Toward the Future of Healthcare Information Work
According to a report from Boston University, 50 percent of the $1.9 trillion that will be spent on healthcare in the United States in 2005 will be lost to waste, excessive pricing and fraud. That makes improving productivity and efficiency in healthcare a critical priority for patients, providers and payers. But improving efficiency cannot come at the expense of two of healthcares most important goals: improving outcomes and extending access objectives that almost always come with added costs.
IT will play a vital role in any effort to tackle the issues that the industry is grappling with today while ensuring that it continues to meet the goals and expectations we have as a society for healthcare. Technology innovations have been the catalyst for a new generation of IT solutions that have delivered new levels of efficiency and productivity for a broad range of industries. Because healthcare is so information-intensive and collaborative, the same innovations that have transformed other industries by targeting the information needs of information workers offer great promise for the healthcare field.
Information worker technology is especially critical because nearly everyone employed in healthcare is fundamentally an information worker. Physicians, nurses, administrators and support staff all depend on having access to the right information at the right time in the optimal format in order to make the decisions that are critical to their jobs. But the healthcare industry has been among the slowest to adopt the kind of IT solutions that have driven efficiencies and productivity improvements in so many other sectors.
There are many reasons that adoption in the medical field has been so slow, including the high cost and complexity of IT infrastructure, the limitations and difficulty of proprietary applications and the lack of standards. Habit plays a role as well. Traditional practices based on paper records, handwritten notes, informal meetings and face-to-face conferences and consultations are deeply entrenched. Unfortunately the combination of paper-based, manual information management methods and increasing complexity has given rise to a seemingly never-ending spiral of rising costs, narrowing access and increasing inconsistency in care quality across the industry.
The lack of a standard for electronic health records (EHRs) is clearly one of the key bottlenecks that impedes the industrys attempts to reign in rising costs. According to an article in Medical Economics, the widespread use of electronic records could save 20 percent of the total of all healthcare costs, while reducing medical mistakes and drastically improving healthcare quality.
The Foundation for Successful Healthcare Information Technology Adoption Today
What will it take to enable healthcare organizations to move away from outdated and inefficient modes of information management and begin to more fully take advantage of EHRs and other technology solutions that streamline patient data creation, storage and access?
The starting point is tools that are matched to both business requirements and information worker skills and practices. Good, effective tools are those that provide easy access to data, processes and people, anywhere and anytime. In healthcare, where timely delivery of correct information can spell the difference between life and death, information workers place a premium on data that can be communicated clearly and succinctly using the simplest available interface and is mobile enough to keep pace with the fast-moving clinical environment.
Before it can replace traditional practices, an EHR solution must meet this need for simplicity, speed and portability. That means interfaces must be intuitive. Because keyboard input is neither comfortable nor practical in many clinical scenarios, tools that allow natural input via digital ink, voice, touch-screen or point-and-click are essential. Applications also need to run on mobile devices and must provide easy ways to connect to central data stores.
Ease of use and access are not the only requirements. Many first-generation healthcare IT products were based on closed, proprietary technology, accessible only through dedicated applications with difficult, inflexible interfaces. Todays solutions must be able to integrate with these systems in meaningful ways. Newer architectures should be interoperable and interconnected, using open standards and a highly distributed model to share information not only among hospitals, clinics and physician offices, but with insurance providers, government agencies and patients.
The final requirement for EHR systems and other IT solutions is low cost of ownership. There are many high-cost components of the healthcare system for example, expertise, equipment and insurance that are perceived as more central to the core mission of providing care than computers and software. The IT tools that can drive better outcomes, greater efficiency and wider access to healthcare must be based on a proven, standard and affordable platform for information work.
Current tools based on Microsoft® products such as Microsoft Office InfoPath®, Microsoft SharePoint® Team Services, Microsoft Office Live Meeting and Microsoft BizTalk® Server provide the foundation for comprehensive electronic record systems that meet all of these requirements. Today these products are delivering enormous benefits across the healthcare system, from clinical care to billing and compliance.
The Future of Healthcare Information Work
More widespread adoption of standard EHR systems is an important near-term priority across the healthcare industry. At the same time there are other innovations in information worker technology on the horizon that will extend the power and value of EHRs, driving better outcomes, greater access and lower costs that are consistent with the priorities of the healthcare industry and its customers.
