A growing population of elderly, an increase in the number of people suffering from chronic conditions, and an increasing demand for emergency care are among the many critical issues facing hospitals today. Hospitals are seeing an increasing need for access to care and efficiency in healthcare delivery due to continually rising costs and decreasing federal reimbursement. A roundtable of healthcare experts joined together in 2006 to address these current and future needs and create a picture of the hospital of the future.
The roundtable’s goal was to examine current healthcare issues such as socioeconomic trends, the physical care environment, technology, patient-centered care values, staffing challenges, and how those issues impact the hospital of the future. Following is a summary of the discussion and conclusion on the topic of technology for the provision of care:
The Cutting Edge of Digital Technology
Digital technology is allowing for care that has historically fallen under the umbrella of the hospital to be served outside of the hospital’s walls. The U.S. Department of Veterans’ Affairs (VA) is on the cutting edge of using this technology to better meet the needs of their patients. Their use of the national Care Coordination Home Telehealth (CCHT) Program, implemented in 2004, is allowing a transition from institutionally-based care to patients’ homes, when appropriate, to enhance and extend care.
Especially beneficial for patients living in remote areas, the CCHT Program emphasis is on patient self-management with a program of care. Remote monitoring technologies enable data, such as the blood glucose levels of a diabetic patient, to be uploaded to their Electronic Health Record (EHR) daily. Care coordinators are able to determine from this data those who require active care management. The CCHT allows each coordinator to support caseloads of 120 to 150 patients.
CCHT helps to reduce disease complications with its emphasis on disease management and vital sign monitoring, since it allows for quicker recognition of signs that may require hospital admission or a doctor’s visit. As of 2006, the CCHT Program supported the care of 33,883 patients in their homes. Data from 17,025 patients demonstrated a 20% reduction in hospital admissions and 25% reduction in hospital bed days of care.
Since 1995, the VA system has decreased its hospital beds from 50,000 to 18,000, while adding more than 1,000 sites that provide primary and ambulatory care in local communities. It has become dramatically more efficient with only a small increase in staffing while serving a doubled patient population from 2.5 million to 5 million. Veteran patients receiving CCHT show a mean satisfaction score of 86%, indicating that the quality of patient care has not diminished.
Innovation and standardization is perhaps more achievable in the VA system due to its integrated, single-payer system. New models of care such as CCHT require changes in clinical practice, technology infrastructure, and business processes that are more difficult for providers operating in fragmented environments. However, with an increasing number of patients suffering chronic diseases, remote patient monitoring could have the same evolutionary impact to hospitals outside of the VA.
Health Information Technology
A comprehensive electronic health record system is at the core of the VA’s Care Coordination Program. Outside of the VA, only about 11% of non-federal hospitals and 12% of physician practices have implemented such programs. The U.S. is a dozen years behind other industrialized nations in adopting health information technology (HIT). Successful implementation of the HIT programs, resulting in reduced costs and improved quality, is credited to the simpler payer structures in those countries, making it easier to standardize nomenclature and create an interoperable platform.
Attempts to implement computerized physician order entry (CPOE) systems in the U.S. has resulted in only about 5% of hospital utilization. This is attributed to the cost of implementation and resistance by physicians. In 2005, the Department of Health and Human Services (HHS) created the American Health Information Community (AHIC). This advisory committee, made up of representatives from both the public and private sectors, was formed to provide recommendations on making health records digital and interoperable, while protecting patient privacy.
To provide financial incentives for healthcare providers to use HIT, the HHS has launched demonstration projects such as allowing the Centers for Medicare and Medicaid Services (CMS) to make bonus payments to small physician practices. Strong evidence supports claims that HIT systems result in significant benefits for safety and quality care, but the level of initial investment is such that hospitals need further incentive.
In addition to implementation costs, many are concerned about work flow disruptions that can come about from full-scale HIT implementation. Key to its success is the involvement of clinical staff using the technology, such as office, pharmacy, and lab personnel. New technologies must be labor-saving in order to maximize already stretched professional resources.
Current issues of interoperability between HIT systems, still unresolved, are resulting in a “wait and see” attitude among many providers before investing in the technology available. Concerns of data privacy as well as system obsolescence add further to delays.
New technologies are being created daily by the well-funded biotechnology industry desiring to create new markets and needs, but making it more difficult for healthcare providers. Some of these new technologies will increase costs and waste in the system as well as disrupt work flow and increase inefficiencies. Little value results from technologies that do not integrate with other technologies.
With such cutting edge information and costly technology-purchasing decisions to be made, an objective authority to help guide these investments is important in making value-based decisions. Until 1995, one such authority existed, the Congressional Office of Technology Assessment (OTA), which offered such objective analysis. Their reports were authoritative and well-respected but unpopular when their findings negatively affected the interests of those industries. ThOTA ceased to be funded in 1995 and has not been re-authorized.