A vision for a smart healthcare system

Healthcare at the edge

Point of View

The healthcare industry is in a unique position to take advantage of the digital revolution, since healthcare’s goals align naturally with the promises of digital transformation to better leverage data, improve customer-centric services and reduce costs. However, pursuing these promises requires balancing efforts across complex and competing demands, and contending with seismic industry and technology shifts.

There are two technology developments affecting healthcare in significant ways. The first is the mandate to move the continuum of care outside of the four walls of the hospital, with the internet of things (IoT) allowing for massive instrumentation of the healthcare experience regardless of the location of the patient and the provider. The second is the use of machine learning and other deep analytics capabilities to increase the quality of care. As healthcare organizations begin to look into “smart” technologies, these two shifts provide opportunities never before seen in the industry (Figure 1).

This leads to what we call “healthcare at the edge,” meaning the care of patients is no longer tied to the physical location of the hospital, and they can get extended access to healthcare systems — not just healthcare facilities.

Figure 1. Moving to the edge: The digital mandate

At the same time, analytics capabilities involving extensive public, government and private datasets promise to provide a more complete view of the patient. This open health platform will allow healthcare organizations to improve patient outcomes and to take outcome-enhancing business processes outside the four walls of the hospital.

Finally, digital healthcare can enable a community of providers and supporting functions that improve the operations of the entire healthcare system, across the continuum of care.

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Healthcare at the edge presents opportunities to extend access and quality of care across healthcare systems, not only healthcare facilities.

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The healthcare enterprise balance

The core dilemma facing healthcare organizations is how to balance patient outcomes and operational efficiencies. In the battle for investment within the organizations, often it isn’t clear which imperative is being addressed. While the two are certainly related, money spent on one is denied the other.

For instance, organizations may wish to digitize the supply chain for medical supplies. While this can have direct patient impact, for the most part, the goal is to improve operational efficiency. If this investment competes with an investment in patient care systems, administrators are faced with the dilemma of how to balance outcomes and efficiency.

In addition, health systems have two broad functional realms. One is the realm that directly interacts with the patient community, the front office; the second is the realm that does not, the back office. Each of these two realms in turn has responsibilities to both operational efficiency and outcomes. The functions and responsibilities can be thought of in four quadrants; Figure 2 shows the enterprise balance.

Figure 2. The healthcare enterprise balance

Smart healthcare systems are in a position to use digital technology to improve patient outcomes while also improving operational efficiency. In addition, smart healthcare systems make it possible to integrate back-office and front-office functions to provide a true end-to-end customer-focused experience. They make it possible to build digital communities to better support operations and outcomes, and are able to extend the use of patient data from core and ancillary systems deep into the healthcare ecosystem.

For each of the four quadrants, we will show specific smart solutions, but the focus will remain on providing improved outcomes and cost efficiencies throughout the continuum of care.

• Health tourism• 360-degree customer view• Wait-time optimization

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• Telecare• Telehealth• Telecoaching

• BPO• Externalized engines• Next-gen supply chain

• MaxCare+• Next-gen lab• Robotics and AI

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Figure 3. Improving front-office operations with CRM software

Quadrant: Digital front-office operations

Front-office operations in a smart healthcare system encompass the digital technologies that enable healthcare providers to better understand and serve customers. In the clinical setting, this primarily focuses on optimizing the patient experience, as shown in Figure 3. In this respect, healthcare organizations have an opportunity to learn from consumer enterprises. Let’s take two examples.

First, healthcare organizations can optimize wait times for patients. A smart healthcare system collects data about patient flow over time and uses predictive analytics to staff appropriately or change appointments as necessary. This makes it possible to reduce wait times and results in datasets that can be used to predict the most effective method for serving patients.

This is a front-office function since it is based on direct interaction with patients, and it affects operations in that it allows for smart healthcare systems to lower costs of operations while not affecting the quality of service provided.

Second, smart healthcare systems can use small devices placed on patient bracelets or anklets and geofencing technology to track how patients move through the healthcare facility. These can be used to ensure that patients are moving about in ways consistent with best practices, and even give hospital administrators insight into operations relative to the staff at the hospital. These devices therefore provide not just real-time alerting capabilities, but also data collection capabilities that can be leveraged to enhance operations in the future.

Another core front-office technology in a smart healthcare system is customer relationship management (CRM) software. CRM tools provide the capability to “know your customer” and better track future demand.

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Deliver FDA-approved wellness tips based on health profile for a subscription fee after hospital visit

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Take multipronged feedback (SMS, mobile app, voice, portal)

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Quadrant: Digital back-office operations

Back-office operations use digital technology to provide behind-the-scenes functions that convert patient experiences into revenue for the healthcare enterprise. While they must always be balanced against the requirement for improved patient outcomes, the efficiencies that smart healthcare systems can deliver allow for better patient service at lower cost.

