Innovation is a constant force in healthcare. Each day there are new ideas to keep patients safer, operations smoother, bottom lines stronger and data more secure. For executive teams leading hospitals and health systems, it all comes down to making the best decisions on what initiative of hundreds to pursue on any given day.
To learn more about the innovation environment in which hospitals and health systems currently operate, Becker's caught up with Tom Foley, director of Global Health Solution Strategy for Lenovo Health. Lenovo Health is supporting a three-day innovation summit in partnership with Becker's Healthcare, from June 6-8. To learn more about this virtual opportunity, click here.
We asked Mr. Foley to weigh in on the largest trends he sees in healthcare's innovation space, including the most common problems innovation set out to solve today, misconceptions he encounters around innovation, and cost-effective yet needle-moving decisions executive teams make when it comes to the next big idea.
1. Tom, can you describe the intensity with which hospitals or health systems are approaching innovation today?
Tom Foley: There's been an opportunity in the market around the need for specific innovation. You see pockets of it out there, more so among the larger institutions that have the financial resources to really go after innovation. I think elsewhere it's difficult for many to see and deploy the [resources] as far as adopting innovation. Sometimes it's tough to see how they can tie innovation in with other major investments they make in health IT and on the EHR side. They'll say, "I want to adopt innovation to facilitate better delivery of care, but how do I integrate that with the EHR I already have?"
There is a great opportunity for innovation, and some folks are moving the needle on that, but for others it can be very difficult. I believe as we move toward a value-based care model, innovation will have to be at the forefront of what healthcare systems do.
2. Of the innovation efforts you've observed in organizations, what are some of the most common problems they set out to solve?
TF: It comes down to, 'How do I enhance my ability to deliver value to a patient?' And when you talk about that in a value-based care model, 'How do I improve outcomes and at same time lower costs?' That is a significant challenge in and of itself. You have to look at the entire care continuum to understand where innovation is most appropriate.
In care management, I talk about two numbers. I talk about 8,760 — that's the number of hours in a given year — and the number 15, which is the average number of hours a Medicare patient with several chronic condition spends in front of his or her physician in any given year. The gap between those two numbers is the care gap. It's not what happens in front of the physician that's most important, it's what happens away from the physician that's most important in care management.
Care delivery providers wants to figure out how to help patients take better care of themselves when they're not in front of them. Sometimes innovation isn't about adopting technology, but it's a matter of finding ways to engage patients differently. In that context, one pivot establishes the home as a care setting in itself — the more I can keep the patient in the home, the more the care delivery system can save.
This is not to discount when a patient is in front of the doctor or in the health system. One of the greatest challenges in those 15 hours is that the average EHR has 10 percent duplicate records — this coupled with Medical identity theft and payment fraud , are compromising the integrity of health data.
As well, given the concern with cybersecurity — as much as we are protecting the back-end of the health IT, the front-end of the health system also has to be protected. To prevent what cyberattackers take from the back-end of the system and bring it with them through the front-end creates significant data integrity challenges. We need to think differently about how we approach data integrity in the front-end — eliminating duplicate records, medical identity theft and payment fraud (which can be done today) will transform the quality of data and have a domino effect on decision support, achieving quality outcomes and/or maintaining wellness.
3. To hospital executives with 2 percent or lower operating margins, the assumption that innovation requires significant capital investments may cause them to tread lightly in terms of innovation. What are some cost-effective yet needle-moving decisions you've seen executive teams make when it comes to innovation?
TF: At the end of the day, some people look at [innovation] as a cost to the business and others look at it as an investment where they can get an actual return. We like to talk about innovation in terms of return on investment. If there is no return, then there shouldn't be an investment. Don't spend money if you don't know what it'll do for you.
That said, to maximize the ability to spread limited financial resources one needs to be able to innovative on how we fund adoption of technology. As an example, certain subscription service models — where you don't pay upfront fees — are a good example of investing in innovation to drive value. Subscription-based services can range from telehealth or secure messaging to unique health safety identifiers. Unlike buying a product upfront, purchasing these innovations on a subscription basis allows you to spread your dollars further and spend more strategically, and even adopt additional innovations to drive value.
4. In your work, either with Lenovo Health or with clients, have you encountered any misconceptions about innovation? If so, what are they? How do you dispel them?