Currently Microsoft is working on a number of emerging technologies that promise to optimize todays EHR solutions by making them more pervasive and less intrusive. These new technologies will add greater automation of low-value activities; smarter, simpler interfaces that can anticipate user needs based on context and observed behavior; improved security that provides more control over sensitive information; ways to model and present complex data in real time; and features that capitalize on lighter, more powerful mobile devices, new form factors for digital devices and new ways to interact with data in the physical world.
These are just a few of the emerging innovations that offer the promise of new approaches to the way patient information is created, stored and accessed through EHR systems in the coming decade and beyond.
Pattern Recognition Technology
While the problems of searching through multiple file systems and formats is being addressed through EHR systems, the task of navigating databases and forming queries to produce relevant results remains a challenge. Pattern recognition technology that simulates human decision-making processes will make the next generation of information worker tools much more contextsensitive. This technology will automate many of the mental steps that workers themselves must now perform, yielding greater speed and better quality of information while enabling healthcare workers to base their decisions on the most solid foundation of data.
Smart Documents
Pattern recognition provides the first layer of efficiency in information management. But often, even well-chosen documentary information is not sufficient to answer the question at hand. Access to the people who authored a document can be critical to getting the information needed to take action. Today locating the right people involves phone calls, leaving messages and waiting to hear back. At best the process is uncertain; at worst there is no way to identify the author of a document.
Smart documents provide the solution. Smart documents contain metadata that dynamically tracks authorship and provides tags to assist in search and retrieval. Author information will communicate with collaboration applications such as contact managers, email, instant messaging and presence detection, providing the information necessary to follow up with the author and even determine whether the author is available immediately to respond to questions.
RFID
New technologies will also provide new and better streams of critical information in real time. Radio frequency identification (RFID) chips tiny transmitters that broadcast a data signature to landand satellite-based receivers are already being used to track inventory in the manufacturing and retail industries. For healthcare, RFID has the potential to introduce dramatic new efficiencies in patient care by providing rich real-time information on patient health, regulating the release of medication and communicating with other devices to reduce errors, assist nurses and clinicians and provide data for more accurate diagnosis and treatment.
Using RFID-based technology, a single nurse can monitor an entire ward with precision and real-time responsiveness from one workstation. Subcutaneous RFID devices for patients could communicate with similar devices embedded in medication labels to alert caregivers to potential allergies or errors in dosage. Outpatients could be monitored remotely, with care dispatched automatically in the event of an emergency.
Adaptive Interfaces
For physicians and nurses, easily comprehensible information display is essential. Interfaces that are counterintuitive and complex can be worse than useless in critical situations. Today many computer applications allow users to customize the way information is presented, but this is a static rather than dynamic process. Using pattern recognition and machine-learning technology, the next generation of information worker applications for healthcare will feature adaptive interfaces that provide clearer, simpler access to relevant information without the need for the user to learn complex features or continually reconfigure applications depending on the circumstance.
Information Rights Management
Maintaining control over who has access to documents is one of the most important problems that the healthcare industry faces. Microsoft Office 2003 includes information rights management (IRM) features for setting permissions on access and transfer of documents. This is an enormous step forward in the protection of intellectual property and confidentiality.
However, current IRM schemes work only at the document level. Evolving IRM technology will enable rights management of content at a more granular level, allowing individual words, lines or paragraphs of documents, cells and formulas of spreadsheets, fields in data records, or slides in a Microsoft PowerPoint® presentation to be tagged as hidden to users who lack proper security credentials.
In healthcare, this means that providers, administrators, payers, regulators and patients could all have access to the same document, but with different views based on their roles and security level. In reports created from multiple documents, confidential content that compromises privacy or security would be automatically removed. And individual fields of medical records could be easily shared for research or compliance purposes without disclosing private patient information.
Conclusion
Today, the healthcare industry faces a steep climb toward the productivity gains and efficiencies promised by healthcare IT solutions that are available now. Promoting the widespread adoption of a standard EHR alone will require an investment of hundreds of billions of U.S. dollars.
Organizations facing this kind of commitment can be excused for having some trepidation about the impact of all this new technology on an industry that has always run on human expertise. How will new information worker software affect the ability of doctors, nurses and administrators to do their jobs? Will busy professionals need to learn new skills and adapt to uncomfortable new procedures to realize the productivity and efficiency benefits that are so urgently needed?
These are reasonable questions. But the fact is that IT tools for healthcare information workers are now converging in the direction of the workers natural skills and practices, giving people the tools to manage information effectively in a complex environment.