The key technology enabler for digital back-office operations is the proper use of enterprise resource planning (ERP) software. Smart healthcare systems use ERP to perform two important tasks. First, ERP allows for digital asset tracking. In smart healthcare systems, important assets are tagged, either with RFID or more sophisticated devices, which makes it possible to optimize resource utilization in such a way as to ensure service for customers while not overprovisioning assets, which are often very expensive (Figure 4).

Second, ERP software can be used to build next-generation supply chain capabilities, where smart healthcare systems can optimize purchasing through pooled suppliers or even online auctions. Further, because these resources are understood in terms of both supply and demand, smart healthcare organizations have the ability to optimize their spend on these supplies.

Smart healthcare systems also recognize that change, particularly in the billing and charging side of the operations, is a constant. As such, smart healthcare systems are turning to “externalized” software billing and charging engines with agile and flexible rulesets. These systems allow for frequent rule changes without the costly workarounds necessary in traditional self-contained billing systems.

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Figure 4. ERP and warehouse management

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Quadrant: Digital front-office outcomes

Switching our focus from operations to outcomes, smart healthcare systems are focused intently on moving the continuum of care outside the four walls of the hospital or clinic. If the only setting for healthcare services remains a traditional facility, a great opportunity to improve outcomes and provide access to underserved populations will have been missed.

Technologies focused on front-office outcomes allow for smart hospital systems to extend the continuum of care (Figure 5). One prime example is telemedicine. While telemedicine has been part of the technology discussion for years, new capabilities in networking, teleconferencing and portable diagnostic devices have allowed for detailed information to be gathered about a patient remotely and at reasonable cost. Taken together, smart healthcare systems can now improve outcomes for patients who may not be able to be seen in traditional facilities.

This also gives healthcare providers more opportunities to move practices further toward the “edge” of the healthcare network. In areas that may have been underserved, digital devices and technologies such as virtual desktop infrastructure (VDI) allow for providers to call up patient data from electronic medical records systems even where bandwidth is restricted. These capabilities improve the outcomes for entire underserved populations while still providing data for population health analytics.

Within the clinical setting, smart healthcare systems are moving toward deeper instrumentation to improve the outcomes for patients. For example, devices that reliably detect falls and send alerts can be attached to patients. This improves reaction time and can often save lives, especially in cases of elderly patients.

These same devices also track whether a patient is restless in bed or walking around a ward. The patterns can provide proactive alerting for times when falls are likely to occur, according to predictive analysis. The devices contain algorithms for determining the status of the patient, meaning there is no centralized database required for providing real-time alerts. That means these devices can be deployed in remote care facilities (e.g., nursing homes and hospices) and still be as effective as if the patient was in a larger facility.

Figure 5. Improving front-office outcomes through technology

Monitoring partner • Record patient attendance• Initiate video call• Provide vital signs readings if needed• Administer drug• Aid consultation• Print prescription, discharge summary and bill

Patient schedules a visit to AMCP

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There are additional use cases, with devices for analyzing skin, measuring blood glucose and many others. The devices all have a basic design principle in common: Real-time diagnostic capabilities are built at the edge of the patient care continuum. So while the devices have significant impacts on outcomes in a hospital, the goal is to engage healthcare consumers at the edge and to improve the quality of care for a population, not just inpatient customers.

Quadrant: Digital back-office outcomes

Smart healthcare systems focus on back-office outcomes largely through allied health and tertiary care, and by adding a focus on robotics and artificial intelligence (AI) to improve outcomes from functions such as laboratory and pharmacy.

In both cases, robotic devices can reduce error rates. In addition, robotic devices can be instrumented to provide data that can then be used for further analysis. For example, robotic dispensing devices for pharmacy can be instrumented to track formulary substitutions. The data regarding these substitutions can then be fed back to a central patient record where additional analytics can reveal whether the substitution is providing equivalent outcomes for patients.

Because the robotic device is precisely calibrated, there is a significantly lower risk of error in dispensation, which means outcome measures are more reliable in terms of the predictive capabilities.

These predictive capabilities then feed into AI algorithms that can be used to more precisely calibrate instrumentation in the lab, optimize the supply chain for pharmaceuticals or many other use cases involving patient outcomes.

Furthermore, automation and AI can enable allied health functions to move closer to the edge of the healthcare continuum (Figure 6). Imagine, for instance, a device that combines telemedicine with pharmacy automation. The device contains key diagnostic instruments required for diagnosis (i.e., motion analyzer or keratometer), a remote viewing screen for a telemedicine practitioner and a fully automated dispensary.

Figure 6. DXC’s Anytime Medication Counseling Pod (AMCP)

Capabilities• Video counseling with healthcare provider • Remote medication• Devices to capture symptoms Use case• Reach underserved populations • Extend the reach of specialists • Postoperative care• Serve corporate clinics• Reach geographically challenged areas (i.e., ships, planes)

Benefits • Improved healthcare • Reduced A&E • Reduced unplanned admissions and readmissions

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A patient is remotely diagnosed based on the results of the various tests provided. A healthcare provider analyzes the results and dispenses drugs as necessary using a mobile application and the fully automated capabilities of the remote dispensary. Finally, the drugs can be tagged with RFID sensors, which allow for the supply information to be fed back into the ERP system. This can ensure access for patients as well as quality of care for a smart healthcare system.

