinicians and policy-makers worldwide there is a growing realisation that the aging population coming through the system will either lead to untenable costs, or a level of pressure on waiting times and access to care which would be unacceptable to the population.
“This can and must impact health policy, because given the demographics we simply cannot continue with more of the same.”
A version of this article appeared in the Sunday Times on 12 May