As CMIOS, CIOs and CTOs, you are dealing daily with technology decisions in healthcare delivery. These decisions usually revolve around your current healthcare enterprise architecture and contained geographical location and, for the most part, can be controlled within those constraints. However, as healthcare becomes more regulated and cost constrained, there is an increasing call for the delivery of healthcare services to outlying facilities and patient homes. Concomitant with that call is the expectation that the quality of the information exchanged and the care provided is as good as that which could be obtained in the current healthcare setting.
There are several ways to look at technology and information services required in healthcare delivery; risk-based, business type based, data type based. From a risk-based scenario, the technology and supporting technologies range from clinical operations that rely upon technology to support a patient’s life (e.g., ventilators) to day-to-day communications (e.g., email).
Between those two extremes lie less critical clinical operations and monitoring (e.g., patient telemetry on a step-down floor), ancillary system support to the clinical operations (e.g., pharmacy information systems, laboratory information systems, ADT systems), infrastructure maintenance and monitoring (e.g., temperature monitoring of blood bank refrigerators) and business-based office operations, such as insurance eligibility and billing.
The business-based perspective radiates around the basic business transaction in healthcare: the patient seeing a clinician for services. This involves ensuring the patient receives the services he or she truly need and the clinician is paid for providing those services.
The data type perspective examines what data are collected from a demographic and metadata perspective (e.g., device status or network status information), as well as the specific clinical or physiological data gathered from or about the patient. The clinician acts upon these data to ascertain the status of the patient and intervenes if necessary with an iterative loop regarding clinical action and patient response. The data types can range from textual (e.g., blood pressure measurement or patient identification information) to graphic (e.g., EKG waveform or fetal monitor tracing) to images (e.g., x-rays, CT scans, etc.), with increasing data sizes and systems for management of that information.
These angles rely upon a flexible infrastructure to deliver optimum functionality across the varied disciplines.
Where vendors fit
In the healthcare technology realm, there is a changing landscape of vendors who can service different aspects of healthcare delivery. Historically, the technologies used in healthcare were divided by the service type: clinical, business and facility. With the evolution of IT, these services are increasingly using the same infrastructure and integrating their data across these spectrums to provide more informed decision-making by healthcare executives, employees and clinicians.
In the traditional model, vendors focused on their areas of expertise building “islands” of information. We now see EMR vendors offering specialty clinical information systems, such as cardiovascular information systems for cath labs, anesthesia information management systems and OB data management systems providing centralized display of fetal electronic tracings. They are providing data integration from the physiological sensor-based devices, which traditionally was done by the medical device vendors using proprietary networks and systems. The current trend within the healthcare enterprise is to use shared infrastructure and strive for as much integration with the EMR systems and back-office applications as possible.
Statistics show that 80 percent of the U.S. healthcare dollar is spent on 20 percent of the patients. Moreover, “total expenses for people with … five major chronic conditions (mood disorders, diabetes, heart disease, asthma and hypertension) rises to $270 billion, or 49 percent of total healthcare costs.” This economic pressure is driving efforts to decrease the costs of treatment of this high-cost cohort. Better use of the evolving technology infrastructure should result in good or better quality treatment for patients with chronic diseases. Numerous studies indicate that increased patient involvement in their own healthcare management, especially those with chronic diseases, decreases healthcare costs while maintaining or even increasing patients’ quality of life.
Use of the expanding mobile telecommunication infrastructure and personal ownership of smartphones provides a platform for healthcare delivery services outside of the traditional geographical healthcare enterprise. Combining physiological sensor technology, mobile telecommunications gateway devices, mobile telecommunications transmission, cloud-based data storage and application delivery, web portal access to the cloud and integration with healthcare enterprise-based applications, extension of healthcare delivery services is possible. Couple this with patient-derived data from outside the traditional healthcare enterprise (health and wellness applications and tracking; personal health records), and the data set that clinicians can use for healthcare delivery expands exponentially.
The traditional mobile telecommunications vendor has established a business model which provides a direct link to their customer and integrates services across a heterogeneous infrastructure. They are able to differentiate the types of services and bill accordingly to each customer. They offer services from basic voice transmission to interactive application interfacing with video images. They have demonstrated their ability to scale their services across large geographical areas and many customers. The topology of their product relies upon industry-based standards to span across the heterogeneous infrastructure while delivering a personalized customer service. The traditional service-based functions are used by mobile telecommunications vendors: call centers, network infrastructure, security mechanisms, integration services, interface services, storage mechanisms and customer service functions. They provide these services worldwide and to many industries.
As we have seen with EMR vendors changing their boundaries and interfaces with traditional medical device and clinical information systems, we will see with mobile telecommunications vendors changing boundaries and interfaces with the traditional healthcare enterprise technology systems. The key in the future will be the capability to integrate different functions and services across disparate infrastructure using agreed upon standards both syntactically and semantically. Mobile telecommunications vendors have and will become larger technology partners in the delivery of healthcare services.