Imagine waiting an hour for a table at a restaurant even though you had a reservation. If the food was fabulous, you might return to give the place another chance, but if you were stuck with another long wait on your second visit, there's no way you'd go back.
Imagine the same scenario at your doctor's office. Long wait? You decide you won't be returning, and instead start booking your routine health appointments with your neighborhood convenient care clinic. This, experts say, is the not-so-distant future of healthcare, and it has industry IT leaders scrambling to act more like their counterparts in the hospitality and retail sectors.
"Healthcare traditionally hasn't been known for its customer service, but with so many more choices in healthcare now, customer service is the critical differentiator," says Jim Stalder, CTO at Cook Children's Health Care System in Fort Worth, Texas. "If the new retail healthcare clinic down the street from your traditional primary care office offers Web-based scheduling, SMS appointment reminders and, most importantly, actually sees you when your appointment is scheduled, well, that's some tough competition."
Customer service followed closely by affordability are two of the biggest factors driving the IT and business agendas in the healthcare industry these days. Equally critical is healthcare's seismic shift from a fee-for-service business model to a value-based cost structure. This means providers are paid for the health outcomes they help achieve rather than by the number and variety of patient visits, tests and procedures.
"We're having to shift from processing claims and conducting transactions to being consumer-focused," says Paul Friedman, director of IT at Humana in Louisville, Ky. Increasingly, that involves providing customers with healthcare services when and where they want them in a low-cost and hassle-free way. "Over the next few years, there will be very big changes playing out," he says.
At the dead center of it all is IT. Virtually all players in healthcare are investing heavily in technology to accomplish the industry's transformation to so-called patient-centered care. This includes systems and services to meet growing regulatory and compliance requirements; new cloud services and mobile apps to meet consumers' demand for easy-to-use self-care tools; and big data and analytics technologies to store, track, and slice and dice the increasing amount of data generated by everything from individual Fitbits to hundreds of millions of electronic health records.
In 2014, healthcare IT spending was projected to increase to more than $34.5 billion, according to Technology Business Research, a Hampton, N.H.-based research firm. This year, Gartner is projecting that enterprise IT spending will grow 2% across all industry segments, with healthcare and retail among the fastest-growing sectors.
Last year, California healthcare provider Kaiser Permanente invested $4 billion in healthcare innovations, ranging from new telemedicine and remote monitoring technologies to patient motion sensors that monitor patients' activity after surgery. Kaiser also has fostered partnerships with various healthcare accelerators, incubator organizations and payer organizations to collaborate on advanced innovations.
"Everyone is trying to move forward because it is critical for our industry," says Faye K. Sahai, former executive director of innovation and advanced technologies at Kaiser Permanente.
The promise of SMAC
Sahai and many of her industry counterparts see great promise in big data and social, mobile, analytic and cloud (SMAC) technologies. "It is the precursor of more self-care and predictive health," she says. "When you look at social determinants of health, the doctor, hospital and clinic are just a small percentage. It's really more about how you eat, sleep, your environment and genetics."
She paints a picture in which healthcare providers and consumers both have a more accurate picture of an individual's ongoing health status and can help consumers take preventive measures by tracking such data and combining it with other predictive information about things like weather patterns and pollen counts. Providers could send text alerts to asthma patients warning them to limit their time outdoors when pollen levels are especially high, for example.
In another scenario, consumers with food allergies might tap into a mobile app on their smartphones to sense and detect if there's something they are allergic to in food they are about to eat. By tracking data and linking it to an individual's healthcare record, it would be possible to prevent certain severe reactions before they occur, which would work to both improve overall care and cut costs, says Sahai, who is now innovation services leader and adviser at Exponential Talent LLC.
"Where the provider was in the center before, we're trying to put the patient," she says. "Now, it's more of a collaborative process of joint decision-making."
At Humana, Friedman says IT is counting heavily on mobile and social technologies to help the healthcare provider "meet patients where they are. The consumer focus is about how we deliver products or services or interactions that consumers really value," he says.
For example, a consumer might visit the Humana website in search of information about his healthcare coverage or the provider's Vitality wellness program. That same individual might also already be a regular user of the Weight Watchers food and weight tracking app and might want to view his healthcare information through that app. To enable that type of activity, Humana has launched a major API management program to deliver the information its customers want when and where they want to view it.
"A big part of where we're heading with these kinds of services is enabled by cloud," Friedman says, noting that Humana's IT unit is able to create APIs and then test and manage them in the cloud. "We have an acceleration center to leverage cloud to spin up environments for testing and then rapid deployment so we can get consumer feedback. It lets us do things in weeks or months. That's an order of magnitude less time than before," he says.
At Nicklaus Children's Hospital (formerly Miami Children's Hospital), IT has created two new mobile apps to deliver patient data and alerts to clinicians' and patients' smartphones. It's all part of the hospital's customer service strategy to provide more information, which in turn boosts customer satisfaction and health outcomes, according to CIO Ed Martinez.
"It's all about the consumer," he says. "We need to do everything with a focus on the fact that consumers have choices. How we need to manage consumers is to provide them an experience that's second to none."
Martinez also noted that the parents and children who use the hospital's services are mobile-savvy, and they expect the hospital to be equally connected.
To that end, other mobile apps in development at Nicklaus Children's Hospital include one that lets patients and visitors order food to their hospital rooms and another that navigates patients from procedure to procedure while they're visiting the hospital. Patients can also obtain an electronic discharge notification complete with a full medical record and an absence note to take when they return to school.
But across the wider healthcare landscape, it's not exactly all sunshine and blue skies. Rare is the provider or payer organization that doesn't continue to wrestle with fundamental systems and data integration issues, even within its own walls.
On the provider side, different departments, such as radiology, pharmacy and patient registration, often track information differently, and they use different data fields and lots of unstructured information. Healthcare vendors' electronic health record systems vary widely. Patching up and then masking these incompatibilities from clinicians, patients and other users at the interface level eats up valuable time and money.