TF: Some people either 1) want to do innovation but won't do it because the payer won't pay for it, or 2) they just don't understand what a particular innovation is going to do for their organization.
In the first case, telehealth comes to mind as an example of people saying they want pursue innovation, but when the payer won't pay for it or their EHR vendor won't offer it, they drop the idea.
In the second case, maybe the vendor has a problem with its communication and messaging. When Lenovo first brought the unique health safety identifier to the market, we described it as a patient identity platform. Organizations would say, "I don't have a patient identity problem." But they did have a data integrity problem, medical identity theft problem, medical fraud problem and duplicate medical record problem. We as vendors do a better job communicating the value of our solutions in context of which business problems we solve. .
Sometimes you go to speak to [a hospital] CIO about a solution and realize you don't understand their business problem yet. At the end of the day, you can't be a trusted advisor if you're forcing something square in to a round hole. The best thing an trusted partner can do is to be honest about whether he can help solve the problem or not.
5. Given the integrated and collaborative nature of care today, hospitals and health systems cannot approach innovative investments or decisions in a vacuum. They must think about how their technology or new offerings will interact with the broader care continuum. Can you share some examples of systems that have successfully innovated to improve outcomes for patients not only in their facility, but throughout the broader care network or community?
TF: The best use case I like to talk about relative to clinical integration and technology adoption has to be what Hudson Valley, now called HudsonDoctors in Hawthorne, N.Y., did long before the Health Information Technology for Economic and Clinical Health Act came into play in 2009.
Here, you had an independent physician association that really drove a clinical integration strategy. They adopted EHRs before HITECH established meaningful use. HudsonDoctors IPA used clinical integration to share data and used technology for the improvement of care. They are one of the first national IPAs to really take a unique approach to clinical integration by using technology as a tool vs. a must-have. They were also the largest population to adopt the National Committee for Quality Assurance Patient Centered Medical Home framework. .
Another example that comes to mind is Oneview Healthcare, which is innovating the in-room patient experience. An inpatient stay lasts 3.5 days on average. When you get discharged, somebody talks to you about what you should be doing when you get home and you probably aren't really listening. Oneview uses technology to take advantage of the 3.5 days during which that patient is a captive audience. Patients can look at their health records while sitting in bed, watch educational videos about their condition and learn what they should be do after they're discharged. It's an educational experience. The adoption of technology like that can be viewed as innovative.
As I see it, there are two continuums. The first is volume to value. The other is bringing patients from awareness to wellness. Those two continuums have to move in parallel. Making people more aware of their health makes them want to learn more about what they can do. The goal is to incrementally change behaviors and work toward a wellness state.
6. Who are some innovators, past or present, you most admire? Why?
TF: I'dhave to call out John Blair, MD, who was chairman of Hudson Valley IPA (now HudsonDoctors IPA). To have the vision he did should be considered innovation. I'd have to look at the chief innovation officer for UPMC, Rasu Shrestha, MD. Talking to him is always exciting. He brings a different perspective to the table on how we solve care delivery challenges while applying technology as a tool.
At the end of the day, it's not about technology or innovation. It has to do with the overall experience — the experience of your employees, physicians and patients. The experience is what draws loyalty to a care delivery system or provider.
7. What should have hospitals innovated yesterday? What problems do you see as low-hanging fruit for innovation? What improvements are most noticed by the trifecta of patients, clinicians and administrative teams?
TF: Hindsight being 20-20, the one fundamental construct we should have integrated in the health IT ecosystem is a deterministic patient matching construct coupled with universal patient identity platform — as the EMPI (probabilistic matching technology) is significant contributor to data quality challenges.
As well, let's look at the classic model. You go to an ambulatory clinic, you get a clipboard, you fill out the clipboard, then you go to another clinic in that same health system — and you get another clipboard. It's a frustrating experience.
Organizations can change the experience model by applying tools that can share a patient's information across multiple settings, so he only has to supply the information once. One would say that's not innovation, that's just applying technology where it makes sense to enhance the experience of the patient.
To learn more about the Virtual Innovation Summit in partnership between Lenovo Health and Becker's Healthcare, click here. You can also sign up for the summit here!