Digital community building

In addition to the above features, one of the keys to delivering a smart healthcare system is building a true community of care across the healthcare continuum. This means there must be deep and significant collaboration from the participants in the system (Figure 7).

We believe one of the most effective ways of building a truly collaborative healthcare culture is through enterprise social media. While enterprise social media may seem like a luxury, for a truly smart healthcare system, it is a requirement. Because the community of care is spread across a potentially large geography, community building is a challenge. The ability to collaborate with colleagues across the healthcare spectrum and across the healthcare system continuum ensures that the smart healthcare system remains focused on its core mission.

In addition, within the facilities themselves, there are significant ways collaboration can improve both the operations and the outcomes for smart healthcare systems. For instance, one hospital in Singapore uses Facebook Workplace to manage requests for facilities maintenance. Previously, employees had to complete forms, submit them to an email address and hope for a response.

In this hospital, employees simply take a picture of the issue with their smartphones and then post to Facebook Workplace with an appropriate hashtag. The facilities team then monitors that hashtag and works to rectify the situation as fast as possible.

Figure 7. Building a digital community

Clinics and hospitals

The pressing need to create a global, inclusive digital engagement platform

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The shift toward patient-centric care may require the redesign of existing healthcare information systems and infrastructure.

Healthcare systems will have to open up to the possibility of receiving data from patients (e.g., collected by mobile apps) and ensuring ubiquitous access to care.

The same system should address corporate wellness.

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Data strategy and health information exchange

Many enabling technologies rely on data analytics to maximize benefits. But because of the requirement to extend the continuum of care beyond the four walls of the hospital, the data strategy needs to be extended as well.

The basic strategy is to identify the data requirements for particular families of queries and determine the requirements for those queries.

For instance, when managing queries related to population health, it is not critical to use the most up-to-date data. If the data is a day or even a week old, the results will likely be the same. This gives smart healthcare systems some options in terms of data “convergence” in the context of population health.

The same cannot be said for an individual patient record. At any given time, a record must be updated with the most recent information and must be fully “converged” before diagnosis or therapy begins. As such, these two types of queries rely on different data strategies.

For population health queries, big data strategies will yield better results at a lower cost, while more traditional database-query methodologies are likely required in the patient record example. Along the same lines, analytics queries regarding the operational data captured through geolocation do not need to be fully converged for insight to be gleaned from the data.

The key point is that the data queries and business value of the analytics behind those queries often change with the context of the query itself. This means a data strategy needs to be articulated that defines the nature of the queries and defines the dataset requirements to answer the question appropriately.

Further, smart healthcare systems no longer restrict their data collection to sources within the four walls of the hospital. A robust integration strategy is required to bring together data from various instrumented devices, patient records and other sources (Figure 8). This is the health information exchange (HIE), the extension beyond just the healthcare information system (HIS). As the continuum of care moves toward the edge, HIE becomes a key requirement for a smart healthcare system.

Figure 8. DXC Integration Engine Viaduct designed for healthcare

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• ER consultant• PCP• Care coordinator

• Pharmacist• Radiographer• Payer

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• Encounters• Episodes• Demographics• Providers• Children services• Immunization• Dental• Chronic diseases

• Laboratories• Transition of care• ED/ER• OR/theatres• Admission• Imaging• Medication• Care plan

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An open health platform is a strategy to integrate more complex datasets, both structured and unstructured, into the continuum of care. While technology is key to execution, smart healthcare systems should develop the data strategy to maximize benefits from the platform’s components.

In conclusion, there is a classic notion in healthcare of the “Iron Triangle,” shown in Figure 9, comprising access, quality and cost. The traditional contention is that healthcare systems can have two of the three. Quality and access are costly; cost efficiency and access reduce quality; cost efficiency and quality reduce access.

We believe digital technology not only drives the evolution of smart healthcare systems but, more importantly, undoes the core assumptions underlying the Iron Triangle. Digital can move us beyond the dilemma of how to balance operations and outcomes and allow smart healthcare systems to become disruptors in a way that can make people healthier.

Figure 9. Breaking the Iron Triangle Digital healthcare creates a unique opportunity to rebalance competing priorities.

By reducing the cost and increasing the efficiency of healthcare processes, digital can finally break the Iron Triangle.

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About DXC Technology

DXC Technology (DXC: NYSE) is the world’s leading independent, end-to-end IT services company, serving nearly 6,000 private and public-sector clients from a diverse array of industries across 70 countries. The company’s technology independence, global talent and extensive partner network deliver transformative digital offerings and solutions that help clients harness the power of innovation to thrive on change. DXC Technology is recognized among the best corporate citizens globally. For more information, visit www.dxc.technology.

© 2018 DXC Technology Company. All rights reserved. MD_9379a-19. January 2019

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