Building the Digital Hospital of the Future
, December 10, 2009
HEALTHLEADERS: What do you need in terms of bandwidth and storage to get ready for more interoperability?
STETTHEIMER: There's at least three sides in terms of looking at data flow involved with those systems. One is how big are your pipes? Are you running copper, fiber? But also when you're hitting a switch, what is that taking you down to in terms of the ability of the pipe to keep bandwidth—from the device, the desktop, the modality to the servers, the storage. You have to look at the management of the data flow on that pipe.
GIBBS: A lot of the systems are becoming ASP-driven, and that means that you now have to have a more robust system in terms of your Internet connection, and you have to have the same level of redundancies to ensure that you're going to have consistent ongoing support.
JOSLYN: It's not that storage and bandwidth requirements aren't daunting, but they're manageable. It's design and architecture—there are good and bad ways to design a network. The stimulus fund timeline is causing some new to EMR to go faster than is prudent, especially in putting together the right architecture.
GIBBS: Most of us have not been as good about doing risk assessment as the financial industry. Until you get to the point where you're actually moving the true clinical data around, it's always been okay to be down for a few hours. Now that you are going into an environment where the live data has to be available on an instant's notice, you have to put the things in place to ensure you are going to have that level of reliability within the network.
MORLEY: Hospitals and health systems are not in desperate need of bandwidth, storage, and computing—most have strong bones on which to build. The significant infrastructure needs are in the ambulatory space.
GIBBS: Vendors are coming out of the woodwork and going into the doctors' offices and trying to sell them every kind of system that's out on the market.
JOSLYN: It highlights a new role for those leading IT efforts. We need to help physicians sort through all those different IT solutions. It places us in the position of being an adviser, and, in some cases, a service provider as well.
STETTHEIMER: You have to offer it to everyone if you're going to offer it. But it's critical that you align with physicians, because—I don't know about you guys—but I've never admitted a patient. Physicians are the core of our business.
HEALTHLEADERS: You have patients now with wireless pacemakers and such; what are the demands to get that data to the physician and connecting that back to the hospital?
GIBBS: The patient is doing a lot of self-monitoring in the home through various devices. That is going to continue to grow. At some point, instead of going to the doctor's office with a kid with an ear infection, you're going to place a stethoscope in the child's ear and send a transmission to the doctor. The doctor is going to be able to electronically order the prescription, and it'll be charged to your credit card. But you have to link all those systems together.
JOSLYN: It's a data diversity issue as much as a data volume issue. The idea of a wireless hub inside the patient's home is not so miraculous anymore. But it's a diverse set of data around which there are really no standards. You can buy these various devices now, whether a diabetes monitor or heart monitor, but how does it make its way into the primary care office system? The practitioner is not interested in floods of data, so you have to learn how to distill it down.
STETTHEIMER: The necessity is more of a connection along the continuum of care. The challenge going forward is, can we, as a nation, really afford to have unconnected components of the continuum in isolation?
HEALTHLEADERS: How ready is the vendor community for this new vision of care delivery?
MORLEY: We haven't discussed a single issue that the technology community can't address. The principal challenge is establishing standards and executing smart, sustainable strategies. Adequate funding is equally important. The banking industry dedicates 10% to 12% of revenues on IT. The healthcare industry spends between 2% and 3%. Those numbers have to shift.
STETTHEIMER: You still have hospitals that perpetually lose money. It's the minority that are actually turning a significant profit. So if you say we expand this as a percentage of cost, that means your revenue has to somehow support that.
JOSLYN: The money moving around the healthcare delivery system is substantial and we should be able to automate much more than we're automating now. You have to get people into a medical home. They need a stop other than the ED.
MORLEY: When you compare the amount of money being spent with patient outcomes, you have to ask whether we are suboptimizing a suboptimal system. Technology will play a pivotal role in the transformation of health delivery, but it's only one part of the equation. We also need to examine workflows, duplication, communication—everything that's a speed bump on the continuum of care. Technology can help overcome those obstacles, but it needs to be implemented correctly in an environment that isn't averse to change.
JOSLYN: We probably are not going to have the opportunity to blow it up to completely redesign it. The biggest opportunity coming along in a long time is the latest legislation on ARRA that gets the environment infused with a great deal of automation.
HEALTHLEADERS: What should providers do now to prepare for the digital hospital of the future?
MORLEY: Everybody has to be focused on improving the quality of care and reducing costs. IT departments may not lead the charge, but they certainly need to operationalize the charge by working closely with administrators and caregivers.
JOSLYN: We're going to have to be more risk-tolerant. Unless we have the courage, the willingness, and leadership to do that, we're not going to make much progress. The opportunity is enormous. The stage has been set. Technology is there. We have to get to a tipping point to overcome the resistance.
GIBBS: It's not just the technology; it's a cultural change that needs to take place within our organizations in order to make this happen. For many of us, it's also about ensuring that the people who are going to utilize these systems are ready for it and effectively trained.
STETTHEIMER: The healthcare genie is out of the bottle, and I don't think it can be stuffed back in. However, inertia is a difficult thing to overcome. We're still trying to get people to wash their hands, for heaven's sake.