Originally published in the BJ-HC (British Journal of Healthcare Computing)
A change has to come to organisations perceptions of digital, not what it can do, not even that its focus has to be business change, no; the biggest change that needs to be considered and understood is that digital costs money.
In healthcare we seem sometimes terrified of the actual cost of digital. Digital failure is often related to the cost, the big headline figure is used to sensationalise a failed project. Have you ever seen a headline that describes the cost that going to digital has saved? Think back to the 1990s, booking a holiday, going to the bank, buying some music, all aspects of life that digital has changed for ever and clearly not only more convenient for ‘you’ the consumer but more efficient for the business delivering the consumer need. And then think how quickly that change has happened. The speed we now are at to get to the magic 50 million users is fed by the investment not just in the digital element but in the change that is required, 62 years to get to 50 million cars; 5 years for PayPal to achieve the same and only 2 years for Twitter to get there.
The political nature of so many healthcare systems means they loathe to invest in digital; after all the need to build a new hospital or recruit new nurses is far easier to explain to the citizen (the voter) than the promise of a more efficient and safer digital health system. And yet, show a patient the medical records room of a large hospital and then take out your phone and ask that patient which format they would prefer to see their care delivered on. I am guessing the answer will always be I want a digital system. A study conducted in Ireland in 2016 showed that if every citizen were to provide an additional 17 Euro a year to the healthcare system for the next 10 years then the system would move from a paper based system to an integrated and open data based provision. When asked over 60% of citizens wanted to vote for the project, one famously taking to the stage and asking why does an EHR even need a business case, surely it is like saying no to world peace to say no to a digital fabric for health.
Some of the largest digital organisations in the world profess to be coming to the digital health market for philanthropic reasons, and the sentiments are always well described, none of these organisations has moved to giving away their solutions and intellectual property quite yet though. Global economists predict that by 2030 GDP in many countries needs to double to cope with the ever increasing healthcare costs. In 1955 there were 2.8 billion people in the world by 2025 six billion people will need a healthcare system of some sorts? In 2025 we expect the word to be around eight billion people and average life expectancy will have gone form 68 today to 73 in 2025, awesome figures and yet terrifying for those of us that work in healthcare. How will we cope, particularly with ‘crisis denial’ and a fear of investing in modernisation.
In the last 150 years, according to a Gartner presentation at this year’s CIO Symposium, the healthcare industry has created more value than any other business, if you push the outputs of healthcare through a cost and value system we really do deliver. But health costs money, it’s not free at the point of care! If we link the value that the system delivers back to Berwick’s triple aim of 2008; improve the patient experience, improve the clinical experience and create greater productivity and lower the per capita cost of care, then it becomes clear quickly that digital has to be a global investment point to achieve these grand aims. And yet digital is a separate business case time and time again.
If only IT were free? Or better still if only we could find a way to build the system perception of the value of digital. Even the promise of digital appears to cost money in so many jurisdictions, although I think we could track even that cost back to a lack of investment. To spend on digital requires not just the investment in the purchase itself but also the investment in proving the case before hand, and yet, how many digital healthcare business cases have come to fruition. Please do not misunderstand what I mean here, I am not suggestion a free for all, but, we insist that a digital decision should take a defined and obstructive amount of time, digital moves too fast for that to be the normal that we work to in 2018.
The return on investment needs to be clear for an investment in digital, but what of the new phenomena driven by Ted Rubin the American digital marketer, a return on relationship (RoR). A digital leader in healthcare needs to now push hard for the governance functions they are working with to begin to believe in a return on the relationship. A digital governance function needs to build trust in digital leadership to the point where the legacy of over engineering permission to invest is released to the digital leadership in a similar way to the HR Executive is empowered to deliver a talent solution for an organisation.
Investment in digital needs to be the catalyst for health system transition from ‘Repair Care’ to a truly transformed ability to deliver healthcare and it can only be empowered to become that catalyst through investment. As digital leaders we need to get better at expressing the way digital can move the system dial from simple enablement on to truly optimizing the system to one where digital will have some of the answers to huge issues like winter pressures and the healthcare system can transform through the presence of digital.
There could be a tactic to use, straight out of the Start-Up mentor handbook; ideation of the new value paradigm. A new digital value that we as digital leaders need to describe; a working value equation that can add to, in a different way, the understanding of the change that digital will make to the provision of healthcare. We as digital leaders need to identify and provide for the health risk cohort to prove our worth, oh, and of course save money. Digital creating value in healthcare could be as much to do with digital taking appropriate ownership of the description of the digital agenda and this can then aid in bridging the value gap that exists in our colleagues’ minds! This does rely on us getting right the clinical ownership, the business engagement, the change management and transformation agenda, hence the use of ideation, explain what it could look like when the investment delivers for the patient. Using ideation as a process will enable us take our systems through the thought process that gets it to an understanding of the future; moving from innovation to development to actualisation.
In the EU today we have 2.5 million doctors and 4.8 million nurses, the beating heart of our system and the delivery function of what we do! But, digital needs to not be considered as a back office to this. As we move to a place where the life expectancy goes form 83 years old (2017 in Japan) to an age that we struggle to compute then the equity of health care delivery needs to be built upon a digital way of working or the system can’t cope. Equity of service means we need to balance some hard numbers, the average 70 year old’s healthcare today cost $3,956 per person globally whereas in the USA the same person would cost $9982. Some of that investment (globally) has to be made in digital or we will stand still, and standing still in healthcare will mean failing whole populations of people.
So the ‘call to arms’ on this has to change. Digital in healthcare is the new utility, we need heating, water and light; we need digital too to deliver healthcare. The new ask is to move from the begging bowl; there for the scraps in the good times and a move on to the polite but considered statement of what cannot be done without digital. After all IT isn’t free!